Form R-5402 - Schedule D - Motor Fuel Tax Multiple Schedule Of State Diversion Corrections
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1R-5402 (7/06)
Page _____ of _____
Schedule D
Motor Fuel Tax Multiple Schedule of
State Diversion Corrections
Company Name
LA Revenue Account Number
Type of Schedule
Product Type
Filing Period
Mode of Transport
Type of Schedule
Product Type (Only one product type per page)
B = Barge
PL = Pipeline
21 Gallons diverted into Louisiana
065 – Gasoline
130 – Jet Fuel
228 – Dyed Diesel
J = Truck
ST = Stationary Transfer
22 Gallons diverted out of Louisiana
123 – Alcohol
072 – Dyed Kerosene 170 – Clear Biodiesel
R = Rail
BA = Book Adjustment
124 – Gasohol
142 – Clear Kerosene 171 – Dyed Biodiesel
S = Ship
125 – Aviation Gasoline 160 – Clear Diesel
Other ________________
(2)
(4)
(6)
(1)
(5)
(3)
(7)
(8)
(9)
Carrier
Destination State
Purchaser
Doc.
Net
Diversion
Date
Name
FEIN
Manifest New
Name
FEIN
Mode
TCN
Number
Gallons
Number
Total
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Parent category: Financial