Schedule Mf-73 - Motor Fuel Refund Bulk Fuel Inventory/reconciliation

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MOTOR FUEL REFUND BULK FUEL INVENTORY/RECONCILIATION SCHEDULE
Purpose:
Use this Schedule to record bulk fuel inventory/reconciliation.
Instructions:
Follow the instructions on back of this Schedule. File and maintain completed Schedule for four years.
NAME AND ADDRESS INFORMATION
NAME
ADDRESS
CITY
STATE
ZIP CODE
BULK FUEL TANK INFORMATION
YEAR
BULK TANK #
TANK CAPACITY
FUEL TYPE
REFUND PERMIT #
REMARKS
BULK FUEL INVENTORY/RECONCILIATION INFORMATION
DISBURSEMENTS
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
MONTHLY
GALLONS
GALLONS
GALLONS
TOTAL
END
AVAILABLE
USED IN
USED IN
USED IN OFF
GALLONS
ENDING
DATE
BEGINNING
BULK FUEL
GALLONS
HIGHWAY
NON/HIGHWAY
ROAD
DISBURSED
INVENTORY
(mm/dd/yy)
INVENTORY
PURCHASES
( B + C )
VEHICLES
VEHILCES
EQUIPMENT
( E + F + G )
( D - H )
TOTAL
GALLONS:
MF-73 (Rev 05-09)

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