Form 80 - Nebraska Motor Fuels Carrier Report Page 2
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1
2FORM
Motor Fuels Diversion Schedule
80
Complete this schedule only if you have diverted loads during this reporting period. Report only the diverted load(s). A diverted
load occurs whenever the bill of lading indicates a destination state other than the state to which the fuel was delivered.
PRODUCT CODeS
61 - Natural Gasoline
123* - Ethanol - Alcohol
142 - Kerosene, Undyed
170* - Biodiesel Blend, Undyed
125 - Aviation Gasoline
65 - Gasoline
160 - Diesel, Undyed
B00 - Biodiesel, Undyed
171* - Biodiesel Blend, Dyed
130 - Aviation Jet Fuel
124* - Gasohol
228 - Diesel, Dyed
D00 - Biodiesel, Dyed
PHC
SeLLeR
PeRSON TO WHOM FUeL WAS DeLIVeReD
GALLONS
Prod.
Name
FeIN
Name
FeIN
Mode
Origin
Name
Destination
FeIN
Date
Doc. #
Gross
NG
Code
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
* The following three-character alternative product codes will also be accepted.
TOTAL
123 (Ethanol-Alcohol) – e00
124 (Gasohol) – e01 to e99, where the number indicates the ethanol portion of the fuel.
170 (Undyed Biodiesel Blend) – B01 to B99, where the number indicates the biodiesel portion of the fuel.
171 (Dyed Biodiesel Blend) – D01 to D99, where the number indicates the biodiesel portion of the fuel.
INSTRUCTIONS
COLUMN 8. Enter the state to which the product was delivered. If the product
COLUMNS 3 & 4. Enter the name and FEIN of the seller of the fuel. In most
was delivered to a terminal, enter the IRS Terminal Code.
cases this will be the person from whose account the fuel was withdrawn at
the terminal.
COLUMN 10. Enter the date the product was delivered (MM/DD/
COLUMN 5. Indicate how the fuel was delivered:
YYYY).
J = Truck
R = Railroad
COLUMN 11. Enter the document number from the bill of lading, manifest,
COLUMN 6. Enter the state from where the product was transported. If the
or invoice.
product was loaded at a terminal, enter the IRS Terminal Code.
COLUMN 12. Enter the gross gallons delivered.
COLUMNS 7 & 9. Enter the name and FEIN of the person to whom the
COLUMN 14. Enter the appropriate product code for each diverted load.
fuel was delivered.
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