Form Com/mft-049 - Motor Fuel Tax Schedule Of Disbursements
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1
2comptroller of maryland
p.o. Box 1751
MATT regulatory division
annapolis, md 21401-1751
410-260-7138
motor fuel tax
1-888-784-0141
motor fuel tax schedule of disbursements
company name
license #
fein #
schedule type & product code
month/year
types of schedule
product codes
5
Gallons deliVered, taX collected
054 - propane (lpG)
142 - undyed kerosene
6
Gallons deliVered to licensed motor fuel distriButors, taX not collected
065 - Gasoline
150 - #1 fuel oil
7
Gallons eXported to the state of ______________ _______________ _ _____ ____
072 - dyed kerosene
152 - heatinG oil
8
Gallons deliVered to u.s. GoVernment, taX eXempt
092 - other
160 - undyed diesel
9
Gallons deliVered to state & local GoVernment, taX eXempt
124 - Gasohol ethanol 170 - biodiesel - undyed
10
Gallons deliVered to other eXempt entities
Blend
224 - compressed natural Gas (cnG)
11
u.s. GoVernment credit card sales
125 - aViation Gas
225 - liquid natural Gas (lnG)
12
prior months adJustments
130 - Jet fuel
228 - dyed diesel
241- ethanol
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
carrier
carrier
mode
point of
sold
date
document
Billed
other
purchaser FEIN/
name
fein
oriGin
destination
to
sold
numBer
Gallons
Gallons
eXemption numBer
total
XXXXX
COM/MFT-049 Rev. 07/07
see instructions on reVerse side
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