Form Tc-110g - Schedule G - Exempt Sales To Government Enfities

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Account number: _________________
Schedule is for
Motor Fuel
TC-110G
(check one):
Rev. 6/94
Account name:
Month: ________________
Aviation Fuel
Manifest
Invoice
Gross
Net
This column for
Name and address of government entity
internal use only
number
Shi p date
number
gal lons
gal lons
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
Report both the gross gall ons and net gallons on this schedul
e. Enter onl y the total gal lons (
gross or net)
you chose as your
COPIES OF I NVOICES
elected reporting basis to TC-109 or TC-109A. Attach this schedul
e to form TC-109 or TC-109A and fil e with the Utah State
MUST BE A TTACHED
Tax Commi ssion
TC-110G.CDR

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