Monthly Alabama National Guard Canteen Gasoline Report - Alabama Department Of Revenue

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A
D
R
SUBT: CR
LABAMA
EPARTMENT OF
EVENUE
Rev. 10/11
B
L
T
D
USINESS AND
ICENSE
AX
IVISION
Reset
M
F
S
OTOR
UELS
ECTION
P.O. Box 327540 • Montgomery, AL 36132-7540 • (334) 242-9608
Monthly Alabama National Guard Canteen Gasoline Report
NAME OF CANTEEN
MONTH OF ACTIVITY
PRESENT ADDRESS (Number and Street or Rural Route)
TELEPHONE (AREA CODE)
CITY OR TOWN
STATE
ZIP CODE
READ INSTRUCTIONS ON BACK OF FORM BEFORE COMPLETING.
DATE GASOLINE
DOCUMENT
GALLONS OF
VENDOR’S NAME AND ADDRESS
RECEIVED
NUMBER
GASOLINE RECEIVED
TOTAL
CERTIFICATION
This is to certify that all the information contained in this report is true and correct to the best of my knowledge and belief.
Signature: _______________________________________________
STEWARD
Signature: _______________________________________________
CANTEEN OFFICER
Date: ___________________________________________________
NOTE: THIS REPORT MUST REACH THE DEPARTMENT OF REVENUE WITHIN 10 DAYS AFTER THE END OF THE MONTH FOR
WHICH THIS REPORT IS FILED.
MAIL FORM TO THE ABOVE ADDRESS.

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