Transporter Schedule Of Deliveries {Schedules 1A-3A}

State Form 49083 (R2/12-05) Schedules 1A, 2A and 3A Transporter Schedule of Deliveries License Number You may photocopy this blank schedule for future filings. Attach additional sheets as necessary. License Holder FEIN Month / Year Schedule Type (Check One) 1A Exports 2A Imports 3A In-State Transfers Product Code/Type (Check One) 142 161 167 226 227 231 284 290 OTH For Use with Reporting Special Fuel Kerosene Low Sulphur Diesel #1 - undyed Low Sulphur Diesel #2 - undyed High Sulphur Diesel - dye added Low Sulphur Diesel - dye added No. 1 Diesel - dye added Biodiesel - undyed Biodiesel - dye added Other 065 124 125 130 142 150 161 231 241 243 282 OTH For Use with Reporting Gasoline/Oil Inspection Gasoline Gasohol Aviation Gasoline Jet Fuel Gasoline Kerosene #1 Fuel Oil - undyed Low Sulphur Diesel #1 - undyed No. 1 Diesel - dye added Ethanol Methanol #1 High Sulphur Diesel - undyed Other Person Hiring the Carrier Seller Information (Fuel Withdrawn From) Delivered to (5) (1) Name (2) FEIN (3) Name (4) FEIN Mode (6) State of Origin (7) Name (8) FEIN (10) (11) (9) Document Document Destination Date Number State (12) Gross Gallons (14) (13) Import Billed or Verification Net Number Gallons Total American LegalNet, Inc. www.FormsWorkflow.com Instructions for Completing Schedule of Deliveries Schedules 1A, 2A and 3A Before You Begin: Webb Oil "Person Hiring Carrier" Columns 1 & 2 Person Filing the SF-401 Enter your identifying information as it is reflected on your Indiana Eaton Transport Transporter's License. Check the appropriate schedule type that Complete Indentifying Information at Top of Schedule you are completing as well as the product type, and complete a ABC Company "Seller" (Fuel Withdrawn From) Columns 3 & 4 separate schedule for each fuel product type. Beverly Oil "Person Delivered To" Columns 7, 8 & 9 Schedule 1A: Exports: This schedule must be completed when transporting fuel from a point inside Indiana to a point outside of Column 5: Enter the mode of transportation used to transport the Indiana. This reporting requirement is not required for exports product: delivered by vehicles with a capacity of less than 5,400 gallons. J= Truck PL= Pipeline Exports in vehicles with a capacity greater than 5,400 gallons should R= Rail B= Barge be reported as follows: ST= Stock Transfer BA= Book Adjustment S= Ship (Great Lakes or Ocean Marine Vessel) 1) Loads/Deliveries to a single location greater than 500 gallons must be itemized on Schedule 1A. All information must be comColumn 6: State of Origin: Enter the state from which the product pleted for each of these transactions. was transported. If the product was loaded at a terminal, enter the 2) Loads/Deliveries to a single location of 500 gallons or less may be terminal code assigned to that terminal. grouped together and reported as "VARIOUS". Column 7, 8 and 9: Enter the name, Federal Identification Number (FEIN - you may need to contact the shipper or person hiring you Carry the totals from Schedule(s) 1A, Column 13 to Line 1 of as the carrier if you are acting in the capacity of a common carrier SF-401. for this information), and address of the company to which the Schedule 2A: Imports: This schedule must be completed when product was delivered (final delivery point). Destination state should transporting fuel from a point outside of Indiana to a point inside be included. You are not required to provide identification numIndiana. This reporting requirement includes all vehicles, regard- bers (Column 8) for deliveries of home heating fuel to residential less of capacity. Each load/delivery imported must be listed regard- customers. less of the number of gallons. Carry the totals from Schedule(s) Column 10: Enter the date the product was delivered as shown on 2A, Column 13 to Line 2 of SF-401. the document issued at the terminal when product is removed over Schedule 3A: In-State Transfers: This schedule must be com- the rack. In the case of pipeline or barge movements, enter the date pleted when transporting fuel from a point starting inside Indiana to shown on the pipeline or barge ticket. If the fuel is from a bulk plant a point ending in Indiana. This reporting requirement is not re- facility, enter the date shown on the load or delivery ticket issued quired for vehicles with a capacity of less than 5,400 gallons. Each by the bulk plant operator. load/delivery imported in a vehicle over 5,400 gallons must be listed regardless of the number of gallons imported. Carry the totals Column 11: Enter the identifying number from the document issued at the terminal when product is removed over the rack. In the from Schedule(s) 3A, Column 13 to Line 3 of SF-401. case of pipeline or barge movements, enter the pipeline or barge ticket number. If the fuel is from a bulk plant facility, enter the Column Instructions: identifying number from the load or delivery ticket issued by the bulk plant operator. Note: When a transport load is split between more than one customer, you must indicate each delivery as a separate line item. Column 12: Enter the amount of gross gallons as shown on the shipping document. Column 1 and 2: Enter the name, address and Federal Identification Number (FEIN) of the person hiring the transporter. If you are trans- Column 13: Enter the amount of billed or net gallons as shown on porting your own fuel, then enter your company's name and FEIN. the shipping document. Column 14: Enter the Import Verification Number (if applicable) as shown on the shipping document. Note: Per Indiana Code 6-62.5-62 it is unlawful for a transporter to bring into Indiana, on behalf of an importer, taxable fuel unless an import verification number has been obtained. A person who knowingly violates or Example: Webb Oil (a non-licensed entity) contacts Eaton Transport knowingly aids and abets another person in violating this subto pick up fuel from ABC Company (From whose account storage section commits a Class D felony. the fuel was withdrawn) to be delivered to Webb Oil's customer Important: Please do not use any forms not approved by the Indiana Department of Revenue. Beverly Oil in Greenwood, Indiana. Column 3 and 4: Enter the name, address and Federal Identification Number (FEIN) of the company selling the special fuel. This should be the company name and location from which the fuel was actually withdrawn. American LegalNet, Inc. www.FormsWorkflow.com