Form 3749 Form 402-xd, Importer Schedule of Disbursements - Michigan

Form 3749 is a Michigan Department of Treasury form also known as the "Form 402-xd - Importer Schedule Of Disbursements". The latest edition of the form was released in August 1, 2008 and is available for digital filing.

Download a fillable PDF version of the Form 3749 down below or find it on Michigan Department of Treasury Forms website.

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Michigan Department of Treasury
402-XD
3749 (Rev. 8-08)
Importer Schedule of Disbursements
Product Code (see instructions on page 2)
This form is issued under authority of P.A. 403 of 2000, as amended. Filing is mandatory.
Company Name
Account Number (FEIN or TR)
License Number
Report Period (MM/YYYY)
Schedule Types: Check the appropriate box. Do not combine schedule or product types.
5
5C
5F
5Z
6F
6Z
8
9
10G
10M
Report Whole Gallons Only
(4)
(5)
(6)
(9)
(10)
(11)
(7)
(8)
(1)
(2)
(3)
Point of
Sold To/Purchaser
Gallons
Date
Document
Carrier Name
Carrier FEIN
Mode
Shipped
Number
Origin
Dest.
Name
FEIN
Net
Gross
Billed
TOTALS
www.michigan.gov/treasury
Reset Form
Michigan Department of Treasury
402-XD
3749 (Rev. 8-08)
Importer Schedule of Disbursements
Product Code (see instructions on page 2)
This form is issued under authority of P.A. 403 of 2000, as amended. Filing is mandatory.
Company Name
Account Number (FEIN or TR)
License Number
Report Period (MM/YYYY)
Schedule Types: Check the appropriate box. Do not combine schedule or product types.
5
5C
5F
5Z
6F
6Z
8
9
10G
10M
Report Whole Gallons Only
(4)
(5)
(6)
(9)
(10)
(11)
(7)
(8)
(1)
(2)
(3)
Point of
Sold To/Purchaser
Gallons
Date
Document
Carrier Name
Carrier FEIN
Mode
Shipped
Number
Origin
Dest.
Name
FEIN
Net
Gross
Billed
TOTALS
www.michigan.gov/treasury
3749, Page 2
402-XD
Instructions for Form 3749, Importer Schedule of Disbursements
General Instructions - Tax is due upon importation or other taxable event and must be included on the return for the report period in which the transaction takes
place.
Schedule Types - Check the appropriate box on page 1.
5
Gallons of taxable fuel removed, sold or imported. Do not include gallons reported on other disbursement schedules.
5C
Gallons of Aviation Fuel sold to Aviation Fuel Registrants for resale.
5F
Gallons of dyed diesel fuel sold/used for taxable purposes, Michigan tax collected/due.
5Z
Gallons sold for Racing Fuel - Michigan tax collected.
6F
Gallons of dyed diesel fuel sold or removed for tax-exempt purposes.
6Z
Gallons sold for racing fuel - Michigan tax not collected.
8
Gallons sold tax-free to U.S. government.
9
Gallons sold tax-free to state and/or local government. Gasoline and diesel fuels only.
10G
Gallons sold tax-free to non-profit, parochial or denominational school, college or university, for use in buses to transport students to authorized school
functions.
10M
Gallons of gasoline sold tax-free to feedstock users.
Product Codes - Enter the appropriate code on page 1. See the Fuel Importer Return instructions or Treasury's Web site for the Michigan Fuel Product
Codes.
Column Instructions
Column (1) & (2):
Carrier - Enter the name and Federal ID Number (FEIN or TR) of the company that transports the product.
Column (3):
Mode of Transport - Enter the mode of transport. Use one of the following:
J = Truck
R = Rail
B = Barge
PL = Pipeline
S = Ship (Great Lakes or ocean marine vessel)
RT = Removal from terminal (other than by truck or rail for sale or consumption.)
Column (4):
Point of Origin/Destination - Enter the location the product was transported from/to.
Column (5) & (6):
Sold to/Purchaser - Enter the name and FEIN of the company the product was sold to.
Column (7):
Date Shipped - Enter the date the product was shipped.
Column (8):
Enter the bill of lading, manifest or other loading document number.
Net Gallons - Enter the net amount of gallons disbursed.
Column (9):
Gross Gallons - Enter the gross amount of gallons disbursed.
Column (10):
Billed Gallons - Enter the number of gallons to be billed to the customer.
Column (11):

Download Form 3749 Form 402-xd, Importer Schedule of Disbursements - Michigan

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