Form 3817 Blender Schedule of Receipts - Michigan

Form 3817 or the "Blender Schedule Of Receipts" is a form issued by the Michigan Department of Treasury.

The form was last revised in September 1, 2006 and is available for digital filing. Download an up-to-date fillable Form 3817 in PDF-format down below or look it up on the Michigan Department of Treasury Forms website.

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Michigan Department of Treasury
3817 (Rev. 9-06)
Blender Schedule of Receipts
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. See page 2 for schedule descriptions. Do not combine schedule types or product codes.
1
2B
Report Whole Gallons Only
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
Gallons
Point of
Purchased or Acquired from Supply Source
Date
Document
Carrier Name
Carrier FEIN
Mode
Shipped
Number
N/A
Origin
Destination
Name
FEIN
Net
Gross
TOTAL
www.michigan.gov/treasury
Reset Form
Michigan Department of Treasury
3817 (Rev. 9-06)
Blender Schedule of Receipts
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. See page 2 for schedule descriptions. Do not combine schedule types or product codes.
1
2B
Report Whole Gallons Only
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
Gallons
Point of
Purchased or Acquired from Supply Source
Date
Document
Carrier Name
Carrier FEIN
Mode
Shipped
Number
N/A
Origin
Destination
Name
FEIN
Net
Gross
TOTAL
www.michigan.gov/treasury
3817, Page 2
Instructions for Form 3817, Blender Schedule of Receipts
General Instructions
Schedule Types - Check the appropriate box on page 1.
1
Gallons of fuel imported/acquired Michigan tax paid to supply source.
2B
Gallons of untaxed blendable stock.
Product Codes - Enter the appropriate product code on page 1. See the Blender Monthly Tax Return Instructions or Treasury's Web site for a list of product
codes.
Column Instructions
Column (1) & (2):
Carrier - Enter the name and FEIN 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
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. When received into or from a terminal, the Terminal Control
Number (TCN) must be used.
Column (5) & (6):
Purchased or Acquired from Supply Source - Enter the name and FEIN of the company from which the product was purchased or acquired.
Column (7):
Date Shipped - Enter the date the product was shipped.
Column (8):
Document Number - Enter the bill of lading number from the manifest issued at the terminal when product is removed over the rack. In
the case of pipeline or barge movements, use the pipeline or barge ticket number. In the case of bulk plant removals, use the withdrawal bill
of lading number.
Column (9):
Net Gallons - Enter the net gallons received. Use whole numbers only.
Column (10):
Gross Gallons - Enter the gross gallons received. Use whole numbers only.

Download Form 3817 Blender Schedule of Receipts - Michigan

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