Form 72a231 - Report Of Dyed Diesel Sold To Licensed Kentucky Dealers

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72A231 (7-00)
REPORT OF DYED DIESEL
Commonwealth of Kentucky
REVENUE CABINET
SOLD TO LICENSED KENTUCKY DEALERS
Tax Paid by Consignee
Name and Address of Dealer
INSTRUCTIONS: This report must be completed by all licensed
Report for Month of ___________________ , 20___
special fuels dealers who have sold fuel to other licensed Kentucky
special fuels dealers. Use a separate line for each shipment. File a
separate report for each consignee (purchaser). Complete this report
Date Report Prepared _________________ , 20____
in duplicate and attach both copies to Form 72A200.
Truck No.
Name and Address
Invoice
Date of
Gallons
Carrier
Car Initial and No.
Origin
Destination
Number
Shipment
Shipped
of Consignee
Barge No.
TOTAL*
*Total sales to Kentucky dealers must equal line 7, Form 72A200.

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Parent category: Financial
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