Form Mfa-10 - Floorstock Tax Return Page 3

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Division use only - DLN Stamp
Division use only Date Stamp
Remit with
Form MFA-10 and send to
Revenue Processing Center
Pursuant to NJSA 54:39-150
PO Box 243, Trenton, NJ 08646-0243
10-2010
FloorStock Tax Return - Diesel & Kerosene Inventories
MFA201
Licensee
Tax ID#
Product
Location of Storage Tank(s)
Taxable Gallons in Inventory
(Insert Code or
Description)
Street Address
1
City, State Zip
Street Address
2
City, State Zip
Street Address
3
City, State Zip
Street Address
4
City, State Zip
Street Address
5
City, State Zip
Street Address
6
City, State Zip
Street Address
7
City, State Zip
Street Address
8
City, State Zip
Street Address
9
City, State Zip
Street Address
10
City, State Zip
if more than 10 locations, use additional MFA201's
Total for this Page
Insert this amount on line
Total for this Schedule
2 of Form MFA-10
Total MFA201s used
Product Codes
Diesel Fuel — Undyed
160
Biodiesel Fuel - Dyed
171
Jet Fuel
130
Diesel Fuel — Dyed
228
Kerosene — Undyed
142
Biodiesel Fuel — Undyed
170
Kerosene — Dyed
042

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