Form L-2104 - Bonded Importer Schedule Of Disbursement

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STATE OF SOUTH CAROLINA
L-2104
DEPARTMENT OF REVENUE
(Rev. 9/8/11)
BONDED IMPORTER SCHEDULE OF DISBURSEMENT
4192
Importer Name
License Number
FEIN
Month/Year
SCHEDULE TYPE (CIRCLE ONE)
PRODUCT TYPE (CIRCLE ONE AND ENTER % WHEN APPLICABLE)
5-A
Gallons Sold Taxable - Non-eligible Purchaser
065
Gasoline
072
Dyed Kerosene
D00
Dyed Biodiesel (100%)
5-C
Gallons Sold Taxable - Eligible Purchaser
122
Blend Components
130
Jet Fuel
B01-B99
Undyed Biodiesel
6-F
Gallons Sold - Dyed Diesel and Heating Fuel
125
Aviation Gasoline
142
Kerosene
Blend (%
)
8
Gallons Sold to the US Government
E00
Fuel Grade
167
Low Sulfur Undyed Diesel
D01-D99
Dyed Biodiesel
9-C
Gallons Sold to SC Department of Education
Ethanol (100%)
226
High Sulfur Dyed Diesel
Blend (%
)
School Bus Program
E01-E99
Gasohol (%
)
227
Low Sulfur Dyed Diesel
092
Other/Substitute
10
Gallons Sold - Other Exempt Sales
B00
Undyed Biodiesel (100%)
Fuel (
)
1
2
3
4
5
6
7
8
9
Carrier
Carrier
Purchaser
Purchaser
Date
Document
Billed
Name
FEIN
Mode
Destination
Name
FEIN
Shipped
Number
Gallons

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