Each exporter shall, not later than the last day of each calendar month, submit to the Department a written statement which sets forth:
1. The number of gallons of motor vehicle fuel, other than aviation fuel, received by the exporter during the previous month;
2. The number of gallons of motor vehicle fuel, other than aviation fuel, sold or distributed by the exporter outside this State;
3. The name and mailing address of each person to whom the exporter sold or distributed motor vehicle fuel, other than aviation fuel, outside this State; and
4. The number of gallons of motor vehicle fuel, other than aviation fuel, sold or distributed by the exporter to each person to whom he or she sold or distributed the fuel outside this State.