Form Wv/mft-507 C - Motor Fuel Transporter Schedule Of Deliveries - 2004
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1MOTOR FUEL TRANSPORTER SCHEDULE OF DELIVERIES
WV/MFT-507 C
REV 11/04
WEST VIRGINIA STATE TAX DEPARTMENT
INTERNAL AUDITING DIVISION
P O BOX 2991
C
Charleston, WV 25330-2991
(304) 558-8623; (304) 558-8624; (304) 558-8625; (304) 558-8626; (304) 558-8627
YOU MUST USE A SEPARATE SCHEDULE FOR EACH PRODUCT TYPE AND EACH HIRING COMPANY
MONTH/YEAR
FEIN
NAME
SCHEDULE 3
LOADED IN WEST VIRGINIA AND DELIVERED IN WEST VIRGINIA
MODE OF TRANSPORTATION
PRODUCT INFORMATION (CHECK APPLICABLE BOX)
□ 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 ___________
B – Barge
□ 124 – Gasohol
□ 142 – Kerosene – Undyed
Product Code __________
□ 065 – Gasoline
HIRING COMPANY
SELLER
DELIVERED TO
GALLONS
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
Mode
Bill of Lading
GROSS
NET
Name
FEIN
Name
FEIN
Point of Origin
Name
Address
FEIN
Date
Number
Delivered
TOTAL THIS PAGE
IMPORTANT NOTICE:
Total all pages Gross Gallons – Transfer to Line 3 on Report
You must obtain prior approval to submit your own schedules
.
Total all pages Net Gallons – Transfer to Line 3 on Report
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