Form Ft-970 - Uniform Manifest For Intrastate Movements Of Motor Fuel And Diesel Motor Fuel

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FT-970
New York State Department of Taxation and Finance
Uniform Manifest for Intrastate Movements of
(9/11)
Motor Fuel and Diesel Motor Fuel
This manifest must be completed by the transporter and carried only for movements of motor fuel or diesel motor fuel that originate within
New York State (NYS). Transporters that transport motor fuel or diesel motor fuel through NYS or that import motor fuel or diesel motor fuel
into NYS must complete and carry Form FT-960, Uniform Manifest for Interstate (Importation) Movements of Motor Fuel and Diesel Motor
Fuel; all other transporters must complete and carry Form FT-970. The manifest must be produced for inspection upon the request of a
police officer or a representative of the Tax Department, and must be identifiable by the assignment of a manifest number by the transporter.
Failure to carry a manifest or carrying one that is not complete in every material respect is a crime and may result in the seizure or
forfeiture of both the vessel or vehicle transporting the fuel and its contents.
It is a felony to willfully prepare a manifest that is known to be not correct in every material respect, or to produce for inspection a
manifest that is known to be false in any material matter.
Print or type
(see instructions)
Part 1 — Transporter
1. Manifest number
2. Name of transporter
3. Automotive fuel carrier (AFC) certificate of registration number
4. Barge name or identification number
Part 2 — Distributor –
Part 2 must be completed only for movements of diesel motor fuel originating within NYS. The distributor’s name
must appear on the current Tax Department list of registered distributors of diesel motor fuel, retailers of non-highway diesel motor fuel only,
or distributors of kero-jet fuel only for the product transported (see Publication 532).
6. NYS diesel motor fuel registration number of owner of product being sold
5. Distributor’s name (owner of product being sold)
D-
R-
K-
Part 3a — First loading
7. Terminal or site where the fuel was loaded (name and address)
8. Date
and time loaded
(mm/dd/yy)
9. Account from which fuel was drawn (name and address or account number)
10. Carryover, if any, for manifest no.
Type
gal.
meter reading (optional)
Type
gal.
meter reading (optional)
Type
gal.
meter reading (optional)
11. Number of gallons of each type of fuel loaded
Motor fuel
Diesel motor fuel
Regular unleaded .............................
gal.
Diesel ...............................................
gal.
Mid-grade unleaded .........................
gal.
Kerosene ...........................................
gal.
Premium unleaded ...........................
gal.
No. 2 fuel oil ......................................
gal.
Other (type
)
gal.
Other (type
)
gal.
Part 3b — Second loading
7. Terminal or site where the fuel was loaded (name and address)
8. Date
and time loaded
(mm/dd/yy)
9. Account from which fuel was drawn (name and address or account number)
10. Carryover, if any, for manifest no.
Type
gal.
meter reading (optional)
Type
gal.
meter reading (optional)
Type
gal.
meter reading (optional)
11. Number of gallons of each type of fuel loaded
Motor fuel
Diesel motor fuel
Regular unleaded .............................
gal.
Diesel ...............................................
gal.
Mid-grade unleaded .........................
gal.
Kerosene ...........................................
gal.
Premium unleaded ...........................
gal.
No. 2 fuel oil ......................................
gal.
Other (type
)
gal.
Other (type
)
gal.

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