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pdfEIA-457G
OMB 1905-0092
Exp. X/XX/202X
Burden: 10 minutes
2024 RECS Fuel Oil and Kerosene Usage Form
Delivery address:
123 Main St.
Apt. 1
Anytown, US 98765
Account number:
Please provide information on fuel oil and kerosene usage for this delivery address between September 2023 and April
2025.
If you have no data for this delivery address, please submit this form without filling in any data and leave a comment
explaining the situation.
Delivery
number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Enter the
delivery
date for
each
delivery
MM/DD/YY
Type of fuel
sold was:
1 = Fuel Oil #1
2 = Fuel Oil #2
3 = Kerosene
4 = Other
(circle one)
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
Enter the
amount
delivered in
gallons
XXXX
Enter the total dollar
amount including taxes
[Exclude late fees,
merchandise, repairs,
and service charges]
$XXX.XX
If the type of fuel sold above was 4 = Other, enter the specific type of fuel here. If a mixture
of fuels was sold, enter the types of fuel and proportion of each:
Comments:
File Type | application/pdf |
Author | Mayclin, Danielle |
File Modified | 2023-12-05 |
File Created | 2023-12-05 |