Schedule Mf-72 - Motor Fuel Refund Bulk Fuel Disbursements Schedule
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2MOTOR FUEL REFUND BULK FUEL DISBURSEMENTS SCHEDULE
Purpose:
Use this Schedule to record individual bulk fuel disbursements for the month.
Instructions:
Follow the instructions on back of this Schedule. File and maintain completed Schedule
for four years.
COMPANY/ INDIVDUAL INFORMATION
NAME
ADDRESS
CITY
STATE
ZIP CODE
BULK FUEL TANK INFORMATION
MONTH
YEAR
BULK TANK #
FUEL TYPE
REFUND PERMIT #
REMARKS
BULK FUEL DISBURSEMENT INFORMATION
GALLONS USED
GALLONS
TAG # /
BEGINNING
GALLONS USED
IN NON-
USED IN OFF
ENDING
DATE
EQUIP
METER
IN HIGHWAY
HIGHWAY
ROAD
METER
(mm/dd/yy)
DESECRIPTION
READING
VEHICLES
VEHICLES
EQUIPMENT
READING
TOTALGALLONS:
MF-72 (Rev 05-09)
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Parent category: Financial