Sd E-Form 0837 - Uniform Schedule Of Disbursements

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SD EForm - 0837
V2
Complete and use the button at the end to print for mailing.
Uniform Schedule of Disbursements
HELP
Please check the transaction type being filed (Original, Modify or Add). Separate schedules must be filed for each transaction type.
Original
Modify Original Schedule Filed (Only submitted with an Amended Return)
Add New Schedule Information (Only submitted with an Amended Return)
Company Name
License Number
Reporting Period
Instructions: Either circle the appropriate schedule type and product type you are reporting on this form, or if you wish to schedule several different types on this
single form, record the appropriate product and schedule type for each disbursement listed below.
Disbursement Schedule Types
Product Types
065 – Gasoline
142 – Kerosene (clear)
5 – Gallons delivered with the tax collected
072 – Kerosene (dyed)
145 – Kerosene Low Sulfur (clear)
6a – Gallons sold exempt of taxes because customer is a licensed exporter
073 – Kerosene Low Sulfur (dyed)
147 – Kerosene High Sulfur (clear)
6b – Gallons sold exempt of taxes because customer is a licensed blender
074 – Kerosene High Sulfur (dyed)
160 – Undyed Diesel Fuel
6c – Gallons sold exempt of taxes because customer is a licensed importer
123 – Alcohol
228 – Dyed Diesel Fuel
6d – Gallons sold exempt of taxes because customer is a licensed supplier
124 – Gasohol
243 – Methanol
6e – Gallons sold exempt of taxes because customer is a licensed LPG vendor
125 – Aviation Gasoline (AVGAS)
284 – Biodiesel (clear)
7 – Gallons exported out-of-state to the state of _______________________
130 – Jet Fuel
*092 – Other (Please list __________)
8 – Gallons sold to U.S. government (tax-exempt)
10 – Gallons sold to other tax-exempt entities
4
1
2
5
6
7
8
9
3
Product
Point of
Schedule
Carrier
Carrier
Sold
Purchaser’s
Date
Manifest
Gross
Mode
Type
Type
Name
FEIN
Origin
Destination
To
FEIN
Shipped
Number
Gallons
Total Gross Gallons
0
MF-310

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