Form Ex-2 - Monthly Exporter'S Report Of Receipts And Disbursements

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EX-2
Department of
Rev. 4/09
Taxation
Reset Form
P.O. Box 530
Columbus, OH 43216-0530
Monthly Exporter’s Report of Receipts and Disbursements
Complete and attach enclosed schedules.
Exporter name
FEIN
Month/year
Street
City
State
ZIP
Check here if new address
Exporter Type A
Exporter Type B
(Check one)
1. Total gallons of all fuel received during month ................................................................................. 1.
2. Total gallons of all fuel exported from Ohio during month ................................................................ 2.
I declare under penalties of perjury that this report (including any accompanying schedules and statements) has been
examined by me and to the best of my knowledge and belief is a true, correct and complete report.
Authorized signature
Title
Telephone number
E-mail
Date
This report must be filed with the Ohio Department of Taxation, Motor Fuel Tax Compliance Unit, P.O. Box 530, Columbus, OH
43216-0530 on or before the last day of each month following the report period. Telephone inquiries (855) 466-3921; Fax (614)
752-8644.

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