Form Mf- 1b - Tax Paid Gasoline Distribution Schedule

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STATE OF CONNECTICUT
MF-1B
DEPARTMENT OF REVENUE SERVICES
Tax Paid Gasoline Distribution Schedule
(REV. 12/00)
Month of
The purpose of this schedule is to provide
information on your taxable sales to licensed
INSTRUCTIONS
distributors.
Name of Licensed Distributor
Schedule Number
Use this schedule to complete
16
Line 16 on Form O-MF1 51,
Gasoline Tax Return .
Connecticut Tax Registration Number
Taxable Sales to
Title of Schedule
Licensed Distributors
Date
Sold To
Method of Delivery
Point of
Whole Gallons
(Round off to the
Shipment
Delivery
nearest gallon)
(1)
(2)
(3)
(4)
(5)
(6)
TOTAL GALLONS
(Transfer this total to Line 16 of Form O-MF1 51, Gasoline Tax Return )

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