Form 3724 - Transporter Quarterly Report
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3Michigan Department of Treasury
Reset Form
800-TRN
3724 (Rev. 09-12)
Transporter Quarterly Report
This form is issued under authority of P.A. 403 of 2000. Filing is mandatory.
This report is due
2. Account Number (FEIN or TR)
2A. License Number
3. Report Period (MM/YYYY)
1. Company Name and Mailing Address
4. Contact Person Name
5. Telephone Number
6. Fax Number
7. E-mail Address
Gross Gallons - Report Whole Gallons Only
This report must be filed by all transporters for
shipments into and out of the State of Michigan.
Column 1
Column 2
Column 3
Column 4
Column 5
Column 6
Complete and attach schedules.
Gasoline
Aviation
Jet Fuel
Undyed
Dyed
Other Products
Gasoline
Diesel Fuel
Diesel Fuel
See page 2 for instructions.
8. Total gallons of petroleum product
transported from Michigan to another state.
Enter total from attached Schedule(s) 14A.
9. Total gallons of petroleum product
transported from out-of-state locations into
Michigan. Enter total from attached
Schedule(s) 14B.
10. Total gallons diverted to Michigan after
having been pulled for destination in another
state (Schedule 11A).
11. Total gallons diverted from Michigan after
having been pulled for destination in
Michigan (Schedule 11B).
12. Total gallons of petroleum product
transported. Add lines 8 through 11.
I declare under penalty of perjury, that I have examined this report, and to the best of my knowledge and belief, it is correct and complete.
Do not discuss my return with my preparer.
I authorize Treasury to discuss my return and attachments with my preparer.
Authorized Signature
Signature of Preparer
Preparer FEIN
Printed Name
Date
Printed Name
Date
Title
Telephone Number
Address
Telephone Number
MAIL REPORT TO: Michigan Department of Treasury, Special Taxes Division, P.O Box 30474, Lansing, Michigan 48909-7974
Questions ? - Please call (517) 636-4600
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