Free TC110G - Utah

Schedule is for (check one): Name and address of government entity 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19.

Motor Fuel Aviation Fuel

Account number: _________________ Account name: Manifest number Shi p date Invoice number Gross gal lons Month: ________________ Net gal lons

TC-110G Rev. 6/94

This column for internal use only

Report both the gross gall ons and net gallons on this schedul e. Enter onl y the total gal lons ( gross or net) you chose as your elected reporting basis to TC-109 or TC-109A. Attach this schedul e to form TC-109 or TC-109A and fil e with the Utah State Tax Commi ssion

COPIES OF I NVOICES MUST BE A TTACHED

IMPORTANT: To protect your privacy, use the "Clear form" button when you are finished.

Clear form

Print Form

TC-110G.CDR