Form 80-011 - Eligible Purchaser / End User Financial Information

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IOWA
Eligible Purchaser / End User
d e p a r t m e n t o f Reve n u e a n d F i na n c e
Financial Information
80-011 (3/99)
I.
Location Name/Address
II.
Eligible Purchaser / End User Only
III.
Eligible Purchaser and End User
List all persons from whom you have purchased fuel in the last year.
(List any additional purchases on reverse side.)
IV.
License Requirements
Attach a copy of your latest fiscal year.

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