Form Smf - 10 Draft - Supplier Of Motor Fuels Report Page 5
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19Division use only — DLN Stamp
Division use only — Date Stamp
Period
Attach to:
mm
yyyy
Form SMF-100
Supplier Gasoline Return
Pursuant to NJSA 54:39-101 et seq
10-2010
Schedule of Other Exempt Gasoline Sales
SMF103
Organize data by Customer ID #and include a summary of gallons per Customer. Use additional SMF103's if needed.
Licensee
Licensee #
Product
Date Customer ID #
Customer
Carrier ID #
Exemption
Gallons
Code
Document #
Destination City
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Total gallons this page
Total Gallons for SMF103
page
of
Report this amount on
Line 3, Form SMF100
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