Form 1536 - Transporter Report Of Deliveries
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MISSOURI DEPARTMENT OF REVENUE
DLN
FORM
TAXATION DIVISION
1536
P.O. BOX 300, JEFFERSON CITY, MISSOURI 65105-0300
(573) 751-2611
TDD (800) 735-2966
PAGE
OF
TRANSPORTER REPORT OF DELIVERIES
(REV. 08-2010)
SEE INSTRUCTIONS ON REVERSE SIDE
COMPANY NAME
LICENSE NUMBER
FEDERAL I.D. NUMBER
SCHEDULE TYPE
MONTH, YEAR
__ __ __ __ __ __ __ __ __
__ __ / __ __ __ __
SCHEDULE TYPE
PRODUCT TYPE — CIRCLE ONE
1A. Total all deliveries of fuel from in-state locations to out of state locations (exports)
065 — Gasoline
125 — Aviation Gasoline 160 — Clear Diesel Fuel
285 — Soy Oil
123 — Alcohol
130 — Jet Fuel
228 — Dyed Diesel Fuel
290 — Bio-Diesel – Dyed B100
2A. Total all deliveries of fuel from out-of-state locations to in-state locations (imports)
241 — Ethanol
142 — Clear Kerosene
284 — Bio-Diesel – Undyed
122 — Blending Components
3A. Totals all deliveries of fuel between points in the state (intrastate)
(Identify)
124 — Gasohol
072 — Dyed Kerosene
B100
SELLER
DELIVERED TO:
PERSON HIRING THE CARRIER
GALLONS
2
4
9
10
11
1
3
5
6
7
8
12
13
DOCUMENT
Federal I.D.
Federal I.D.
Federal I.D.
DATE
MODE
ORIGIN
NAME
ADDRESS
NET
GROSS
COMPANY NAME
COMPANY NAME
Number
Number
Number
DELIVERED
NUMBER
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PAGE TOTAL
SCHEDULE TOTAL
This form is available upon request in alternative accessible format(s).
MO 860-1214 (08-2010)
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Parent category: Financial