Schedules 1 Through 4 Schedule Of Receipts
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1
2Schedules 1 through 4
SF# 49081
Schedule of Receipts
(R3 / 12-08)
Company name
License number
Month / Year
Fein
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
1A Gallons Received, Tax Paid (Gasoline Return Only)
code-matrix.pdf
□
2
Gallons Received from Licensed Distributor or Oil inspection Distributor, Tax Unpaid
(Gasoline Only)
□
2e Gallons Received for export (Special Fuel Exporter Only)
□
2K Gallons of non-Taxable Fuel Received and Sold or Used for a Taxable Purpose
□
2X Gallons Received from Distributor on exchange (Gasoline Only)
□
3
Gallons imported Via Truck, Barge, or Rail, Tax Unpaid
□
4
Gallons imported into Own Storage (Gasoline Only)
Transporter information
(4)
Purchased From information
(1)
(2)
(3)
Point of
(5)
(6)
(7)
(9)
(10)
(11)
(8)
net
name
Fein
Mode
name
Fein
Date
Document
Gross
Billed
Origin
Dest.
Received
number
Gallons
Gallons
Gallons
(State)
(State)
Total
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