Form Smf - 10 Draft - Supplier Of Motor Fuels Report Page 17
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19Division use only — DLN Stamp
Division use only — Date Stamp
Period
Attach to:
mm
yyyy
Form SMF200
Supplier Diesel & Kerosene Return
Pursuant to NJSA 54:39-101 et seq
10-2010
Schedule Diesel & Kerosene Purchased with Tax Included
SMF208
Organize data by Customer ID #and include a summary of gallons per Customer. Use additional SMF208's if needed.
Licensee
Licensee #
Product
Tax
Tax
Date Customer ID #
Customer
Carrier ID#
Carrier
Code
Gallons
Rate
Paid
BOL #
Destination City
1
13½¢
2
13½¢
3
13½¢
4
13½¢
5
13½¢
6
13½¢
7
13½¢
8
13½¢
9
13½¢
10
13½¢
11
13½¢
12
13½¢
13
13½¢
14
13½¢
15
13½¢
16
13½¢
17
13½¢
18
13½¢
19
13½¢
20
13½¢
21
13½¢
22
13½¢
23
13½¢
24
13½¢
25
13½¢
26
13½¢
27
13½¢
28
13½¢
29
13½¢
30
13½¢
Total Tax Paid From This Page
Total Tax paid on SMF208
page
of
Report this Amount on
Line 11, Form SMF200
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