Sd Eform-0836 - Uniform Schedule Of Receipts

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SD EForm - 0836
V2
Complete and use the button at the end to print for mailing.
HELP
Uniform Schedule of Receipts
Please check the transaction type being filed (Original, Modify or Add). Separate schedules must be filed for each transaction type:
Original
Modify Original Schedule Filed (Only submitted with an Amended Return)
Add New Schedule Information (Only submitted with an Amended Return)
Company Name
License Number
Reporting Period
Instructions: Either circle the appropriate schedule type and product type you are reporting on this form, or if you wish to schedule several different types on this
single form, record the appropriate product and schedule type for each receipt listed below.
Receipt Schedule Types
Product Types
065 – Gasoline
142 – Kerosene (clear)
072 – Kerosene (dyed)
145 – Kerosene Low Sulfur (clear)
1a – Gallons imported tax-paid
073 – Kerosene Low Sulfur (dyed)
147 – Kerosene High Sulfur (clear)
2a – Gallons imported tax-unpaid
074 – Kerosene High Sulfur (dyed)
160 – Undyed Diesel Fuel
123 – Alcohol
228 – Dyed Diesel Fuel
124 – Gasohol
243 – Methanol
125 – Aviation Gasoline (AVGAS)
284 – Biodiesel (clear)
130 – Jet Fuel
*092 – Other (Please list __________)
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1
2
5
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9
3
Product
Point of
Schedule
Carrier
Carrier
Acquired
Seller’s
Date
Manifest
Gross
Mode
Type
Type
Name
FEIN
From
FEIN
Received
Number
Gallons
Origin
Destination
Total Gross Gallons
0
MF-312

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