Schedule A - Petroleum Products Transporter Schedule Of Deliverie - Tennessee Department Of Revenue

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TENNESSEE DEPARTMENT OF REVENUE
Schedule
A - Petroleum Products Transporter Schedule of Deliveries (Attach to PET 373)
Company Name:
SSN/FEIN:
Terminal Code:
Month of (MM-YY):
Product Type (Circle One)
65 GASOLINE
161 DIESEL (LOW SULFUR) #1
SCHEDULE TYPE
124 ETHANOL/GASOLINE (UNLEADED ONLY)
167 DIESEL (LOW SULFUE) #2
125 AVIATION GASOLINE
226 DIESEL (HIGH SULFUR DYED)
1 A PRODUCT LOADED AT A TENNESSEE TERMINAL OR BULK PLANT FACILITY AND DELIVERED TO ANOTHER STATE
130 JET FUEL
227 DIESEL (LOW SULFUR DYED)
2 A PRODUCT LOADED AT AN OUT-OF-STATE TERMINAL OR BULK PLANT FACILITY AND DELIVERED IN TENNESSEE
142 KEROSENE
241 ETHANOL
3 A PRODUCT LOADED AT A TENNESSEE REFINERY AND DELIVERED IN TENNESSEE
OTHER (SEE FTA PRODUCT CODE LIST)
PERSON HIRING
DELIVERED TO:
GALLONS
SUPPLIER
CARRIER
(5)
(6)
(10)
(11)
(1)
MODE
(2)
(3)
(4)
(7)
(8)
DATE
DOCUMENT
(13)
STATE OF
(9)
(12)
ORIGIN
COMPANY NAME
FEIN
COMPANY NAME
FEIN
DELIVERED
NUMBER
NET
NAME
ADDRESS
FEIN
GROSS
RV-1400501

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