Form 01-911 - Schedule To Support Refunds

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– SAMPLE – SAMPLE – SAMPLE – SAMPLE – SAMPLE –
01-911
(Rev.6-06/3)
SCHEDULE TO SUPPORT REFUNDS
NOTE: Schedule invoices in date sequence by vendor.
VENDOR
AMOUNT
REFUND
REFUND
REFUND
REFUND
REFUND
VENDOR
INVOICE
INVOICE
ITEM
CITY
COUNTY
SPD
MTA
TOTAL
TAXPAYER
CODE*
SUBJECT
STATE
CITY
COUNTY
SPD
MTA
NAME
NUMBER
DATE
DESCRIPTION
NAME
NAME
NAME
NAME
TAX
NUMBER
TO TAX
TAX
TAX
TAX
TAX
TAX
example a.
ABC PARTS
17531111111
7447 01/27/06 knife, kits, tooth
3.300(d)(2)
23.48
1.47 FORT WORTH
0.23 NONE
0.00 SCCFOR
0.12 MTAFOR
0.12
1.94
ABC PARTS
17531111111
7506 03/31/06 bearing
3.300(d)(14)
7.35
0.46 FORT WORTH
0.07 NONE
0.00 SCCFOR
0.04 MTAFOR
0.04
0.61
ABC PARTS
17531111111
7929 04/29/06 seal, kit, bushing 3.300(d)(7)
66.45
4.15 FORT WORTH
0.66 NONE
0.00 SCCFOR
0.33 MTAFOR
0.33
5.47
ROYAL OIL CO.
32222211111
12345 04/04/06 chain oil
3.300(d)(7)
100.00
6.25 NACOGDOCH
1.50 NACOGDOCH
0.00 SHDNAC
0.50 NONE
0.00
8.25
example b.
FRANK’S RANCH 17421111111
66666 05/09/06 over kit
3.296(g)
35.30
2.21 CONROE
0.71 NONE
0.00 NONE
0.00 NONE
0.00
2.92
FRANK’S RANCH 17421111111
66666 05/09/06 over kit
3.296(a)
32.85
2.05 CONROE
0.66 NONE
0.00 NONE
0.00 NONE
0.00
2.71
FRANK’S RANCH 17421111111
66666 05/09/06 over kit
3.296(b)
4.24
0.27 CONROE
0.08 NONE
0.00 NONE
0.00 NONE
0.00
0.35
FRANK’S RANCH 17421111111
66666 05/09/06 over kit
3.296(g)
34.55
2.16 CONROE
0.69 NONE
0.00 NONE
0.00 NONE
0.00
2.85
SAFETY SUPPLY
17441111111
55555 06/20/06 defibrillator
3.284
38.80
2.43 CONROE
0.78 NONE
0.00 NONE
0.00 NONE
0.00
3.21
example c.
TEXAS TILE
17561111111
2918 07/27/06 kit, bearing, pin
1a
83.61
5.23 HOUSTON
0.84 NONE
0.00 NONE
0.00 MTAHOU
0.84
6.91
TEXAS TILE
17561111111
2964 08/26/06 over kit
1a
83.10
5.19 HOUSTON
0.83 NONE
0.00 NONE
0.00 MTAHOU
0.83
6.85
TEXAS TILE
17561111111
3800 09/30/06 stamper
1d
65.94
4.12 HOUSTON
0.66 NONE
0.00 NONE
0.00 MTAHOU
0.66
5.44
TIMBER MGMT
17521111111
42797 12/14/04 coil
1a
5.82
0.36 LUFKIN
0.09 ANGELINA
0.03 NONE
0.00 NONE
0.00
0.48
TIMBER MGMT
17521111111
42909 08/17/05 pin, cup, baffel
2a
52.58
3.35 LUFKIN
0.80 ANGELINA
0.27 NONE
0.00 NONE
0.00
4.42
TIMBER MGMT
17521111111
43514 09/28/05 valve
2d
65.33
4.08 LUFKIN
0.98 ANGELINA
0.33 NONE
0.00 NONE
0.00
5.39
TIMBERJACK
17541111111 142793 05/27/06 bearing, pin
4
93.94
5.87 NONE
0.00 ANGELINA
0.47 NONE
0.00 NONE
0.00
6.34
TIMBERJACK
17541111111 142994 06/10/06 service manual
4
36.65
2.29 NONE
0.00 ANGELINA
0.18 NONE
0.00 NONE
0.00
2.47
VICTOR’S PART
17571111111
45000 01/02/05 waterpump
1d
84.39
5.27 WOODVILLE
1.27 TYLER
0.42 NONE
0.00 NONE
0.00
6.96
VICTOR’S PART
17571111111
46001 04/05/05 coil
1a
8.12
0.51 WOODVILLE
.12 TYLER
0.04 NONE
0.00 NONE
0.00
0.67
VICTOR’S PART
17571111111
47000 05/05/05 knife, kits, tooth
1c
134.55
8.41 WOODVILLE
2.02 TYLER
0.67 NONE
0.00 NONE
0.00
11.10
VICTOR’S PART
17571111111
50000 07/11/05 seal kit, bushing
1d
30.55
1.91 WOODVILLE
0.46 TYLER
0.15 NONE
0.00 NONE
0.00
2.52
TOTAL REFUND REQUESTED
1,087.60
68.04
13.45
2.56
0.99
2.82
87.86
*CODE can be keyed to a variety of different references such as:
a. Specific exemption references in the tax rules, such as - 3.300 - manufacturing, or
b. Specific exemption references in the tax rules, such as - 3.296 - agricultural, or
c. An Equipment Schedule of exempt machinery receiving repair or replacement parts such as - timber.
The web address for local sales tax information is
– SAMPLE – SAMPLE – SAMPLE – SAMPLE – SAMPLE –

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