Form L-2116 - Occasional Importer Schedule Of Disbursements

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L-2116
1350
STATE OF SOUTH CAROLINA
DEPARTMENT OF REVENUE
(Rev. 10/5/11)
OCCASIONAL IMPORTER SCHEDULE OF DISBURSEMENTS
4204
Importer Name
License Number
FEIN
Month/Year
SCHEDULE TYPE (CIRCLE ONE)
PRODUCT TYPE (CIRCLE ONE AND ENTER % WHEN APPLICABLE)
5
065
Gasoline
072
Dyed Kerosene
D00
Dyed Biodiesel (100%)
Gallons Delivered Subject to User Fee
6-F
122
Blend Components
130
Jet Fuel
B01-B99
Undyed Biodiesel
Gallons Sold - Dyed Diesel and Heating
125
Aviation Gasoline
142
Kerosene
Blend (%
)
Fuel
8
E00
Fuel Grade Ethanol (100%)
167
Low Sulfur Undyed Diesel
D01-D99
Dyed Biodiesel
Gallons Sold To The US Government
9-C
E01-E99
Gasohol (%
)
226
High Sulfur Dyed Diesel
Blend (%
)
Gallons Sold To SC Department of
227
Low Sulfur Dyed Diesel
092
Other/Substitute
Education School Bus Program
B00
Undyed Biodiesel (100%)
Fuel (
)
10
Gallons Sold - Other Exempt Sales
1
2
3
4
5
6
7
8
9
Carrier
Carrier
Purchaser
Purchaser
Date
Document
Billed
Name
FEIN
Mode
Destination
Name
FEIN
Shipped
Number
Gallons

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