Form Pt-102.2 - Diesel Motor Fuel Nontaxable Sales Page 2

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Page 2 of 3 PT-102.2 (1/14)
Part 2 — Sales of non-highway diesel motor fuel to exempt organizations
(list sales, except sales for residential heating/cooling, to exempt organizations qualified under Tax Law
sections 1116(a)(4) or 1116(a)(5); this exemption is for sales of non-highway diesel motor fuel only)
Date
Mode of
Carrier’s name
Purchaser’s name
Origin
Destination
Exempt
Gallons
Product
shipped
delivery
and EIN
and EIN
terminal control
terminal control
organization
code*
number or
number or
number
(city, state)
(city, state)
Total gallons
(enter here and on Form PT-102, line 11)
..........................................................................................................................................................................
Part 3 — Exempt sales on Indian reservations
(include sales to exempt Indian nations or tribes and qualified Indian consumers; see instructions)
Date
Mode of
Carrier’s name
Purchaser’s name
Origin
Destination
Manifest
Gallons
Product
shipped
delivery
and EIN
and EIN
terminal control
terminal control
number
code*
number or
number or
(city, state)
(city, state)
Total gallons
..........................................................................................................................................................................
(enter here and on Form PT-102, line 21)
*From Publication 902, Product Codes for Fuels.

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