Form Pt-102.2 - Diesel Motor Fuel Nontaxable Sales (Page 3 of 3) in pdf

Form Pt-102.2 - Diesel Motor Fuel Nontaxable Sales Page 3

PT-102.2 (1/14) Page 3 of 3

Name of distributor

EIN

Month/year

Part 4 — Sales to New York State, its municipalities or to the United States government

Date

Mode of

Carrier’s name

Purchaser’s name

Origin

Destination

Contract or

Gallons

Product

shipped

delivery

and EIN

terminal control

approval number

code*

number or

(city, state)

Total gallons

..........................................................................................................................................................................

(enter here and on Form PT-102, line 22)

Part 5 — Sales or use of non-highway diesel motor fuel for farming

Date

Mode of

Carrier’s name

Purchaser’s name

Origin

Destination

Product

shipped

delivery

and EIN

terminal control

Gallons used

Other gallons

code*

number or

directly and

(city, state)

exclusively in the

production phase

1 Total gallons used directly and exclusively in the production phase

...........................................

(enter here and on Form PT-102, line 12)

2 Total other gallons

...................................................................................................................................................................

(total the amounts in column B)

3 Gallons of B20 included in column B

.........................................................................................................................

(enter here and on Form PT-102, line 30)

4 Other gallons

...................................................................................................................

(subtract line 3 from line 2 and enter here and on Form PT-102, line 31)

*From Publication 902, Product Codes for Fuels.