Form Wv/mft-511d - Exporter Schedule Of Diversions From West Virginia To Another State - 2003
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2WEST VIRGINIA STATE TAX DEPARTMENT
WV/MFT-511 D
Org. (5/03)
INTERNAL AUDITING DIVISION
P O BOX 2991
Charleston, WV 25330-2991
(304) 558-8500
EXPORTER SCHEDULE OF DIVERSIONS FROM WEST VIRGINIA TO ANOTHER STATE
FEIN/SSN
NAME
SCHEDULE NUMBER
MONTH/YEAR
11A
PRODUCT INFORMATION (CHECK APPLICABLE BOX)
MODE OF TRANSPORTATION
(COMPLETE SEPARATE SCHEDULES FOR EACH PRODUCT TYPE YOU DIVERT)
CODES
□ 150 – #1 Fuel Oil
□ 228 – Diesel – Dyed
□ 054 – Propane
J – Truck
□ 125 – Aviation Gasoline
□ 160 – Diesel – Undyed
□ 224 – Compressed Natural Gas
R – Rail
□ 130 – Aviation Jet Fuel
□ 284 – Biodiesel – Undyed
□ 225 – Liquefied Natural Gas
□ 122 – Blending Components
□ 072 – Kerosene – Dyed
□ Other – Product Type ___________
□ 124 – Gasohol
□ 142 – Kerosene – Undyed
Product Code __________
□ 065 – Gasoline
PRODUCT RECEIPT INFORMATION
(1)
(2)
(3)
(4)
(5)
(7)
(8)
(9)
(10)
(11)
(12)
(6)
Mode
Point of
Date
Document
Gross
Net
INVOICED
Diversion
Motor Fuel
Motor Fuel
Purchaser’s
Purchaser’s
Transporter’s
Transporter’s
Origin
Destination
Name
Received
Number
Gallons
Gallons
GALLONS
Number
FEIN/SSN
Name
FEIN/SSN
SUB TOTAL
GRAND TOTAL OF BILLED GALLONS (Transfer to Lines 3 and 4)
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