Schedule Ga-1c - Multiple Schedule Of Adjustments To Previous Monthly Reports

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GA-1C
12-03
STATE OF NEW JERSEY
DIVISION OF TAXATION
MOTOR FUEL TAX
MULTIPLE SCHEDULE OF ADJUSTMENTS
PRODUCT CODE **
TO PREVIOUS MONTHLY REPORTS
(Use a SEPARATE form for each line and product)
FID No.
Company Name:
Month of
** PRODUCT CODE (PC) – TYPE OF PRODUCT
For Line (check one box):
A – Gasoline
D – Quantity Extender
LINE 22 Add Adjustments of Previous Months
B – Alcohol/Gasoline
E – Other (Identify)
LINE 23 Less Adjustments of Previous Months
C – Aviation Gasoline
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
Name of Carrier
Purchaser
Date
Origin
Destination
Sold To
Federal ID No.
MM / DD / YY
Document No.
Gallons
Other
TOTAL

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