Form Pt-102.3 - Diesel Motor Fuel - Transfers And Sales Out Of New York State And Sales In New York State For Immediate Export Page 2

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PT-102.3 (10/06) (back)
Name of distributor
FEIN
Month/year
Submit in duplicate. Use a separate sheet for each state and province. To the state or province of:
Part 2 — Sales in New York State for immediate export
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 and on Form PT‑102, line 20)
*From Publication 902, Product Codes for Fuels.

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