Schedule 10e - Schedule Of Uncollectible Tax From Eligible Purchasers - Indiana Department Of Revenue

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Schedule 10E
State Form 49084
(R1/08-04)
Schedule of Uncollectible Tax from Eligible Purchasers
License Number
Company Name
FEIN
Month / Year
You may photocopy this blank schedule for future filings. Attach additional sheets as necessary.
Schedule Type (Check One)
Product Code/Type (Check One)
1
Gallons Received, Tax Paid, (Special Fuel Returns Only)
For Use with Reporting Special Fuel
For Use with Reporting Gasoline/Oil Inspection
2
Gallons Received from Licensed Distributor or Oil Inspection Distributor, Tax
142
Kerosene
065
Gasoline
Unpaid
161
Low Sulphur Diesel #1 - undyed
124
Gasohol
167
Low Sulphur Diesel #2 - undyed
125
Aviation Gasoline
2 E
Gallons Received for Export (Special Fuel Exporter Only)
226
High Sulphur Diesel - dye added
130
Jet FuelGasoline
2K
Gallons of Non-Taxable Fuel Received and Sold or Used for a Taxable Purpose
227
Low Sulphur Diesel - dye added
142
Kerosene
2X
Gallons Received from Distributor on Exchange
228
Diesel/Fuel Oil Dyed - dye added
150
#1 Fuel Oil - undyed
3
Gallons Imported Via Truck, Barge, or Rail, Tax Unpaid
231
No. 1 Diesel - dye added
161
Low Sulphur Diesel #1 - undyed
4
Gallons Imported into Own Storage
284
Biodiesel - undyed
231
No. 1 Diesel - dye added
290
Biodiesel - dye added
241
Ethanol
OTH
Other
243
Methanol
282
#1 High Sulphur Diesel - undyed
OTH
Other
Eligible Purchaser
(9)
(10)
(11)
(8)
Document
(6)
(7)
Date of
Billed
Unpaid Indiana
Name
FEIN
Transaction
Number
Gallons
Special Fuel Taxes
Total
$

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