Form Mfa-10 - Floorstock Tax Return Page 4
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5Division 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 - LPG Inventories
MFA301
Licensee
Tax ID #
Location of Storage Tank(s)
Taxable Gallons in Inventory
Product
Street Address
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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
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City, State Zip
Street Address
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City, State Zip
Street Address
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City, State Zip
Street Address
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City, State Zip
Street Address
10
City, State Zip
if more than 10 locations, use additional MFA301's
Total for this Page
Insert this amount on line
Total for this Schedule
3 of Form MFA-10
Total MFA301s used
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Parent category: Financial