Form Wv/mft-508 A - Importer Schedule Of Tax-Paid Receipts - 2004
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1WV/MFT-508 A
IMPORTER SCHEDULE OF TAX-PAID RECEIPTS
REV 11/04
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
YOU MUST COMPLETE SEPARATE SCHEDULES FOR EACH PRODUCT TYPE AND SELLER
FEIN
NAME
MONTH/YEAR
SCHEDULE
1A
PRODUCT INFORMATION (CHECK APPLICABLE BOX)
MODE OF TRANSPORTATION
□ 150 – #1 Fuel Oil
□ 228 – Diesel – Dyed
□ 054 – Propane
J – Truck
□ 125 – Aviation Gasoline
□ 160 – Diesel – Undyed
□ 224 – Compressed Natural Gas
R – Rail
□ 130 – Aviation Jet Fuel
□ 284 – Biodiesel – Undyed
□ 225 – Liquefied Natural Gas
B – Barge
□ 122 – Blending Components
□ 072 – Kerosene – Dyed
□ Other – Product Type ___________
□ 124 – Gasohol
□ 142 – Kerosene – Undyed
Product Code __________
□ 065 – Gasoline
PRODUCT RECEIPT INFORMATION
(1)
(2)
(3)
(4)
(5)
(7)
(8)
(9)
(10)
(11)
(6)
Transporter Name
Transporter
Point of
FEIN
Origin
Destination
Seller Name
Net Gallons
INVOICED
Seller FEIN
Mode
Date Loaded
Bill of Lading
Gross
(TCN)
GALLONS
Number
Gallons
TOTAL THIS PAGE
IMPORTANT NOTICE: YOU MUST OBTAIN PRIOR APPROVAL TO SUBMIT YOUR OWN SCHEDULES
TOTAL ALL PAGES
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Parent category: Financial