Department of Revenue Services
State of Connecticut                                                    Form MF-D
PO Box 5031                                               Motor Vehicle Fuels Tax Schedule of Disbursements   
Hartford CT  06102-5031
(Rev. 06/18)

 Name of Licensed Distributor         CT Tax Registration Number                  Federal Employer ID Number (FEIN)  Schedule Type  Product Code       Month   

            Types of Schedule                                                                            Product Codes
            5 Taxable sales to licensed distributors                                                     054 Propane                150 #1 fuel oil
            6 Nontaxable sales and transfers to licensed distributors                                    065 Gasoline               152 Heating oil
            7 Sales and transfers out of Connecticut and sales in Connecticut for immediate export       072 Dyed kerosene          160 Undyed diesel
            8 Gallons sold to U.S. government tax-exempt                                                 092 Other                  224 Compressed natural gas (CNG)
            9 Gallons delivered to state and local goverment tax-exempt                                  125 Aviation gas           225 Liquid natural gas (LNG)
            10 Nontaxable sales to farmers, dyed diesel sold to licensed marine fuel docks, other exempt 130 Jet fuel               228 Dyed diesel
              purchases, and nontaxable use                                                              139 Gasohol 10%            241 Ethanol
            13 Dealer sales to govermental entities                                                      142 Undyed kerosene        284 Biodiesel, undyed

              (1)             (2)            (3)            (4)                   (5)                                 (6)           (7)            (8)          (9)
            Carrier           Carrier        Mode        Point of                 Sold                                Purchaser     Date Document              Billed 
            Name              FEIN                   Origin           Destination to                                   FEIN         Sold         Number  Whole Gallons 

                                                                                                                                         Total

                                                                             Schedule Instructions
Complete a separate distribution schedule, Form MF-D,Motor vehicle Fuels Tax Schedule of Disbersments, 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 5           Report taxable sales to licensed distributors only.
Schedule 6           Report nontaxable sales to licensed distributors. 
Schedule 7           Report gallons exported to another state. You must complete a separate schedule for each state. 
Schedule 8           Report nontaxable sales to U.S. government. 
Schedule 9           Report nontaxable sales to the State of Connecticut and municipalities of this state. List each agency separately.
Schedule 10          Report nontaxable use, nontaxable sales to farmers, dyed diesel sold to licensed marine fuel docks, and other nontaxable distribution. Do not complete Form 
                     MF-D for sales of #2 heating oil for heating purposes.
Schedule 13          Report credit card sales to governmental entities.

                                                                                 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 TCN’s are available at www.irs.gov.
Column (5)           Sold To - Enter the name of the company the product was sold to.
Column (6)           Purchaser FEIN - Enter the FEIN of the company the product was sold to.
Column (7)           Date Sold - Enter the date the product was sold. Rack sales may be consolidated by customer for the month.
Column (8)           Document Number - Rack sales, 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 number 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 customer and product. All gallons must be rounded to the nearest whole gallon.
You must file a separate form 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, call the Excise Taxes Unit at  
860-541-3224, Monday through Friday, 8:30 a.m. to 4:30 p.m.

Form MF-D Back (Rev. 06/18)