Form Smf-10 - Supplier Of Motor Fuels Report Page 21
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31Division use only — DLN Stamp
Division use only — Date Stamp
Period
Attach to:
mm
yyyy
Form SMF100,
Pursuant to NJSA 54:39-101 et seq
Supplier Schedule of Motor Fuels Tax Due
10-2010
Schedule of Diesel & Kerosene Purchased with Tax Included
SMF208
Supplier
Supplier FID #
Page
of
Date
Seller
Carrier
Carrier
Terminal Point of Point of
Document
Product
Invoiced
Tax
Tax
Seller
Mode
Shipped
FID Number
Name
FID Number
Code
Origin
Dest.
Number
Code
Gallons
Rate
Paid
13.5¢
13.5¢
13.5¢
13.5¢
13.5¢
13.5¢
13.5¢
13.5¢
13.5¢
13.5¢
13.5¢
13.5¢
13.5¢
13.5¢
13.5¢
13.5¢
Page Total
Schedule Total (report this amount on line 15, form SMF 100)
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