Form Mf-D - Motor Vehicle Fuels Tax Schedule Of Disbursements
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1
2Department of Revenue Services
Form MF-D
PO Box 5031
Motor Vehicle Fuels Tax Schedule of Disbursements
Hartford CT 06102-5031
(Rev. 05/09)
Name of Licensed Distributor
CT Tax Registration Number
Federal Employer ID Number (FEIN) Schedule Type
Product Code
Month
Types of Schedule
Product Codes
5
Taxable sales to licensed distributors
054
Propane
150
#1 fuel oil
6
Nontaxable sales and transfers to licensed distributors
065
Gasoline
152
Heating oil
7
Sales and transfers out of Connecticut and sales in Connecticut for immediate export
072
Dyed kerosene
160
Undyed diesel
8
Gallons sold to U.S. government tax-exempt
092
Other
224
Compressed natural gas (CNG)
9
Gallons delivered to state and local goverment tax-exempt
125
Aviation gas
225
Liquid natural gas (LNG)
10
Nontaxable sales to farmers, other exempt purchases, and nontaxable use
130
Jet fuel
228
Dyed diesel
13
Dealer sales to govermental entities
139
Gasohol 10%
241
Ethanol
142
Undyed kerosene
284
Biodiesel, undyed
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Carrier
Carrier
Mode
Point of
Sold
Purchaser
Date
Document
Billed
Name
FEIN
Origin
Destination
to
FEIN
Sold
Number
Whole Gallons
Total
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