Form 3767 (Schedule 1) - Retail Marine Diesel Dealer Schedule Of Receipts

Download a blank fillable Form 3767 (Schedule 1) - Retail Marine Diesel Dealer Schedule Of Receipts in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 3767 (Schedule 1) - Retail Marine Diesel Dealer Schedule Of Receipts with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Reset Form

Michigan Department of Treasury

621-DR

3767 (Rev. 9-06)

Schedule 1: Retail Marine Diesel Dealer Schedule of Receipts

This form is issued under authority of P.A. 403 of 2000. Filing is mandatory.

Product Code (see instructions on page 2)

Company Name

Account Number (FEIN or TR)

License Number

Report Period (MM/CCYY)

A separate schedule must be submitted for each product code. See the Retail Marine Diesel Dealer Return Instructions or Treasury's Web site for a list of product codes.

Report Whole Gallons Only

(No Fractions or Decimal Places)

(9)

(10)

(11)

(1)

(2)

(3)

(4)

(5)

(6)

(7)