Form L-2115 - Fuel Blender Return Page 4
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41350
1350
STATE OF SOUTH CAROLINA
DEPARTMENT OF REVENUE
L-2197
Schedule B
(Rev. 7/7/11)
Schedule of Gallons Purchased
4353
Name
License Number
FEIN
Month/Year
PRODUCT TYPE (CHECK ONE)
Use a separate schedule for each product type
E00 Fuel Grade Ethanol (100%)
B00 Undyed Biodiesel (100%)
D00 Dyed Biodiesel (100%)
SCHEDULE OF GALLONS PURCHASED
INFORMATION ONLY
NOT USED FOR USER FEE CALCULATION
Purchased From
Gallons
INSTRUCTIONS FOR SCHEDULE B
Gallons reported on Schedule B are not used in the calculation of the motor fuel user fee, inspection
fee or environmental fee.
Complete a separate schedule for each product code.
PURCHASE INFORMATION - Enter the name of the company from which the product was purchased
and the total gallons from each company.
43531037
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