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Totals
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Gasoline / Aviation
K-1/K-2
From
All Other
Gasoline / Gasohol
Kerosene
Schedule
Products
Section A: Receipts
Section A: Receipts
A
D
B
C
1.
Gallons received, gasoline tax or inspection fee paid
1A
2.
Gallons received from licensed distributors or oil inspection
2
distributors, tax unpaid
3.
Gallons of non-taxable fuel received and sold or used for a taxable
purpose
2K
4.
Gallons received from licensed distributors on exchange agreements,
tax unpaid
2X
5.
Gallons imported directly to customer
3
6.
Gallons imported into own storage
4
7.
Diversions into Indiana
11
8.
Total receipts - add Lines 1-7, carry total (Column D) to Section 2,Line 1
on front
9.
Total Receipts - add Lines 1-7, carry total (Column D) to Section 3, Line 1
on front
Gasoline / Aviation
K-1/K-2
All Other
Totals
Section B: Disbursements
From
Gasoline / Gasohol
Kerosene
Products
Section B: Disbursement
Schedule
A
B
C
D
1.
Gallons delivered, tax collected
5
2.
Diversion out of Indiana
11
3.
Gallons sold to licensed distributors, tax not collected
6D
4.
Gallons disbursed on exchange
6X
5.
Gallons exported (must be filed in duplicate)
7
6.
Gallons delivered to U.S. Government - tax exempt
8
7.
Gallons delivered to licensed marina fuel dealers
10A
8.
Gallons delivered to licensed aviation fuel dealers
10B
9.
Miscellaneous deduction - theft/loss
E-1
9a.
Miscellaneous deduction - off road, other
E-1
10.
Total non-taxable disbursements - add Lines 2-9a, carry total to Section 2,
line 2 on front.
11.
Total non-taxable disbursements - add Lines 2-6, carry total to Section 3,
line 2 on front