Form Mf-206 - Liquid Fuel Carrier Petroleum Products Report - Schedule Of Deliveries

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LFCL
KANSAS DEPARTMENT OF REVENUE
CUSTOMER RELATIONS
Postmark Date_______________________
915 SW Harrison St.
TOPEKA, KANSAS 66625-8000
Office Use Only
Phone Number: (785) 368-8222
Fax: (785) 296-2703
LIQUID FUEL CARRIER PETROLEUM PRODUCTS REPORT - SCHEDULE OF DELIVERIES
FEIN NO.
MONTH AND YEAR
NAME OF CARRIER
LICENSE NO.
SCHEDULE NO.
ADDRESS
(See instructions)
CITY, STATE, ZIP
PERSON HIRING THE CARRIER
SELLER
DELIVERED TO:
DATE
DOCUMENT
GALLONS
PRODUCT
COMPANY NAME
FEIN
COMPANY NAME
FEIN
MODE
ORIGIN
NAME
ADDRESS
FEIN
DELIVERED
NUMBER
GROSS
NET
CODE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
This report must be filed with the Department of Revenue on or before the 15th day of the following month for which the report is made.
I certify this to be a true, complete, and accurate report of all fuels transported as a duly licensed carrier.
MF-206
(Rev. 06/10)
Signature of authorized person
Contact Phone Number

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