Form Pt-102.4 - Diesel Motor Fuel Taxable Sales Or Use, Sales To Manufacturers For Use In Manufacturing, And Sales To Railroads For Use As Railroad Diesel
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1
2PT-102.4
New York State Department of Taxation and Finance
Diesel Motor Fuel Taxable Sales or Use, Sales to Manufacturers for
(9/11)
Use in Manufacturing, and Sales to Railroads for Use as Railroad Diesel
Read instructions (Form PT-102-I) carefully. Keep a copy of this completed form for your records.
Name of distributor
Federal employer identification number (EIN)
Month/year
Part 1 — Taxable sales or use
Date
Mode of
Carrier’s name
Purchaser’s name
Origin
Destination
Manifest
Gallons
Product
shipped
delivery
and EIN
and EIN
terminal control
terminal control
number
code*
number or
number or
(city, state)
(city, state)
Total gallons
.................................................................................
(Enter here only and attach this schedule to Form PT-102. This figure is not transferred to Form PT-102.)
Part 2 — Sales or use of non-highway diesel motor fuel in manufacturing
Date
Mode of
Carrier’s name
Purchaser’s name
Origin
Destination
Manifest
Gallons
Product
shipped
delivery
and EIN
and EIN
terminal control
terminal control
number
code*
number or
number or
(city, state)
(city, state)
Total gallons
...........................................................................................................................................................................
(enter here and on Form PT-102, line 10)
*From Publication 902, Product Codes for Fuels.
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