Form Mvf-1b(10a) - Motor Vehicle Fuels Tax Export Schedule

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STATE OF CONNECTICUT
DEPARTMENT OF REVENUE SERVICES
(REV. 01/00)
MVF-1B(10A)
Month of
Connecticut distributors making
MOTOR VEHICLE FUELS TAX
sales in this state to out-of-state
EXPORT SCHEDULE
distributors licensed in
Name of Licensed Distributor
Name of Licensed Exporter
Connecticut as gasoline
exporters, must complete this
schedule.
Connecticut Tax Registration Number
Date
Point of Pick Up
State of Destination
Gallons
(Round off to the
nearest gallon)
(1)
(2)
(3)
(4)
TOTAL GALLONS
(Transfer this total to line 10 of Form O-MF1 52, Motor Vehicle Fuels Tax Return)
This schedule must be submitted in duplicate. Prepare a separate set for licensed exporter.

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