Form 573 - Schedule Of Supplier Tax-Paid Receipts
Download a blank fillable Form 573 - Schedule Of Supplier Tax-Paid Receipts 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 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
1
2DLN
MISSOURI DEPARTMENT OF REVENUE
FORM
TAXATION DIVISION
Print Form
Reset Form
573
P.O. BOX 300, JEFFERSON CITY, MO 65105-0300
(573) 751-2611
TDD (800) 735-2966
PAGE
(REV. 02-2011)
SCHEDULE OF SUPPLIER TAX-PAID RECEIPTS
OF
SEE INSTRUCTIONS ON REVERSE SIDE
SUPPLIER’S NAME
LICENSE NUMBER
FEIN
SCHEDULE TYPE
MONTH, YEAR
1
__ __ __ __ __ __ __ __ __
__ __ / __ __ __ __
PRODUCT TYPE — Complete a separate schedule for each product type
CIRCLE ONE
228 — Dyed Diesel Fuel
290 — Bio-Diesel – Dyed B100
065 — Gasoline
124 — Gasohol
142 — Clear Kerosene
122 — Blending Components
284 — Bio-Diesel – Undyed B100
123 — Alcohol
125 — Aviation Gasoline
072 — Dyed Kerosene
(Identify)
285 — Soy Oil
241 — Ethanol
130 — Jet Fuel
160 — Clear Diesel Fuel
4
2
7
8
9
10
11
1
3
5
6
POINT OF
CARRIER’S
DATE
DOCUMENT
NET
GROSS
INVOICED
NAME OF CARRIER
MODE
SELLER’S NAME
SELLER’S FEIN
FEIN
ORIGIN
DEST.
SHIPPED
NUMBER
GALLONS
GALLONS
GALLONS
_ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _
_ _ /_ _ /_ _ _ _
_ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _
_ _ /_ _ /_ _ _ _
_ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _
_ _ /_ _ /_ _ _ _
_ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _
_ _ /_ _ /_ _ _ _
_ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _
_ _ /_ _ /_ _ _ _
_ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _
_ _ /_ _ /_ _ _ _
_ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _
_ _ /_ _ /_ _ _ _
_ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _
_ _ /_ _ /_ _ _ _
_ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _
_ _ /_ _ /_ _ _ _
_ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _
_ _ /_ _ /_ _ _ _
_ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _
_ _ /_ _ /_ _ _ _
_ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _
_ _ /_ _ /_ _ _ _
_ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _
_ _ /_ _ /_ _ _ _
_ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _
_ _ /_ _ /_ _ _ _
_ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _
_ _ /_ _ /_ _ _ _
_ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _
_ _ /_ _ /_ _ _ _
_ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _
_ _ /_ _ /_ _ _ _
0
0
0
PAGE TOTAL
SCHEDULE TOTAL
This publication is available upon request in alternative accessible format(s).
MO 860-1110 (02-2011)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial