SCHEDULE OF LOCATIONS, GROSS SALES AND COLLECTIONS, DEDUCTIONS, AND AMOUNT USED AS MEASURE OF THE TAX
USE THIS PAGE ONLY FOR REPORTING SALES SHOWN IN COLUMN C ON PAGE 1. IF SALES ARE ALSO REPORTED IN COLUMN A AND B OF
PAGE 1 USE A SUPPLEMENTAL SHEET FOR SCHEDULE OF LOCATIONS AND SCHEDULE OF WHOLESALE SALES.
LOCATION
TOTAL AMOUNT OF GROSS SALES
TOTAL AMOUNT
DEDUCTIONS
LIST ALPHABETICALLY BY COUNTY & BY POST OFFICE WITHIN COUNTY
PROPERTY USED AND COLLECTIONS
REMAINING AS
CLAIMED
FOR THE PERIOD
MEASURE OF TAX
POST OFFICE
STREET OR R.F.D.
TOTAL
IF MORE SPACE IS NEEDED ATTACH SUPPLEMENTARY SCHEDULE
SCHEDULE OF WHOLESALE SALES
LIST TOTAL WHOLESALE SALES TO EACH CUSTOMER FOR PERIOD COVERED BY THIS RETURN:
(NOT REQUIRED OF DEALERS WHOSE PRINCIPAL BUSINESS CONSISTS OF SELLING AT WHOLESALE)
TOTAL AMOUNT SOLD
CUSTOMER'S
CUSTOMER'S NAME
ADDRESS
ACCOUNT NUMBER
TO EACH CUSTOMER
NO CLAIM
EXEMPTION FOR WHOLESALE SALES WILL
OF
TOTAL AMOUNT OF WHOLESALE SALES
BE ALLOWED UNLESS LISTED AS ABOVE REQUIRED
SCHEDULE OF DISTRIBUTORS OR SUPPLIERS OF GASOLINE & DIESEL FUEL
THIS SECTION TO BE USED BY SERVICE STATIONS AND/OR RETAIL SELLERS OF GASOLINE AND DIESEL FUEL. REPORT OR LIST ALL GALLONS OF
GASOLINE AND/OR DIESEL FUEL AS WELL AS DISTRIBUTOR WHICH SUPPLIED FUEL.
GASOLINE
DIESEL
INVOICE NO.
DISTRIBUTOR
ADDRESS
GALLONS
GALLONS