Form Dmf -10 - Distributor Of Motor Fuels Tax Return Page 22
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44Division use only — DLN Stamp
Division use only — Date Stamp
Period
Attach to:
mm
yyyy
Form DMF-10, Distributor Return
Pursuant to NJSA 54:39-101 et seq
10-2010
Schedule of Unblended Diesel & Kerosene Blendstocks
DMF219
Organize data by Customer ID #and include a summary of gallons per Customer. Use additional DMF219's if needed.
Licensee
Licensee #
Product
Date Customer ID #
Customer
Carrier ID #
Carrier
Gallons
Code
Document #
Destination City
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Total gallons this page
Total Gallons for DMF219
page
of
Report this amount on
Form DMF-10, Line 19, Column B
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