Form Dmf -10 - Distributor Of Motor Fuels Tax Return Page 6

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Division 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 Exempt Gasoline Purchased
DMF106
Organize data by Seller ID#and include a summary of gallons per Seller. Use additional DMF106's if needed.
Licensee
Licensee #
Destination
Product
Date Seller ID#
Seller
Carrier ID #
Exemption
Gallons
Code
Document #
City
1
2
3
4
5
6
7
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Total gallons this page
Total Gallons for DMF106
page
of
Report this amount on
Form DMF-10, Line 6, Column A

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