Looking for a New York State Tax Forms And Templates? Download it for free!

Form Ft-970 - Uniform Manifest For Intrastate Movements Of Motor Fuel And Diesel Motor Fuel Page 2

Page 2 of 2 FT-970 (9/11)

Part 4 — Off-loading –

Delivery points where fuel is to be off-loaded

Complete line 12A below for each delivery. For deliveries by truck, you may instead attach delivery tickets or invoices and complete line 12B or line 12C

below. See the instructions for further details.

Delivery tickets or invoices for taxable deliveries may be attached only if all deliveries are taxable (see line 12B below).

In all other cases, delivery tickets or invoices may be attached if line 12C is completed. If any taxable deliveries are then to be made, those taxable deliveries

would be listed on line 12A (see line 12C below).

12A. Delivery points:

Name

Delivery location

Date

Time

Quantity

Type

12B. Delivery tickets for taxable deliveries:

Are delivery tickets or invoices for multiple taxable deliveries attached?

Note: Delivery tickets or invoices may be attached only if all deliveries are taxable. Generally, in the case of motor fuel, all deliveries are taxable

except those to be made to a federal, state, or local government agency and those to be made to a qualified hospital. With respect to diesel

motor fuel, taxable deliveries include, but are not limited to, deliveries of all highway diesel motor fuel to a service station, and deliveries of both

highway and non-highway diesel motor fuel to construction sites.

12C. Delivery tickets for nontaxable deliveries:

Are delivery tickets or invoices for multiple nontaxable deliveries attached?

Note: If the driver of the vehicle is to make any taxable deliveries (see above) during his or her work shift as well, then delivery tickets or invoices

for those deliveries cannot be attached. Complete 12A above for each taxable delivery.

Part 5 — Carryover

13. Enter the number of gallons, if any, to be carried over to new manifest (and/or the meter reading, if used).

Type of fuel

gal.

and/or meter reading

New manifest number

Type of fuel

gal.

and/or meter reading

New manifest number