Form 3784 (302-Sd) - Supplier Schedule Of Disbursements - 2006 Page 2
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23784, Page 2
302-SD
Instructions for Form 3784, Supplier Schedule of Disbursements
General Instructions -
Tax is due upon removal, importation or other taxable event and must be included in the report for the month in which the transaction takes place.
Schedule Types - Check the appropriate box on page 1.
5
Gallons of taxable fuel removed, sold or imported. Do not include gallons reported on other disbursement schedules.
5C
Gallons of aviation fuel sold to Aviation Fuel Registrants for resale.
5F
Gallons of dyed diesel/dyed biodiesel fuel sold/used for taxable purposes with Michigan tax collected.
6F
Gallons of dyed diesel/dyed biodiesel fuel sold or removed for tax-exempt purposes.
6P
Gallons sold to licensed suppliers for immediate delivery outside Michigan, with Michigan tax not collected.
6X
Gallons delivered to another supplier or permissive suppliers on exchange agreement above the terminal rack.
7A
Gallons exported by supplier or sold for export - Destination state tax collected or accrued. (Michigan tax was not collected.) Attach separate schedule for each
state/province/country.
7B
Gallons sold for export with Michigan tax collected. Attach separate schedule for each state/province/country. Submit two copies of each.
8
Gallons sold tax-free to U.S. government located in Michigan.
9
Gallons sold tax-free to state and/or local government in Michigan, including public schools. Gasoline, ethanol blends, undyed diesel, undyed biodiesel, and dyed
biodiesel only.
10B
Gallons of Foreign Trade Zone aviation fuel disbursed.
10F
Gallons delivered into tax-free terminal storage. Must be a qualified Michigan terminal.
10G
Gallons sold tax-free to non-profit, private, parochial or denominational school, college or university, used in buses for transportation of students for authorized functions.
10M
Gallons of gasoline and ethanol blends sold tax-free to fuel feedstock users.
13C
Gallons for tax exempt credit card sales made to the United States Government.
13F
Gallons in which the tax has been deemed uncollectible.
13H
Gallons for tax exempt credit card sales made to the State and Local government.
Product Codes - Enter the appropriate code on page 1. See the Supplier Return instructions or Treasury's Web site for a list of product codes.
Column Instructions
Column (1) & (2):
Carrier - Enter the name and Federal Employer ID Number (FEIN) of the company that transports the product.
Column (3):
Mode of Transport - Enter the mode of transport. Use one of the following:
J = Truck
R = Rail
B = Barge
PL = Pipeline
S = Ship (Great Lakes or ocean marine vessel)
RT= Removal from terminal (other than by truck or rail for sale or consumption)
Column (4) & (5):
Point of Origin/Destination - Enter the location the product was transported from/to. When received into or from a terminal, the Terminal Control
Number (TCN) must be used.
Column (6) & (7):
Sold to - Enter name of purchaser and FEIN.
Column (8):
Date Shipped - Enter the date the product was shipped.
Column (9):
Document Number - Enter the bill of lading number from the manifest issued at the terminal when product is removed. In the case
of pipeline or barge movements, use the pipeline or barge ticket number. In the case of bulk plant removals use the withdrawal bill of
lading number.
Column (10):
Net Gallons - Enter the net amount of gallons disbursed.
Column (11):
Gross Gallons - Enter the gross amount of gallons disbursed.
Column (12):
Billed Gallons - Enter the number of gallons to be billed to the customer.
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