Form 86-003 - Retailers E85 Schedule

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Iowa Department of Revenue
Retailers E85 Schedule
86-003 (2/17/06)
Name:
Attach schedule to form 86-002
Iowa Department of Revenue
Sales Tax Permit:
Compliance Division
Period:
Mail to:
Motor Fuel Unit
List all E85, E70, alcohol and gasoline purchases related to the E85 sales
PO Box 10456
reported on your quartly report. For purposes of this schedule, report E70 as
Des Moines, IA 50306-0456
E70 and E85 as E85.
Product
(E85, E70,
From whom purchased
Tax Paid
Invoice
Date of
Alcohol,
Name, Address, City, State, Phone
Number
Gallons
on Gallons
Purchase
Gasoline)
Total
Use additional schedules if needed

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