Form Wv/mft-511c - Exporter Schedule Of Diversions Into West Virginia - 2003
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2WV/MFT-511 C
WEST VIRGINIA STATE TAX DEPARTMENT
Org. (5/03)
INTERNAL AUDITING DIVISION
P O BOX 2991
Charleston, WV 25330-2991
(304) 558-8500
EXPORTER SCHEDULE OF DIVERSIONS INTO WEST VIRGINIA
FEIN/SSN
NAME
SCHEDULE NUMBER
MONTH/YEAR
11
PRODUCT INFORMATION (CHECK APPLICABLE BOX)
MODE OF TRANSPORTATION
(COMPLETE SEPARATE SCHEDULES FOR EACH PRODUCT TYPE YOU DIVERT)
CODES
□ 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
□ 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)
(12)
(6)
Motor Fuel
Motor Fuel
Mode
Point of
Purchaser’s
Date
Document
Gross
Net
INVOICED
Diversion
Purchaser’s
Origin
Destination
Received
Number
Gallons
Gallons
GALLONS
Number
Transporter’s
Transporter’s
Name
FEIN/SSN
Name
FEIN/SSN
SUB TOTAL
GRAND TOTAL OF INVOICED GALLONS (Transfer to Lines 11 and 12)
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