Form Wv/mft-501 A - Distributor Schedule Of Tax-Paid Receipts - 2003
ADVERTISEMENT
1
2WV/MFT-501 A
WEST VIRGINIA STATE TAX DEPARTMENT
Org. 11/03
INTERNAL AUDITING DIVISION
P O BOX 2991
Charleston, WV 25330-2991
(304) 558-8500
DISTRIBUTOR SCHEDULE OF TAX-PAID RECEIPTS
FEIN/SSN
NAME
SCHEDULE NUMBER
MONTH/YEAR
1
PRODUCT INFORMATION (CHECK APPLICABLE BOX)
MODE OF TRANSPORTATION
(COMPLETE SEPARATE SCHEDULES FOR EACH PRODUCT TYPE YOU RECEIVE)
CODES
□ 150 – #1 Fuel Oil
□ 228 – Diesel – Dyed
□ 054 – Propane
J – Truck
R – Rail
□ 125 – Aviation Gasoline
□ 160 – Diesel – Undyed
□ 224 – Compressed Natural Gas
□ 130 – Aviation Jet Fuel
□ 284 – Biodiesel – Undyed
□ 225 – Liquefied Natural Gas
□ 122 – Blending Components
□ 072 – Kerosene – Dyed
□ Other – Product Type ___________
□ 124 – Gasohol
□ 142 – Kerosene – Undyed
Product Code __________
□ 065 – Gasoline
PRODUCT RECEIPT INFORMATION
(1)
(2)
(3)
(4)
(5)
(7)
(8)
(9)
(10)
(11)
(6)
Gross Gallons
Mode
Date
Document
Motor Fuel
Motor Fuel
Point of
Seller’s
Net Gallons
INVOICED
Seller’s
Received
Number
Transporter’s
Transporter’s
GALLONS
Origin
Destination
Name
FEIN
Name
FEIN
Sub-Total
GRAND TOTAL OF INVOICED GALLONS
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial