Form Wv/mft-507 A - Motor Fuel Transporter Schedule Of Deliveries - Schedule Number 1
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1
2WEST VIRGINIA STATE TAX DEPARTMENT
WV/MFT-507 A
Orig. (5/03)
INTERNAL AUDITING DIVISION
P O BOX 2991
Charleston, WV 25330-2991
(304) 558-8500
MOTOR FUEL TRANSPORTER SCHEDULE OF DELIVERIES
FEIN/SSN
NAME
SCHEDULE NUMBER – 1
MONTH/YEAR
Loaded in West Virginia and
delivered to another state
MODE OF
PRODUCT INFORMATION (CHECK APPLICABLE BOX)
TRANSPORTATION CODES
(COMPLETE SEPARATE SCHEDULES FOR EACH PRODUCT TYPE YOU DELIVER)
□ 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
HIRING COMPANY
SELLER
DELIVERED TO
GALLONS
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
Name
FEIN/SSN
Name
FEIN/SSN
Mode
Point of Origin
Name
Address
FEIN/SSN
Date
Document
GROSS
NET
Delivered
Number
Sub Total
–
–
GROSS GRAND TOTAL
NET GRAND TOTAL
Transfer to Line 1 of Report
Transfer to Line 1 of Report
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Parent category: Financial