Free TC110F - Utah

Schedule is for (check one): Seller's name 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19.

Motor Fuel Aviation Fuel Transporter's name

Account number: _________________ Account name: Product type Month: ________________ Manifest number Ship date Invoice number Gross gallons

TC-110I Rev. 6/94 Net gallons

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.

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

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Print Form TC-110I.CDR