Form Sf# 49084 - Schedule 10e Schedule Of Uncollectible Tax From Eligible Purchasers 2007

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Schedule 10E
SF# 49084
(R2/ (05-07)
Schedule of Uncollectible Tax from Eligible Purchasers
FEIN
Month / Year
Company Name
License Number
You may photocopy this blank schedule for future fi lings. Attach additional sheets as necessary.
Schedule Type (Check One)
Product Code/Type (Check One)
1
Gallons Received, Tax Paid, (Special Fuel Returns Only)
For Use with Reporting Special Fuel
For Use with Reporting Gasoline/Oil Inspection
2
Gallons Received from Licensed Distributor or Oil Inspection Distributor, Tax
142
Kerosene
065
Gasoline
160
Diesel Fuel - clear
124
Gasohol
Unpaid
170
Biodiesel - undyed (blended product)
125
Aviation Fuel
2E
Gallons Received for Export (Special Fuel Exporter Only)
171
Biodiesel - dyed (blended product)
130
Jet Fuel
2K
Gallons of Non-Taxable Fuel Received and Sold or Used for a Taxable Purpose
228
Diesel Fuel - dyed
142
Kerosene
3
Gallons Imported Via Truck, Barge, or Rail, Tax Unpaid
B00
Biodiesel (B-100) - undyed
150
#1 Fuel Oil - undyed
D00
Biodiesel (B-100) - dyed
161
Low Sulfur Diesel #1 - undyed
OTH
Other (specify)
231
No. 1 Diesel - dyed
167
Low Sulfur Diesel #2 - undyed
E00
Ethanol - (100%)
161
Low Sulfur Diesel #1 - undyed
E85
85% Ethanol / 15% Gasoline
M00
Methanol - (100%)
OTH
Other (specify)
Eligible Purchaser
(8)
(9)
(10)
(11)
Document
Billed
Unpaid Indiana
(6)
(7)
Date of
Number
Gallons
Special Fuel Taxes
Name
FEIN
Transaction
Total
$

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