Schedule 10e - Schedule Of Uncollectible Tax From Eligible Purchasers
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1
2Schedule 10E
SF# 49084
(R3 / 12-08)
Schedule of Uncollectible Tax from Eligible Purchasers
Fein
Month / Year
Company name
License number
.
You may photocopy this blank schedule for future filings. Attach additional sheets if necessary
Schedule Type (Check One)
□
1
Gallons Received, Tax Paid, (Special Fuel Returns Only)
□
Please see the product code matrix on the Web site at
2e
Gallons Received for export (Special Fuel Exporter Only)
□
2K
Gallons of non-Taxable Fuel Received and Sold or Used for a Taxable Purpose
□
3
Gallons imported Via Truck, Barge, or Rail, Tax Unpaid
eligible Purchaser
(8)
(9)
(10)
(11)
Document
Billed
Unpaid indiana
(6)
(7)
Date of
number
Gallons
Special Fuel Taxes
name
Fein
Transaction
Total
$
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