Form 83 Mfr - Nebraska Producer'S Schedule Of Receipts

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Nebraska Producer's Schedule of Receipts
FORM 83 MFR
Producer's Name
FEIN
NE ID Number
Tax Period
Sample Oil Company
123456789
001234567
01/2012
VALID PRODUCT CODES
VALID SCHEDULE CODES
2
Gross gallons received without tax or PRF fee from a licensed producer, supplier, distributor, or importer
061
Natural Gasoline Denaturant
3
Gross gallons imported without tax or PRF fee via transport or rail from another state
123 or E00 Ethanol-Alcohol
B00
Biodiesel
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
Sch.
Bill of Lading
Document/ Bill of
Gross
Product
Carrier Name
Carrier FEIN
Mode
Origin
Destination
Seller Name
Seller FEIN
Code
Date
Lading No.
Gallons
Code
2
Carrier Name
123456789
J
NE
NE
Seller Name
333222333
1/1/2012
00123456
2,000
123
2
Carrier Name
123456789
J
NE
NE
Seller Name
333222333
1/13/2012
003214
2,000
061

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