Form L-2104 - Bonded Importer Schedule Of Disbursement (Page 3 of 3) in pdf

Form L-2104 - Bonded Importer Schedule Of Disbursement Page 3

BONDED IMPORTER SCHEDULE OF DISBURSEMENTS

INSTRUCTIONS FOR L-2104

Please note that the specific product code for biodiesel blends and gasohol must be indicated, i.e. E10-B20.

Complete a separate schedule for each schedule type and product type.

COLUMN 1 & 2: Carrier -

Enter the name of the company that transported the product from the terminal or bulk plant

and the federal identification number if available.

COLUMN 3:

Mode of Transport - Enter the mode of transport from the terminal. Use one of the following:

Truck

Pipeline

Ship

Stock Transfer

Book Adjustment

Barge

Rail

COLUMN 4:

Point of Destination - Enter the name of the state of destination (abbreviations are acceptable).

COLUMN 5 & 6: Purchaser - Enter the name of the company that purchased the product and the federal identification

number if available.

COLUMN 7:

Date Shipped - Enter the date the product was shipped from the terminal.

COLUMN 8:

Document Number - Enter the identifying number from the document issued at the terminal or bulk

plant where the product was removed for import into South Carolina.

COLUMN 9:

Billed Gallons - Enter the number of gallons billed to the customer. The total from column 9 will be

the amount you need to enter on the proper line on the user fee return.

44601011

L-2104 I

(Rev. 9/8/11) 4460

Form L-2104 - Bonded Importer Schedule Of Disbursement Page 3