Form L-2106 - Bonded Importer Schedule Of Receipts (Page 3 of 3) in pdf

Form L-2106 - Bonded Importer Schedule Of Receipts Page 3

BONDED IMPORTER SCHEDULE OF RECEIPTS

INSTRUCTIONS FOR L-2106

Please note that the specific product code for biodiesel blends and gasohol must be indicated, i.e. E10-B20.

Complete a separate schedule for each schedule type and product type.

COLUMN 1 & 2: Carrier -

Enter the name of the company that transported the product from the terminal and the

federal identification number if available.

COLUMN 3:

Mode of Transport - Enter the mode of transport from the terminal. Use one of the following:

Truck

Pipeline

Ship

Stock Transfer

Book Adjustment

Barge

Rail

COLUMN 4:

Point of Origin/Destination - Enter the name of the state of origin and destination (abbreviations are

acceptable).

COLUMN 5:

Terminal Code - Enter the number issued by the federal government to identify the terminal from

which the product was exported.

COLUMN 6 & 7:

Supplier - Enter the name of the company that removed the product from the terminal and the

federal identification number if available.

COLUMN 8:

Date Shipped - Enter the date the product was shipped from the terminal.

COLUMN 9:

Document Number - Enter the identifying number from the document issued at the terminal where

the product was removed over the rack.

COLUMN 10:

Billed Gallons - Enter the number of gallons billed to you. The total from column 10 will be the

amount you need to enter on the proper line on the user fee return.

COLUMN 11:

Import Verification Number - Enter the number listed on the terminal issued shipping paper obtained

from the Department of Revenue's agent under Section 12-28-1545.

44611010

L-2106 I

(Rev. 9/8/11)

4461

Form L-2106 - Bonded Importer Schedule Of Receipts Page 3