Form L-2176 - Motor Fuel Transporter Monthly Return printable pdf download

Form L-2176 - Motor Fuel Transporter Monthly Return

STATE OF SOUTH CAROLINA

1350

L-2176

DEPARTMENT OF REVENUE

MOTOR FUEL TRANSPORTER MONTHLY RETURN

(Rev. 10/1/14)

4330

Mail to: SC Department of Revenue, Motor Fuel, Columbia, SC 29214-0132

NAME AND ADDRESS

Office Use Only

License Number

FEIN

Month/Year

34-2103

Gallon Information

1. Total of all deliveries of fuels from a point inside South Carolina to a point outside

South Carolina (Schedule 14A)

2. Total of all deliveries of fuels from a point outside South Carolina to a point inside

South Carolina (Schedule 14B)

3. Total of all deliveries of fuels between two points in South Carolina (Schedule

14C)

4. TOTAL GALLONS OF MOTOR FUEL TRANSPORTED (Add Lines 1, 2 and 3)

CERTIFICATION

Name of Contact Person:

Phone Number:

Signature and Title:

Date:

I certify that to the best of my knowledge, this return is accurate and complete.

Email Address:

Returns are due by the 22nd of the Next Month

Questions:

Email: motfuellic@dor.sc.gov

Telephone Number (803) 896-1990

Fax Number (803) 896-1779

43301027

Form L-2176 - Motor Fuel Transporter Monthly Return