Form 3788 - Carrier Schedule Of Deliveries

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Michigan Department of Treasury
203-PD
3788 (Rev. 9-06)
Reset Form
Carrier Schedule of Deliveries
Product Code (see instructions on page 2)
This form is issued under authority of P.A. 403 of 2000. Filing is mandatory.
Company Name
Account Number (FEIN or TR)
License Number
Report Period (MM/YYYY)
INSTRUCTIONS: Schedule Types: Check the appropriate box below. Use separate sheet for each schedule type and product code. Sort entries by each
terminal "Delivered To" (Columns 7/9) and provide subtotals for each terminal in Columns 12 and 13.
Schedule 14A - Deliveries of petroleum product from Michigan transported to locations outside of Michigan (Exports).
Schedule 14B - Deliveries of petroleum product from out-of-state terminals and refineries transported into Michigan (Imports).
Schedule 14C - Deliveries of petroleum product from Michigan terminals and refineries transported elsewhere in Michigan (Intrastate).
(1) (2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
Hired By
Origin
Date
Ticket
Net
Gross
Seller
Delivered To
Mode
TCN
Delivered
Number
Gallons
Gallons
Name FE
TCN or City & State
Company Name
FEIN
Name
FEIN
TOTAL

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