Schedule Of Receipts {Schedules 1-4}

State Form 49081 (R1/8-04) Schedules 1 through 4 Schedule of Receipts License Number You may photocopy this blank schedule for future filings. Attach additional sheets as necessary. Company Name FEIN Month / Year Schedule Type (Check One) 1 Gallons Received, Tax Paid, (Special Fuel Returns Only) 1A Gallons Received, Tax Paid (Gasoline Return Only) 2 Gallons Received from Licensed Distributor or Oil Inspection Distributor, Tax Unpaid (Gasoline Only) 2 E Gallons Received for Export (Special Fuel Exporter Only) 2K Gallons of Non-Taxable Fuel Received and Sold or Used for a Taxable Purpose 2X Gallons Received from Distributor on Exchange (Gasoline Only) 3 Gallons Imported Via Truck, Barge, or Rail, Tax Unpaid 4 Gallons Imported into Own Storage (Gasoline Only) Product Code/Type (Check One) For Use with Reporting Special Fuel 142 Kerosene 161 Low Sulphur Diesel #1 - undyed 167 Low Sulphur Diesel #2 - undyed 226 High Sulphur Diesel - dye added 227 Low Sulphur Diesel - dye added 231 No. 1 Diesel - dye added 284 Biodiesel - undyed 290 Biodiesel - dye added OTH Other For Use with Reporting Gasoline/Oil Inspection 065 Gasoline 124 Gasohol 125 Aviation Gasoline 130 Jet FuelGasoline 142 Kerosene 150 #1 Fuel Oil - undyed 161 Low Sulphur Diesel #1 - undyed 231 No. 1 Diesel - dye added 241 Ethanol 243 Methanol 282 #1 High Sulfur Diesel - undyed OTH Other Transporter Information (1) Name (2) FEIN (3) Mode (4) Point of Origin (State) Dest. (State) Purchased From Information (5) Name (6) FEIN (7) Date (8) Document (9) Net (10) Gross (11) Billed Total American LegalNet, Inc. www.FormsWorkflow.com Instructions for Completing Schedule of Receipts Schedules 1 - 4 Before you begin: These schedules provide detail in support of the amount(s) shown as receipts on the Consolidated Special Fuel Monthly Tax Return, Form SF-900, and Consolidated Gasoline Monthly Tax Return, Form MF-360. Enter your identifying information as it is reflected on your Indiana Fuel Tax License. Be certain to check the appropriate schedule type that you are completing as well as the product type. Complete a separate schedule for each fuel product type. If product type "Other" is specified, please name specific fuel type. Schedule Type: Indicate the appropriate schedule type you are completing: 1 Gallons Received , Tax Paid, (Special Fuel Returns Only) 1A Gallons Received, Tax Paid (Gasoline Return Only) 2 Gallons Received from Licensed Distributor or Oil Inspection Distributor, Tax Unpaid (Gasoline Only) 2E Gallons Received for Export (Licensed Special Fuel Exporters Only) 2K Gallons of Non-Taxable Fuel Received and Sold or Used for a Taxable Purpose 2X Gallons Received from Distributor on Exchange (Gasoline Only) 3 Gallons Imported Via Truck, Barge or Rail, Tax Unpaid 4 Gallons Imported into Own Storage (Gasoline Only) Column Instructions: Columns 1 and 2: Enter the name and Federal Employer's Identification Number (FEIN) of the company that transports the fuel. This may or may not be your company. Column 3: Enter the mode of transport. One of the following codes should be used for each entry. J R ST S = = = = Truck Rail Stock Transfer Ship (Great Lakes or Ocean Marine Vessel) PL B BA = Pipeline = Barge = Book Adjustment Column 4: Enter the point of origin and destination state. Columns 5-8: Enter the seller's name and Federal Identification Number (FEIN), the date of receipt and the document number. Invoice numbers cannot be used in lieu of bill of lading or manifest numbers. Column 9: Enter the net gallons. Column 10: Enter the gross gallons. Column 11: Enter the billed (invoiced) gallons, which should equal either the net or the gross gallons. American LegalNet, Inc. www.FormsWorkflow.com