Iowa Department of Revenue
LPG and CNG Monthly Meter Reading
Schedule L1
81-022a (8/9/00)
Tax Period ________________________
Page ____of ____
month, year
License Number _______________________
Location Address and City __________________________________________________
REPORT IN WHOLE GALLONS
Pump No.___
Pump No.___
Pump No.___
Pump No.___
Total
Enter pump meter reading at end
1
of month.
Enter pump meter reading at first
2
of month.
Enter pumped gallons per meter.
3
Subtract line 2 from line 1.
License Number _______________________
Location Address and City __________________________________________________
REPORT IN WHOLE GALLONS
Pump No.___
Pump No.___
Pump No.___
Pump No.___
Total
Enter pump meter reading at end
1
of month.
Enter pump meter reading at first
2
of month.
Enter pumped gallons per meter.
3
Subtract line 2 from line 1.
License Number _______________________
Location Address and City __________________________________________________
REPORT IN WHOLE GALLONS
Pump No.___
Pump No.___
Pump No.___
Pump No.___
Total
Enter pump meter reading at end
1
of month.
Enter pump meter reading at first
2
of month.
Enter pumped gallons per meter.
3
Subtract line 2 from line 1.
License Number _______________________
Location Address and City __________________________________________________
REPORT IN WHOLE GALLONS
Pump No.___
Pump No.___
Pump No.___
Pump No.___
Total
Enter pump meter reading at end
1
of month.
Enter pump meter reading at first
2
of month.
Enter pumped gallons per meter.
3
Subtract line 2 from line 1.