Free TC110F - Utah

to Utah licensed distributors

Schedule is for (check one):

Motor Fuel Aviation Fuel Customer's account number

Account number: _________________ Account name: Transporter's name Manifest number Ship date Month: ________________ Invoice number Gross gallons

TC-110F Rev. 6/94 Net gallons

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

Provide a total for each separate seller . Report both the gross gallons and net gallons on this schedule. Enter only the grand total gallons (gross or net) you chose as your elected reporting basis to TC-109 or TC-109A. Attach this schedule to form TC-109 or TC-109A and file with the Utah State T ax Commission.

TC-110F.CDR

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