Form 4124 - Blender Schedule Of Disbursements Page 2

Download a blank fillable Form 4124 - Blender Schedule Of Disbursements 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 4124 - Blender Schedule Of Disbursements 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.

ADVERTISEMENT

Form 4124, Page 2
Instructions for Form 4124, Blender Schedule of Disbursements
General Instructions -
Tax is due upon removal, importation or other taxable event and must be included in the report for the month in which the transaction takes place.
Schedule Types - Check the appropriate box on page 1.
5
Gallons of taxable fuel removed, sold or imported. Do not include gallons reported on other disbursement schedules.
5C
Gallons of aviation fuel sold to Aviation Fuel Registrants for resale.
5F
Gallons of dyed diesel/dyed biodiesel fuel sold/used for taxable purposes with Michigan tax collected.
5Z
Gallons sold for Racing Fuel - Michigan tax collected.
6F
Gallons of dyed diesel/dyed biodiesel fuel sold or removed for tax-exempt purposes.
6Z
Gallons sold for racing fuel - Michigan tax not collected.
7A
Gallons exported by supplier or sold for export - Destination state tax collected or accrued. (Michigan tax was not collected.) Attach separate schedule for each
state/province/country. Licensed Suppliers and Exporters only.
Gallons sold for export with Michigan tax collected. Attach separate schedule for each state/province/country. Submit two copies of each. Licensed Suppliers and
7B
Exporters only.
Gallons sold tax-free to U.S. government located in Michigan.
8
Gallons sold tax-free to state and/or local government in Michigan, including public schools. Gasoline, ethanol blends, undyed diesel, undyed biodiesel, and dyed
9
biodiesel only. Does not apply to aviation fuel.
Gallons of Foreign Trade Zone aviation fuel disbursed. Licensed Suppliers only.
10F
Gallons sold tax-free to non-profit, private, parochial or denominational school, college or university, used in buses for transportation of students for authorized functions.
10G
Gallons of gasoline, ethanol, or gasoline-ethanol blends sold tax-free to fuel feedstock users.
10M
Product Codes - Enter the appropriate code on page 1. See the Blender Monthly Tax Return instructions or Treasury's Web site for a list of product
codes.
Column Instructions
Column (1) & (2):
Carrier - Enter the name and Federal Employer ID Number (FEIN) of the company that transports the product.
Column (3):
Mode of Transport - Enter the mode of transport. Use one of the following:
J = Truck
R = Rail
B = Barge
S = Ship (Great Lakes or ocean marine vessel)
RT= Removal from terminal (other than by truck or rail for sale or consumption)
Column (4):
Point of Origin - Enter the location from which the product originated.
Column (5)
Point of Desination - Enter the location to which the product was delivered. If delivered into tax-free terminal storage (Schedule 10F), the Terminal
Control Number must be reported.
Column (6) & (7):
Sold to - Enter name of purchaser and FEIN.
Column (8):
Date Shipped - Enter the date the product was shipped.
Column (9):
Document Number - Enter the bill of lading number.
Column (10):
Net Gallons - Enter the net amount of gallons disbursed.
Column (11):
Gross Gallons - Enter the gross amount of gallons disbursed.
Column (12):
Billed Gallons - Enter the number of gallons to be billed to the customer.

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Rpd-41306c - Schedule Of Disbursements Form Rpd-41306c - Schedule Of Disbursements Financial
Form 3784 - Supplier Schedule Of Disbursements Form 3784 - Supplier Schedule Of Disbursements Financial
Form 3749 - Importer Schedule Of Disbursements Form 3749 - Importer Schedule Of Disbursements Financial
Form 81-015 - Schedule Of Disbursements - Supplier, Restricted Supplier, Importer And Blender - Iowa Department Of Revenue And Finance Form 81-015 - Schedule Of Disbursements - Supplier, Restricted Supplier, Importer And Blender - Iowa Department Of Revenue And Finance Financial
Form 81-015a - Schedule Of Disbursements Supplier, Restrictive Supplier, Importer And Blender Form 81-015a - Schedule Of Disbursements Supplier, Restrictive Supplier, Importer And Blender Financial
Form 81-015a - Schedule Of Disbursements Supplier, Restrictive Supplier, Importer And Blender Form 81-015a - Schedule Of Disbursements Supplier, Restrictive Supplier, Importer And Blender Financial
Form 3817 - Blender Schedule Of Receipts Form 3817 - Blender Schedule Of Receipts Financial
Sd E-form 0837 - Uniform Schedule Of Disbursements Sd E-form 0837 - Uniform Schedule Of Disbursements Financial
Schedule B Motor Fuel Tax Multiple Schedule Of Disbursements Form - Louisiana Department Of Revenue Schedule B Motor Fuel Tax Multiple Schedule Of Disbursements Form - Louisiana Department Of Revenue Financial
Form 105-50-a - Fuel Blender - Schedule Of Receipts Form 105-50-a - Fuel Blender - Schedule Of Receipts Financial

Related Categories

Parent category: Financial
Download
Go
Page of 2