Schedules 1a, 2a And 3a - Transporter Schedule Of Deliveries - Indiana Department Of Revenue

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Schedules 1A, 2A and 3A
State Form 49083
(R1/8-04)
Transporter Schedule of Deliveries
License Holder
License Number
Month / Year
FEIN
You may photocopy this blank schedule for future filings. Attach additional sheets as necessary.
Product Code/Type (Check One)
Schedule Type (Check One)
For Use with Reporting Special Fuel
For Use with Reporting Gasoline/Oil Inspection
142
Kerosene
065
Gasoline
1A Exports
161
Low Sulphur Diesel #1 - undyed
124
Gasohol
2A Imports
167
Low Sulphur Diesel #2 - undyed
125
Aviation Gasoline
226
High Sulphur Diesel - dye added
130
Jet Fuel Gasoline
3A In-State Transfers
227
Low Sulphur Diesel - dye added
142
Kerosene
231
No. 1 Diesel - dye added
150
#1 Fuel Oil - undyed
284
Biodiesel - undyed
161
Low Sulphur Diesel #1 - undyed
290
Biodiesel - dye added
231
No. 1 Diesel - dye added
OTH
Other
241
Ethanol
243
Methanol
282
#1 High Sulphur Diesel - undyed
OTH
Other
Person Hiring
Seller Information
Delivered to
(14)
(13)
the Carrier
(Fuel Withdrawn From)
(5)
(6)
(10)
(11)
(12)
Billed or
Import
(9)
(2)
(7)
(8)
(1)
(3)
(4)
Mode
State of
Document
Document
Gross
Net
Verification
Destination
Name
Name
FEIN
FEIN
FEIN
Name
Origin
Date
Gallons
Number
Number
Gallons
State
Total

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