Form Wv/mft-508 - A Importer Schedule Of Tax-Paid Receipts - 2007
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1WV/MFT-508 A
IMPORTER SCHEDULE OF TAX-PAID RECEIPTS
REV 06/07
WEST VIRGINIA STATE TAX DEPARTMENT
INTERNAL AUDITING DIVISION
P O BOX 2991
J
Charleston, WV 25330-2991
(304) 558-8623; (304) 558-8624; (304) 558-8625; (304) 558-8626; (304) 558-8627
MONTH/YEAR
FEIN
NAME
SCHEDULE
1A
PRODUCT INFORMATION (CHECK APPLICABLE BOX)
MODE OF TRANSPORTATION
□ 150 – #1 Fuel Oil
□ 228 – Diesel – Dyed
□ 054 – Propane
□ 125 – Aviation Gasoline
□ 160 – Diesel – Undyed
□ 224 – Compressed Natural Gas
J – Truck
Report Tax Paid fuel loaded at a
□ 130 – Aviation Jet Fuel
□ 284 – Biodiesel – Undyed
□ 225 – Liquefied Natural Gas
R – Rail
Terminal Rack ONLY from a
□ 122 – Blending Components
□ 072 – Kerosene – Dyed
□ Other – Product Type ___________
licensed permissive supplier
B – Barge
□ 124 – Gasohol
□ 142 – Kerosene – Undyed
Product Code __________
□ 065 – Gasoline
PRODUCT RECEIPT INFORMATION:
YOU MUST COMPLETE SEPARATE SCHEDULES FOR EACH PRODUCT TYPE AND SELLER
(1)
(2)
(3)
(4)
(6)
(7)
(8)
(9)
(10)
(5)
Point of
Transporter
Origin (TCN)
Destination
Net Gallons
INVOICED
Supplier Name
Seller Name
Mode
Date Loaded
Bill of Lading
Gross
Name
GALLONS
Number
Gallons
TOTAL THIS PAGE only
IMPORTANT NOTICE: You must obtain prior approval to submit your own schedules
All columns must be completed for each transaction
TOTAL ALL PAGES
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Parent category: Financial