Form 72a099 - Transporter'S Report Delivery Schedule

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72A099 (7-07)
TRANSPORTER'S REPORT
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
SCHEDULE 14—DELIVERY SCHEDULE
Transporter Name
FEIN
Terminal Code
Product Code (See instructions
Report Period (MM/YY)
on page 2)
DELIVERED TO
GALLONS
PERSON HIRING THE CARRIER
SELLER
(10)
(11)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(12)
(13)
Date
Document
Company Name
FEIN
Company Name
FEIN
Mode
Origin
Name
City and State
FEIN
Gross
Net
Delivered
Number
TOTAL

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