Schedule A ‑ Motor Fuel Purchases
Page 2 of 4 AU‑631 (4/11)
(Attach additional sheets if necessary.)
Date of
Seller’s
Invoice
Number of
Excise
Petroleum business
Sales
purchase
number
gallons
tax paid
tax paid
tax paid
Name
City
County
11 Total gallons purchased
........
(enter here and on lines 1, 4, and 7, Column A)
12 Total excise tax paid/reimbursement claimed
..........
(enter here and on line 1, Column B)
13 Total petroleum business tax paid/reimbursement claimed
.............
(enter here and on line 4, Column B)
14 Total state and local sales tax paid/refund claimed
......................................................
(enter here and on line 7, Column B)