Form Smf-10 - Supplier Of Motor Fuels Report Page 27
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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 Exempt Aviation Kerosene Sales - Licensed Aviation Fuel Dealer*
SMF212C
Page
of
Supplier
Supplier FID #
*Exempt from the $0.135 per gallon gasoline tax and the $0.02 AST
Date
Customer
Carrier
Carrier
Terminal Point of Point of
Document
Net
Gross
Invoiced
Customer
Mode
Shipped
FID Number
Name
FID Number
Code
Origin
Dest.
Number
Gallons
Gallons
Gallons
Page Total
Schedule Total (report this amount on line 4, form SMF 400)
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