Form Smf - 10 Draft - Supplier Of Motor Fuels Report
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19Division use only — DLN Stamp
Division use only — Date Stamp
Send Report and all Schedules to:
Month
Year
Revenue Processing Center
PO Box 243
Pursuant to NJSA 54:39-101 et seq
Trenton, NJ 08646-0243
10-2010
Supplier of Motor Fuels Report
SMF - 10
Taxpayer
Taxpayer ID #
Address
Check Type of
Motor Fuels Supplier
Permissive Motor Fuels Supplier
License Held
Net tax due for Gasoline
$
1
From Form SMF100
Net Tax due for Diesel & Kerosene
$
2
From Form SMF200
Net Tax due for LPG
$
3
From Form SMF300
Net Airport Safety Tax Due
$
4
From Form SMF400
Total Tax Due
$
5
Penalty and Interest Due
$
6
Total Amount Due
$
7
EFT Confirmation #
By signing, I declare under the penalties provided by the law that this return (including any accompanying
schedules and statements) has been examined by me and to the best of my knowledge and belief is a true,
correct, and complete return.
If the return is prepared by a person other than the Taxpayer, this declaration is based on all the information
relating to the matters required to be reported in the return of which he has knowledge.
Signature of individual Filing this Report
Company
Date
Signature of Taxpayer or Authorized Officer
Title
Date
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