Form 199-C - Schedule 3 - Receipts Of Sales Of Special Fuel To Service Stations Or To Persons Acting As A Special Fuel Dealer Or Special Fuel User

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Form 199-C
Revised 1-2012
Motor Fuel Division - Oklahoma Tax Commission
Schedule 3
Receipts of Sales of Special Fuel to Service Stations or to Persons Acting
as a Special Fuel Dealer or Special Fuel User
This report to be filed with the Oklahoma Tax Commission on or before the
20th day of each month for the calendar month preceding.
Name of Special Fuel Dealer or User
OTC License Number
Month/Year
Street Address or Box Number
City or Town
State
Zip
Loading Ticket or
Gallons of
Delivery Invoice
Special Fuel
LPG, Butane,
Date
Number
To Whom Sold
Destination
OTC No.
Propane, etc.
Total
__________________________________________________
____________________________________
__________________________________
Name of Reporting Person, Firm or Corporation
By
Official Title

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