Form 2994 - Schedule Of Supplier/permissive Supplier Terminal Rack Removals
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MISSOURI DEPARTMENT OF REVENUE
FORM
TAXATION DIVISION
P.O. BOX 300, JEFFERSON CITY, MISSOURI 65105-0300
2994
(573) 751-2611
TDD (800) 735-2966
SCHEDULE OF SUPPLIER/PERMISSIVE SUPPLIER
PAGE
(REV. 02-2011)
TERMINAL RACK REMOVALS
OF
SEE INSTRUCTIONS ON REVERSE SIDE
SUPPLIER’S NAME
LICENSE NUMBER
FEIN
SCHEDULE TYPE
MONTH, YEAR
__ __ __ __ __ __ __ __ __
__ __ /__ __ __ __
SCHEDULE TYPE
PRODUCT TYPE (CIRCLE ONE)
5A.
Gallons sold from in-state terminals.
065 — Gasoline
160 — Diesel Fuel
5B.
Gallons sold for import from state of ____________ .
123 — Alcohol
228 — Dyed Diesel Fuel
5F.
Gallons of dyed diesel sold for taxable purposes from in-state terminals (Missouri tax collected).
241 — Ethanol
284 — Bio-Diesel – Undyed B100
5G. Gallons of dyed diesel sold for taxable purposes for import from state of _____________ (Missouri tax collected).
124 — Gasohol
285 — Soy Oil
5H.
Gallons sold for export to state of ___________________ destination state tax paid. (2 copies)
125 — Aviation Gasoline
290 — Bio-Diesel – Dyed B100
6.
Gallons delivered to distributors — tax not collected (jet fuel, alcohol, Bio-Diesel – Undyed B100, blending
components and undyed kerosene for non-highway use)
142 — Kerosene
122 — Blending Components
7.
Gallons exported to state of ____________________ by supplier. (2 copies)
130 — Jet Fuel
(Identify)
8.
Gallons delivered to U.S. government — tax exempt.
072 — Dyed Kerosene
10.
Gallons delivered to other tax exempt entities (airlines, railroads and barges)
10D. Credit card sales to U.S. government.
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POINT OF
NAME OF CARRIER
CARRIER’S
MODE
TERMINAL
SOLD TO
PURCHASER’S
DATE
DOCUMENT
NET
GROSS
INVOICED
FEIN
ORIGIN
DEST.
CODE
FEIN
SHIPPED
NUMBER
GALLONS
GALLONS
GALLONS
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PAGE TOTAL
SCHEDULE TOTAL
This form is available upon request in alternative accessible format(s).
MO 860-2093 (02-2011)
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Parent category: Financial