Department of Revenue Services
PO Box 5031                                                                      Form MF-R
Hartford CT  06102-5031                           Motor Vehicle Fuels Tax Schedule of Receipts 
(Rev. 05/09)
                                                                                      
  Name of Licensed Distributor         CT Tax Registration Number                Federal Employer ID Number (FEIN)  Schedule Type  Product Code       Month   

            Types of Schedule                                                                         Product Codes
            1    Gallons purchased state tax paid within Connecticut                                 054  Propane                  150 #1 fuel oil
            2    Gallons purchased state tax unpaid from sources located within Connecticut          065  Gasoline                 152 Heating oil
            3    Gallons imported direct to customers located within Connecticut                     072  Dyed kerosene            160 Undyed diesel
            4    Gallons imported from sources located outside Connecticut                           092  Other                    224 Compressed natural gas (CNG)
                                                                                                     125  Aviation gas             225 Liquid natural gas (LNG)
                                                                                                     130  Jet fuel                 228 Dyed diesel
                                                                                                     139  Gasohol 10%              241 Ethanol
                                                                                                     142  Undyed kerosene          284 Biodiesel, undyed

             (1)               (2)      (3)         (4)                                     (5)                        (6)             (7)        (8)          (9) 
  Carrier                      Carrier  Mode Point of                                       Acquired               Seller’s        Date     Document           Billed 
            Name               FEIN          Origin                  Destination            From                   FEIN            Received   Number    Whole Gallons 

                                                                                                                                            Total

                                                                     Receipts Schedule Instructions
Complete a separate receipts schedule Form MF-R ,Motor vehicle Fuels Tax Schedule of Reciepts, for each product code and attach it to the appropriate tax return.
Complete a separate form for each schedule required. Prepare in duplicate and retain a copy for your file.
Schedule 1            Report all purchases state excise tax paid from sources within Connecticut.
Schedule 2            Report all purchases state excise tax unpaid from sources within Connecticut. 
Schedule 3            Report shipments from another state direct to customers in this state.
Schedule 4            Report gallons imported from another state into Connecticut storage.
 
                                                                                  Column Instructions
Column (1) and (2)    Carrier - Enter the name and federal Employer Identification Number (FEIN) of the company that transports the product.
Column (3)            Mode of Transportation - Enter the mode of transport. Use one of the following: 
                      J = truck             R = rail  B = barge
                      PL = pipeline         S   = ship (ocean marine vessel)
Column (4)            Point of Origin/Destination - Enter the location the product was transported from and to. When received into or from a terminal, use the  Internal Revenue 
                      Service (IRS) Terminal Control Number (TCN). These are available at www.irs.gov.
Column (5)            Acquired From - Enter the name and license number of the company the product was acquired from.
Column (6)            Seller’s FEIN - Enter the FEIN of the company the product was acquired from.
Column (7)            Date Received - Enter the date the product was received for bulk transactions. Rack purchases may be consolidated by supplier for the month.
Column (8)            Document Number - Rack purchases, if not consolidated, must enter the identifying number from the document issued at the terminal. In case of pipeline or 
                      barge movements, it is the pipeline or barge ticket number.
Column (9)            Billed Whole Gallons - Enter the numbert of gallons sold. Round off to the nearest whole gallon.

                                                                                  General Instructions
Diesel fuel, # 2 oil, propane, natural gas, jet fuel, biodiesel, and kerosene are reported on Form OP-216 ,Special Fuel Tax Return. Gasoline, gasohol, and aviation gas are reported on 
Form O-MF  , Motor Vehicle Fuels Tax Return.
You must report monthly gallon subtotals by supplier and by product. All gallons must be rounded to the nearest whole gallon.
You must file a separate schedule for each product and include product code with schedule number.
Computer tab runs may be used as backup detail if preapproved by the Excise Taxes Unit. For further information on the motor vehicle fuels tax, please call the Excise Taxes Unit at 
860-541-3224, Monday through Friday, 8:30 a.m. to 4:30 p.m.

Form MF-R  Back (Rev. 05/09)