Form Dr-309633 Sample - Mass Transit System Provider Fuel Tax Return - 2015 Page 6

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DR-309633
R. 01/13
Page 6
Schedule of Receipts — Mass Transit (continued)
Schedule Type/Product Type
Company Name
FEIN
Collection Period Ending
(mm/dd/yy)
(1)
(2)
(3)
(4)
(5)
Name of Supplier
Supplier’s FEIN/DEPN
Date Received
Invoice Number
Gallons Received
Total

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