Schedule Mf-1a - Tax Paid Gasoline Receipts Schedule - State Of Connecticut - Department Of Revenue Services
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1STATE OF CONNECTICUT
SCHEDULE MF-1A
DEPARTMENT OF REVENUE SERVICES
TAX PAID GASOLINE RECEIPTS SCHEDULE
(REV. 03/00)
Month of
The purpose of this schedule is to provide
Use this schedule to prepare
specific information on your gasoline
Schedules 2, 3, 4, and 5 for
purchases.
Form O-MF1 51.
Name of Licensed Distributor
Schedule Number
Prepare a separate schedule for
each schedule required.
Connecticut Tax Registration Number
Title of Schedule
Insert schedule number and title
in the spaces provided.
Point of
Whole Gallons
Date
Name of Supplier
Method of Delivery
Shipment
Delivery
Connecticut Taxes Paid
(1)
(2)
(3)
(4)
(5)
*(6)
TOTAL GALLONS
*Gallons reported in Column 6 must be deducted on Line 21 of Tax-Paid Purchases on Form O-MF1 51, Gasoline Tax Return.
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