Form Dr-309634 Sample - Local Government User Of Diesel Fuel Tax Return - 2015 Page 7

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00004
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DR-309634
R. 01/14
Page 7
Schedule of Disbursements — Local Government User
Schedule Type/Product Type
Company Name
FEIN
Collection Period Ending
(mm/dd/yy)
Schedule Types:
Product Types:
065 Gasoline
226 High Sulfur Diesel Fuel - Dyed
B00 Undyed/Unblended
5A. Gallons Disbursed - Tax Paid
124 Gasohol
227 Low Sulfur Diesel Fuel - Dyed
Biodiesel (B100)
6B. Gallons of Dyed Diesel
167 Low Sulfur Diesel #2/
D00 Dyed Biodiesel (B100)
Disbursed - Florida Tax Unpaid
Undyed/Blended Biodiesel
(B20, B10, B5, B2)
(1)
(2)
(3)
(4)
(5)
Name of Purchaser
Date Sold
Document Number
Gallons Sold
Subtotal

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