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