Form 4429 - Retail Marine Diesel Dealer Schedule Of Disbursement
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2Michigan Department of Treasury
4429 (Rev. 9-08)
Retail Marine Diesel Dealer Schedule of Disbursement
Product Code (see instructions on Page 2)
This form is issued under authority of P.A. 403 of 2000, as amended. Filing is mandatory.
Company Name
Account Number (FEIN or TR)
License Number
Report Period (MM/CCYY)
Schedule Types: Check the appropriate box. See page 2 for schedule descriptions. Do not combine schedule types or product codes.
6F
9
8
Report Whole Gallons Only
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
Gallons
Point of
Sold to Purchaser
Date
Document
Carrier Name
Carrier FEIN
Mode
Shipped
Number
N/A
Origin
Destination
Name
FEIN
N/A
Gross
TOTAL
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Parent category: Financial