Form 72a098 - Transporter'S Report Of Motor Fuel Delivered
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172A098 (7-07)
FOR DEPARTMENT USE ONLY
TRANSPORTER'S REPORT
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
OF MOTOR FUEL DELIVERED
9 2
__ __ __ __ __ __ / __ __ / __ __ / __ __
Acct #
Tax
Mo.
Yr.
Name and Address of Transporter
License Number ___________________________________________
Federal Employer ID Number
___ ___ – ___ ___ ___ ___ ___ ___ ___
Contact Person ______________________________________
Telephone(_____) _____________________________________
Report Period ______________________________________________
Gasoline
Special Fuels
Total of gallons transported (net gallons) Form 72A099 (Schedule 14)
GENERAL INSTRUCTIONS
WHO MUST FILE
This report must be filed by every person who is issued a motor fuels transporter's
license under the provisions of Kentucky Revised Statute 138.320 by the Motor
Fuels Tax Compliance Section of the Kentucky Department of Revenue. The license
permits the deliveries of gasoline and special fuels into Kentucky from other states
and between points within Kentucky.
WHEN TO FILE
This report is due on or before the 25th day of each month covering all deliveries
made during the preceding calendar month.
ASSISTANCE AND
Motor Fuels Tax Compliance Section
INFORMATION
Telephone (502) 564-3853
MAIL REPORT TO
Kentucky Department of Revenue
Motor Fuels Tax Compliance Section
P.O. Box 1303, Station 63
Frankfort, KY 40602-1303
I hereby certify that this report is to the best of my knowledge and belief, a true, correct and complete report of
motor fuel deliveries into Kentucky and between points within Kentucky.
(Print) Name of Authorized Company Representative
Signature of Authorized Company Representative
Date Signed
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