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Utah State Tax Commission

Carrier's Monthly Report of Shipments Of Special Fuel
THIS REPORT MUST BE FILED EVEN IF NO SHIPMENTS WERE MADE.
Name, address, city, state and ZIP code. Correct any errors.

TC-334 Rev. 1/97

THIS RETURN IS DUE ON THE LAST DAY OF THE FOLLOWING MONTH Tax Period

Account number

Use this number on all references Date Invoice or Car number Gallons True name of product Origin Consignee Destination

I certify that this return, including any accompanying schedules, has been examined by me and to the best of my knowledge is a true, correct and complete return. Signed Title Mail to: Telephone Telephone: (801) 297-2200 for assistance (1-800-662-4335 outside Salt Lake City but inside Utah) Date Carrier's Monthly Report - Special Fuel Auditing Division Utah State Tax Commission 210 North 1950 West Salt Lake City, Ut 84134