Form 3748 - Importer Schedule Of Receipts
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Michigan Department of Treasury
401-XR
3748 (Rev. 9-06)
Importer Schedule of Receipts
Product Code (see instructions on page 2)
This form is issued under authority of P.A. 403 of 2000, as amended. Filing is mandatory.
Company Name
Account Number (FEIN or TR)
License Number
Report Period (MM/YYYY)
Schedule Types: Check the appropriate box. See page 2 for schedule description. Do not combine schedule types or product codes.
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2C
If Importer Schedules 2C or 3B are checked, indicate State/Province/Country of Origin __________________________
A separate schedule must be filed for each state/province/country.
3B
Report Whole Gallons Only
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(1)
(2)
(3)
Point of
Purchased or Acquired From Supply Source
Date
Document
Gallons
Carrier Name
Carrier FEIN
Mode
Received
Number
Origin
Dest.
Name
FEIN
Net
Gross
N/A
Total
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