Free TC-110B - Utah

Schedule B -Tax Paid Purchases

Schedule is for (check one):

Motor Fuel Aviation Fuel

Account number: _________________ Account name: ________________________________________ Month: _____________

TC-110B Rev. 9/02

Seller's name and account number
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19.

Manifest number

Ship date

Seller's invoice number

Gross gallons

Net gallons

Destination

Report both the gross gallons and net gallons on this schedule. Enter only the total gallons (gross or net) you chose as your elected reporting basis on TC-109 or TC-109A. Attach this schedule to form TC-109 or TC-109A and file with the Utah State Tax Commission.

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