Form 72a066 - Application For Refund Of Kentucky Tax Paid On Gasoline Used In Operation Of Aircraft (Krs 138.341 To 138.342) Page 2

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72A066 (4-09)
Page 2
PURCHASES
Attach Original Invoices
Invoice Number
Date of Purchase
Name and Address of Supplier
Gallons Purchased
Total gallons purchased (enter grand total here and on line 2 of reserve side) ........................................

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