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FT-960

New York State Department of Taxation and Finance

Uniform Manifest for Interstate (Importation)

(9/11)

Movements of Motor Fuel and Diesel Motor Fuel

This manifest must be completed by the transporter and carried for all movements of motor fuel or diesel motor fuel into or through New

York State (NYS) that originate from a point outside NYS. For all movements of motor fuel and diesel motor fuel that originate from a point

within NYS, complete Form FT-970, Uniform Manifest for Intrastate Movements of Motor Fuel and Diesel Motor Fuel. 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

known to be false in any material matter.

Print or type

(see instructions)

Part 1 — Transporter

1. Manifest number

2. Name of transporter

3. NYS importing transporter license number

4. Automotive fuel carrier (AFC) certificate of registration number

5. Barge name or identification number

Part 2 — Distributor

6. Distributor’s (importer’s) name

7. NYS distributor number

M-

D-

R-

K-

8. Firm ordering transportation (name and address)

9. Firm paying for transportation (name and address)

Part 3a — First loading

10. Terminal or site where fuel was loaded (name and address)

11. Date

and time loaded

(mm/dd/yy)

12. Owner of fuel after loading (name and address)

13. Date

and time of departure

(mm/dd/yy)

14. Account from which fuel was drawn (name and address or account number)

15. 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

10. Terminal or site where fuel was loaded (name and address)

11. Date

and time loaded

(mm/dd/yy)

12. Owner of fuel after loading (name and address)

13. Date

and time of departure

(mm/dd/yy)

14. Account from which fuel was drawn (name and address or account number)

15. 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.

(continued)

Form Ft-960 - Uniform Manifest For Interstate (Importation) Movements Of Motor Fuel And Diesel Motor Fuel

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