Form R-5291 Schedule A "Motor Fuel Tax Multiple Schedule of Receipts" - Louisiana

What Is Form R-5291 Schedule A?

This is a legal form that was released by the Louisiana Department of Revenue - a government authority operating within Louisiana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2006;
  • The latest edition provided by the Louisiana Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form R-5291 Schedule A by clicking the link below or browse more documents and templates provided by the Louisiana Department of Revenue.

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Download Form R-5291 Schedule A "Motor Fuel Tax Multiple Schedule of Receipts" - Louisiana

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R-5291 (7/06)
Page _____ of _____
Schedule A
Motor Fuel Tax Multiple Schedule of Receipts
Company Name
LA Revenue Account Number
Type of Schedule
Product Type
Filing Period
Type of Schedule
Mode of Transport
Product Type (Only one product type per page)
1
Gallons received tax and inspection fee paid
B = Barge
PL = Pipeline
065 – Gasoline
130 – Jet Fuel
228 – Dyed Diesel
2
Gallons received inspection fee paid
J = Truck
ST = Stationary Transfer
123 – Alcohol
072 – Dyed Kerosene
170 – Clear Biodiesel
3
Gallons imported without Louisiana tax or fee paid
R = Rail
BA = Book Adjustment
124 – Gasohol
142 – Clear Kerosene
171 – Dyed Biodiesel
4
Gallons of non-motor fuel product used in blending
S = Ship
125 – Aviation Gasoline
160 – Clear Diesel
Other _______________
5
Gallons blended
(2)
(5)
(3)
(4)
(1)
(6)
(7)
Seller
City, State of
Doc.
Net
Name
Rev. ID
Origin
Number
Gallons
Date
Destination
Mode
Carrier Name
Total
R-5291 (7/06)
Page _____ of _____
Schedule A
Motor Fuel Tax Multiple Schedule of Receipts
Company Name
LA Revenue Account Number
Type of Schedule
Product Type
Filing Period
Type of Schedule
Mode of Transport
Product Type (Only one product type per page)
1
Gallons received tax and inspection fee paid
B = Barge
PL = Pipeline
065 – Gasoline
130 – Jet Fuel
228 – Dyed Diesel
2
Gallons received inspection fee paid
J = Truck
ST = Stationary Transfer
123 – Alcohol
072 – Dyed Kerosene
170 – Clear Biodiesel
3
Gallons imported without Louisiana tax or fee paid
R = Rail
BA = Book Adjustment
124 – Gasohol
142 – Clear Kerosene
171 – Dyed Biodiesel
4
Gallons of non-motor fuel product used in blending
S = Ship
125 – Aviation Gasoline
160 – Clear Diesel
Other _______________
5
Gallons blended
(2)
(5)
(3)
(4)
(1)
(6)
(7)
Seller
City, State of
Doc.
Net
Name
Rev. ID
Origin
Number
Gallons
Date
Destination
Mode
Carrier Name
Total