FORM NN-CAR
F
C
R
UEL
ARRIER'S
EPORT
TIN / SSN : # ________________
Taxpayer Name
Period (Month)
Mailing Address
Telephone Number
(
)
Physical Address
License Number
Delivery
Type of
Net
Date
Distributor
BOL #
Manifest #
Fuel
Gallons
Location of Delivery
Total This Page :
Total From NNCAR-A :
Page ______ of _______
Note: Attach Additional Pages If Necessary
Grand Total :
I declare that the information contained in this document and any attachments thereto is true and correct to
the best of my knowledge and belief pursuant to all Navajo Nation laws and regulations.
x
(
)
/
/
Taxpayer or Duly Authorized Agent Signature
Print or Type Name
Telephone Number
Date
ONTC
FET Carriers Report
Revised: 2/12/02