Form Mf-184 - Schedule Iii - Biodiesel Sales To Retail Stations, Unlicensed Distributors/importers/exporters, End Consumers

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KANSAS DEPARTMENT OF REVENUE
CUSTOMER RELATIONS
915 SW HARRISON ST.
TOPEKA, KANSAS 66625-8000
Phone Number: (785) 368-8222
FAX (785) 296-4993
SCHEDULE III
BIODIESEL SALES TO RETAIL STATIONS, UNLICENSED DISTRIBUTORS/IMPORTERS/EXPORTERS, END CONSUMERS
COMPANY NAME
FEIN NO.
REPORTING PERIOD
PC – Product Code
284 – Undyed Biodiesel
290 – Dyed Biodiesel
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
NAME OF
CARRIER
POINT OF:
SOLD
DATE
DOCUMENT
GROSS
CARRIER
FEIN
MODE
ORIGIN
DESTINATION
TO
SHIPPED
NUMBER
GALLONS
PC
CITY, STATE
CITY,STATE
TOTAL
SEE INSTRUCTIONS ON REVERSE
MF-184 (Rev. 2/07)

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