Form Com/mft-016 - Schedule Of Disbursements
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1
2P.O. Box 1751
MATT Regulatory Division
Comptroller of Maryland
Annapolis, MD 21401-1751
Motor Fuel Tax
410-260-7138
Schedule of Disbursements
1-888-784-0141
Company Name
Account Number
Schedule
Month / Year
C
E
F
Z
To whom sold
Fuel
Product
used for
Code
Gallons
Day
Name
Address
Transfer total of Schedule “C” to Line Number
7 of your worksheet
Total
Transfer total of Schedule “E” to Line Number 10 of your worksheet
See instructions on back
Transfer total of Schedule “F” to Line Number 11 of your worksheet
Transfer total of Schedule “Z” to Line Number 15 of your worksheet
COM/MFT-016
Rev. 7/07
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Parent category: Financial