Form 573 - Schedule Of Supplier Tax-Paid Receipts - 2016

Download a blank fillable Form 573 - Schedule Of Supplier Tax-Paid Receipts - 2016 in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 573 - Schedule Of Supplier Tax-Paid Receipts - 2016 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

Reset Form
Print Form
Document Locator Number
Missouri Department of Revenue
Form
573
Schedule of Supplier Tax-Paid Receipts
Page _______ of _______
Supplier’s Name
License Number
Schedule Type
Federal Employer I.D. Number
Month and Year
__ __ /__ __ __ __
1
Select One (Complete a separate schedule for each product type)
r
r
r
r
r
065 - Gasoline
124 - Gasohol
142 - Clear Kerosene
284 - Bio-Diesel - Undyed B100
285 - Soy Oil
r
r
r
r
r
123 - Alcohol
125 - Aviation Gasoline
072 - Dyed Kerosene
228 - Dyed Diesel Fuel
225 - Liquefied Natural Gas
r
r
r
r
r
122 - Blending Components (Identify) _____________
241 - Ethanol
130 - Jet Fuel
160 - Clear Diesel Fuel
290 - Bio-Diesel - Dyed B100
Point of
Carrier’s
Seller’s
Date
Document
Net
Gross
Invoiced
Name of Carrier
Mode
Seller’s Name
FEIN
FEIN
Shipped
Number
Gallons
Gallons
Gallons
Origin
Dest.
Page Total
Mail to: Taxation Division
Phone: (573) 751-2611
Visit
P.O. Box 300
Fax: (573) 522-1720
Schedule Total
Jefferson City, MO 65105-0300
TTY: (800) 735-2966
for additional information.
E-mail:
excise@dor.mo.gov
Form 573 (Revised 01-2016)

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go