Form Mfd For Schedules 2, 3, 4, 5 - Inventories And Receipts - Nh Road Toll Bureau - 2005
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1
2NOTICE
STATE OF NEW HAMPSHIRE
SCHEDULE NUMBER:_______
USE THIS FORM FOR SCHEDULES:
ROAD TOLL BUREAU
“INVENTORIES AND RECEIPTS”
MONTH/YEAR____________
2 & 3-RECEIPTS INTO WHOLESALE BULK
4 & 5-DIRECT SHIPMENTS
DISTRIBUTOR NAME: ____________________________
PAGE_______ OF _________
FEIN: _________________________________________
TRANSPORTER
PURCHASED
POINT OF
DELIVERY
PRODUCT
SOLD TO
FROM/OR
(CITY/STATE)
(CITY/STATE)
GALLONS
DATE
NAME
ADDRESS
TYPE
(Name, City & State)
SUPPLIER
SHIPMENT
DELIVERY
TOTAL THIS PAGE-
NOTE: There must be one (1) schedule submitted for each product type or it may be disallowed
TOTAL TO LINE 2, 3, 4 OR 5 ON THE MFD 1-S/AF REPORT
FORMS MFD 2, 3, 4, 5 (Revised 07/05)
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