Schedules 1 Through 4 - Schedule Of Receipts - Indiana Department Of Revenue

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Schedules 1 through 4
State Form 49081
(R1/8-04)
Schedule of Receipts
Company Name
License Number
Month / Year
FEIN
You may photocopy this blank schedule for future filings. Attach additional sheets as necessary.
Product Code/Type (Check One)
Schedule Type (Check One)
For Use with Reporting Special Fuel
For Use with Reporting Gasoline/Oil Inspection
1
Gallons Received, Tax Paid, (Special Fuel Returns Only)
142
Kerosene
065
Gasoline
1A Gallons Received, Tax Paid (Gasoline Return Only)
161
Low Sulphur Diesel #1 - undyed
124
Gasohol
167
Low Sulphur Diesel #2 - undyed
125
Aviation Gasoline
2
Gallons Received from Licensed Distributor or Oil Inspection Distributor, Tax Unpaid
226
High Sulphur Diesel - dye added
130
Jet FuelGasoline
(Gasoline Only)
227
Low Sulphur Diesel - dye added
142
Kerosene
2 E Gallons Received for Export (Special Fuel Exporter Only)
231
No. 1 Diesel - dye added
150
#1 Fuel Oil - undyed
2K Gallons of Non-Taxable Fuel Received and Sold or Used for a Taxable Purpose
284
Biodiesel - undyed
161
Low Sulphur Diesel #1 - undyed
2X Gallons Received from Distributor on Exchange (Gasoline Only)
290
Biodiesel - dye added
231
No. 1 Diesel - dye added
3
Gallons Imported Via Truck, Barge, or Rail, Tax Unpaid
OTH
Other
241
Ethanol
4
Gallons Imported into Own Storage (Gasoline Only)
243
Methanol
282
#1 High Sulfur Diesel - undyed
OTH
Other
Transporter Information
Purchased From Information
(4)
Point of
(9)
(1)
(2)
(3)
(5)
(6)
(7)
(8)
(10)
(11)
Name
FEIN
Mode
Name
FEIN
Date
Document
Net
Gross
Billed
Dest.
Origin
(State)
(State)
Total

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