Form Rfm-10 - Combined Motor Fuel Tax Return - State Of New Jersey Division Of Revenue Page 11

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Division use only — DLN Stamp
Division use only — Date Stamp
Period
mm
yyyy
Attach to Form RMF-10
Pursuant to NJSA 54:39-101 et seq
01-2011
Consumer's Tax Liability
RMF516
Taxpayer Name
Taxpayer ID Number
Date
Seller Name & Address
Product
Gallons
Rate
Tax Liability
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Total Tax Liability
Report this amount on RMF-10, Line 16

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