Form Pt-102.1 - Diesel Motor Fuel Receipts

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PT-102.1
New York State Department of Taxation and Finance
Diesel Motor Fuel Receipts
(1/07)
Read instructions (Form PT-102-I) carefully. Keep a copy of this completed form for your records.
Name of distributor
FEIN
Month/year
Part 1 — Receipts in New York State from sources located outside this state
Date
Mode of
Carrier’s name
Seller’s name
Origin
Destination
Gallons
Product
received
delivery
and FEIN
and FEIN
terminal control
terminal control
code*
number or
number or
(city, state)
(city, state)
Total gallons
................................................................................................................................................................
(enter here and on Form PT‑102, line 2)
*From Publication 902, Product Codes for Fuels.

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