Form Pt-103.3 - Residual Petroleum Product - Sales As Bunker Fuel And Sales For Manufacturing Or Farming Purposes Page 2
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1
2Page 2 of 2 PT-103.3 (9/11)
Name of petroleum business
EIN
Month/year
Part 3 - Sales or use for farming
A
B
Date
Name and address of purchaser
EIN
Other gallons
Gallons used
directly and
exclusively in
the production
phase
1 Total gallons used directly and exclusively in the production phase
(enter here and on line 18
.................................................................................................................................. 1
of Form PT-103)
2 Total other gallons ............................................................................................................................................................ 2
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