Form R-5348 - Schedule G - Motor Fuel Transporter Deliveries
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1R-5348 (7/06)
Page _____ of _____
Schedule G
Motor Fuel Transporter Deliveries
PLEASE PRINT OR TYPE.
Company Name
LA Revenue Account Number
Mode of Transport
Type of Schedule
Product Type
Filing Period
Type of Schedule
Mode of Transport
Product Type (Only one product type per page)
23
Gallons transported to destination in Louisiana
B = Barge PL = Pipeline
065 – Gasoline
130 – Jet Fuel
228 – Dyed Diesel
24
Gallons transported to destination out of Louisiana
J = Truck
ST = Stationary Transfer
123 – Alcohol
072 – Dyed Kerosene
170 – Clear Biodiesel
25
Gallons transported solely within Louisiana
R = Rail
BA = Book Adjustment
124 – Gasohol
142 – Clear Kerosene
171 – Dyed Biodiesel
S = Ship
125 – Aviation Gasoline
160 – Clear Diesel
Other ________________
(2)
(1)
(3)
(4)
(5)
(6)
Company/location fuel removed from
Destination
Document
Net
Date
Purchaser Name
(City, State)
Number
Gallons
Name
City, State
TCN/FEIN
Total gallons this page
Total of Gallons this Schedule by Product Type
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Parent category: Financial