Form St11 - Capital Equipment Refund Claim Page 3
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4ST11-REF
Capital Equipment Refund Schedule
See sample schedule on back. Attach to Form ST11.
Project
Invoice
Invoice
Specify
Mo/yr
Purchase
Total
MN tax
Local tax
Detailed description of
number
date
number
Vendor name
Equipment purchased
sales or
tax was
price
tax paid
refund
refund
how equipment is used
use tax
paid
claimed
claimed
Total
Stock No. 2100114 (Rev. 12/09)
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Parent category: Financial