Form Au-526 - Sales And Use Tax Refund Application For Purchases Made Under The "Buy Connecticut" Provision Page 2

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Schedule A: Qualifying Purchases for Refund Under the “Buy Connecticut” Provision
Please identify each qualifying purchase for which you are claiming a refund. For each item listed, provide a copy of the purchase invoice or bill of sale together with documentation substantiating that
the qualifying tangible personal property has been shipped outside Connecticut by common or contract carrier. Attach additional sheets if necessary. For more information, see Special Notice 2001(5),
The “Buy Connecticut” Provision .
Description of tangible personal
Sales or Use
Date Shipped
Destination of tangible
Date of Purchase
Vendor (name and address)
Invoice Number
Invoice Amount
property (including quantities)
(if already shipped)
personal property
Tax Paid
Total Sales Tax Refund Claimed: $
AU-526 (BACK)
(Rev. 08/01)

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