Carrier/warehouser Monthly Report Of Petroleum Products Received, Stored Or Delivered In Alabama - Alabama Department Of Revenue

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A
D
R
SUBT: MFC
LABAMA
EPARTMENT OF
EVENUE
8/11
Reset
B
& L
T
D
USINESS
ICENSE
AX
IVISION
M
F
S
OTOR
UELS
ECTION
P. O. Box 327540 • Montgomery, AL 36132-7540 • (334) 242-9608
Carrier/Warehouser Monthly Report of Petroleum Products Received, Stored or Delivered in Alabama
COMPANY NAME
MONTH OF_____________________________________________________, 20______
PRESENT ADDRESS (Number and street or rural route)
IMPORTANT: See reverse side of report for
instructions before completing! This report
FEIN / SOCIAL SECURITY NO. _____________________________________________
is due the 15th day of the month following
CITY
STATE
ZIP
the month of activity.
TELEPHONE NO. (__________) ____________________________________________
BUSINESS CLASSIFICATION (Check only one)
Pipeline
Truck
Railroad
Marine
Warehouse
CONTACT PERSON ______________________________________________________
1
2
3
4
5
6
7
NAME OF
CONSIGNOR & ORIGIN
CONSIGNEE & DESTINATION
DOCUMENT DATE
DOCUMENT NUMBER
PETROLEUM PRODUCT
GALLONS
POUNDS / BARRELS
OR SUBSTITUTE
CONSIGNOR’S NAME:
CONSIGNEE’S NAME:
ADDRESS
ADDRESS
CITY
STATE
CITY
STATE
ORIGIN OF SHIPMENT:
DESTINATION OF SHIPMENT:
CITY
STATE
CITY
STATE
CONSIGNOR’S NAME:
CONSIGNEE’S NAME:
ADDRESS
ADDRESS
CITY
STATE
CITY
STATE
ORIGIN OF SHIPMENT:
DESTINATION OF SHIPMENT:
CITY
STATE
CITY
STATE
CONSIGNOR’S NAME:
CONSIGNEE’S NAME:
ADDRESS
ADDRESS
CITY
STATE
CITY
STATE
ORIGIN OF SHIPMENT:
DESTINATION OF SHIPMENT:
CITY
STATE
CITY
STATE
CONSIGNOR’S NAME:
CONSIGNEE’S NAME:
ADDRESS
ADDRESS
CITY
STATE
CITY
STATE
ORIGIN OF SHIPMENT:
DESTINATION OF SHIPMENT:
CITY
STATE
CITY
STATE
SUBTOTAL (Page Total) . . . . . . . . . . . . .
NOTE: ALL PREVIOUS SUBT: MFC FORMS ARE OBSOLETE AND SHOULD BE DESTROYED.
GRAND TOTAL . . . . . . . . . . . . . . . . . . . . .
Page Number ____________ of ____________

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