Form Sft-3 - Supplier'S Tax Return - Special Fuels Page 3

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Schedule B. Taxable Gallons Consumed

List gallons placed or used in owned or leased registered motor vehicles. Do not include liquid gases. Use separate Schedule LG.

Total gallons

Vehicle identification

End of month

(for each vehicle for the month)

Type (tractor,

Odometer

Engine hour

From own

“Road” purchase

Make

backhoe, etc.)

reading

storage

from others

Total taxable gallons. Enter here and on page 2, line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Schedule C. Taxable Gallons Sold

List gallons sold to others and placed in a registered motor vehicle. Do not include liquid gases. Use separate Schedule LG.

Total gallons

Name(s) of purchaser(s)

Address(es)

for month

Total taxable gallons. Enter here and on page 2, line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Use additional sheets and attach to this return if necessary.