Schedule 11 - Schedule Of State Diversion Corrections

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Schedule 11
SF# 49085
(R3/ 12-08)
Schedule of State Diversion Corrections
Supplier name
License number
Month / Year
Fein
You may photocopy this blank schedule for future filings. Attach additional sheets if necessary
.
Please see the product code matrix on the Web site at
(4)
Carrier information
Purchaser information
(5)
(1)
(10)
(11)
(2)
(3)
Original
Revised
(6)
(7)
(8)
(9)
(12)
(13)
Terminal
Carrier
Carrier
Mode
Dest.
Dest.
Purchaser
Date
Document
net
Gross
Billed
Diversion
Purchaser
name
Fein
State
State
name
Fein
Shipped
number
Gallons
Gallons
Gallons
number
Code
Total

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Related Categories

Parent category: Financial
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