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Get 09-12) 620-MRN Retail Marine Diesel Dealer Return This Report Is Due 1

Ress 2. Report Period (MM/DD/YYYY) 3. Account Number (FEIN or TR) 4. Contact Person Name 3A. License Number 5. Telephone Number 6. Fax Number 7. E-mail Address INSTRUCTIONS: All licensed marine diesel dealers must file this report with remittance on or before the 20th day of the month following the end of the reporting period. Please only report whole gallons. File even if no tax is due. Failure to file is punishable by penalty, interest and revocation of your license. Complete all appli.

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