Form Wv/mft-507 A - Motor Fuel Transporter Schedule Of Deliveries - 2004
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1MOTOR FUEL TRANSPORTER SCHEDULE OF DELIVERIES
WV/MFT-507 A
REV 11/04
WEST VIRGINIA STATE TAX DEPARTMENT
INTERNAL AUDITING DIVISION
C
P O BOX 2991
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 HIRING COMPANY
FEIN
NAME
MONTH/YEAR
SCHEDULE 1
LOADED IN WEST VIRGINIA AND DELIVERED TO ANOTHER STATE
MODE OF
PRODUCT INFORMATION (CHECK APPLICABLE BOX)
TRANSPORTATION
J – Truck
□ 150 – #1 Fuel Oil
□ 228 – Diesel – Dyed
□ 054 – Propane
□ 125 – Aviation Gasoline
□ 160 – Diesel – Undyed
□ 224 – Compressed Natural Gas
R – Rail
□ 130 – Aviation Jet Fuel
□ 284 – Biodiesel – Undyed
□ 225 – Liquefied Natural Gas
□ 122 – Blending Components
□ 072 – Kerosene – Dyed
□ Other – Product Type ___________
B – Barge
□ 124 – Gasohol
□ 142 – Kerosene – Undyed
Product Code __________
□ 065 – Gasoline
HIRING COMPANY
SELLER
DELIVERED TO
GALLONS
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
Name
FEIN
Name
FEIN
Mode
Point of Origin
Name
Address
FEIN
Date
Bill of Lading
GROSS
NET
Delivered
Number
TOTAL THIS
PAGE
:
IMPORTANT NOTICE
Total all pages Gross Gallons - Transfer to Line 1 on Report
You must obtain prior approval to submit your own schedules
Total all pages Net Gallons - Transfer to Line 1 on Report
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