Monthly Wholesale Motor Fuel Report Template - City Of Auburn, Alabama - Finance Department Of Revenue

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FINANCE DEPARTMENT
REVENUE OFFICE
144 Tichenor Avenue, Suite 6
AUBURN, AL 36830
(334) 501-7228
City of Auburn
MONTHLY WHOLESALE MOTOR FUEL REPORT
FOR THE MONTH OF __________________
(Pursuant to Ordinance 891)
Name_____________________________
Address___________________________
City/St____________________________
Number of gallons of motor fuel
sold in the City of Auburn ____________________ X $.02…………………….. $_____________
Number of gallons of motor fuel sold
in the Police Jurisdiction _____________________ X $.01………………….…. $ ____________
Amount of tax due (sum of City and Jurisdiction) …………………………………………$ ____________
Late payment penalty (tax amount x 20%)………………………………………………… $ ____________
(If the previous month’s tax amount is paid after
th
the 20
day of the following month)
Total amount enclosed (tax amount & penalty, if any)…………………………... $_____________
STATE OF ALABAMA
LEE COUNTY
BEFORE ME, ___________________________________, A NOTARY PUBLIC IN AND FOR
SAID STATE AND COUNTY, PERSONALLY APPEARED __________________________________
WHO BEING BY ME DULY SWORN DEPOSES AND SAYS THAT HE OR SHE IS THE OWNER, OR
A DESIGNATED AGENT OF __________________________________________, WHO IS DULY
(Name of Licensee)
LICENSED TO SELL MOTOR FUELS AT WHOLESALE: THAT THE ABOVE REPORT IS TRUE
AND ACCURATELY SHOWS THE TOTAL GALLONS OF MOTOR FUELS SOLD BY SUCH
LICENSEE DURING THE PRECEDING MONTH.
SIGNATURE OF LICENSEE OR DESIGNATED AGENT ______________________________
SUBSCRIBED AND SWORN TO BEFORE ME THIS THE __________OF ___________________2000
NOTARY PUBLIC _________________________________

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