Form Mf 2-2 - Licensed Dealer'S Schedule Of Disbursements

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MF 2-2
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Rev. 11/08
P.O. Box 530
Columbus, OH 43216-0530
Licensed Dealer’s Schedule of Disbursements
Dealer’s Name
FEIN
Schedule Type
Month/Year
Schedule Type
Product Type (check one)
5 Distributed for taxable use or used taxable
65 Gasoline
226 High sulfur diesel (dyed)
6 Sold tax-free to other dealers
142 Kerosene
227 Low sulfur diesel (dyed)
7 Exported to state of
160 Diesel fuel (clear)
Other products
8 Sold to U.S. government
10 Sold or used for nontaxable use (not applicable for gasoline and clear diesel)
10B Sold for operation of aircraft
(1)
(2)
(3)
(6)
(7)
(8)
(9)
(4)
(11)
Date
State of
Purchaser’s
Document
Gross
Carrier Name
Shipped
Carrier FEIN
Mode
Sold To
FEIN
Number
Destination
Gallons
Total gallons

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