Form Pt-101.5 - Sales In New York State With The Motor Fuel Tax Passed Through And Sales Of Lpg And Cng

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PT-101.5
New York State Department of Taxation and Finance
Sales in New York State with the
(9/06)
Motor Fuel Tax Passed Through and Sales of LPG and CNG
Read instructions (Form PT-101-I) carefully. Keep a copy of this completed form for your records.
Name of distributor
FEIN
Month/year
Part 1 — Sales
or use of motor fuel (not including LPG or CNG; see Parts 2 and 3 on the back)
Date
Mode of
Carrier’s name
Purchaser’s name
Origin
Destination
Manifest
Gallons
Product
shipped
delivery
and FEIN
and FEIN
terminal control
terminal control
number
code*
number or
number or
(city, state)
(city, state)
Total gallons
...............................................................................
(Enter here only and attach this schedule to Form PT-101. This figure is not transferred to Form PT-101.)
*From Publication 902, Product Codes for Fuels.

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