Form Sft-3 - Supplier'S Tax Return - Special Fuels Page 4

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Schedule D. Taxable Gallons Sold to User-Sellers (Bulk Sales)

List each sale separately. Do not include liquified gases. Use separate Schedule LG.

Date of

License

Delivery address (if more than one

sale

To whom sold

number

location list each location separately)

Gallons

Total taxable gallons sold. Enter here and on page 2, line 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Schedule E. Nontaxable Gallons Sold or Used.

Do not include liquified gases. Use separate Schedule LG.

May be subject to sales and/or use tax under the provisions of Massachusetts General Laws, Chapters 64H and I.

A. Own use (specify use and/or type of machine using fuel):

Gallons

Total gallons used (Part A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sales to Others.

Complete B and C below.

B. In state (specify intended use — home heating oil, nonregistered equipment, jet fuel, watercraft):

Gallons

Name

Destination

Intended use

Total gallons sold (Part B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

C. Transfers out of state. From attached Schedule E, Part C

Gallons

Total gallons sold (Part C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total nontaxable gallons. Add Parts A, B and C. Enter here and on page 2, line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Use additional sheets and attach to this return if necessary.