Form 3750 - Schedule Of Diversions

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Michigan Department of Treasury
303-DV
3750 (Rev. 9-06)
Schedule 11
Schedule of Diversion
Use this Schedule to Report all Diversions.
Issued under authority of P.A. 403 of 2000, as amended. Filing is mandatory.
INSTRUCTIONS: Some diversions require payment of tax within three days. See page 2 for instructions. You must
use a separate schedule for diversion to Michigan (11A) and diversions from Michigan (11B) and also for each fuel
Product Code (see Michigan Fuel Product Codes on Treasury's Web site)
product. Check the appropriate box below.
Company Name
Account Number (FEIN or TR)
License Number
Report Period (MM/YYYY)
11A Diversions TO Michigan - Enter the Original Point of Destination in Column 5.
11B Diversions FROM Michigan - Enter the Revised Point of Destination in Column 5.
A separate schedule must be filed for each State/Province/Country.
Report Whole Gallons Only
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(13)
(10)
(11)
(12)
Carrier
Carrier
Point of
Point of Destination
Date
Document
Diversion
Purchaser
Gallons
Name
FEIN
Mode
Origin
Shipped
Number
Number
TCN
City & State
Name
FEIN
Net
Gross
Billed
TOTALS
* For Original Destination and Revised Destination, enter either Terminal Control Number or City and State.

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