Form S-220a Schedule P - Buyer'S Claim For Refund Of Wisconsin State, County And Stadium Sales Taxes Page 2

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SECTION 3 – LIST OF PURCHASES
List only those purchases for which you are claiming a refund. If the total amount you paid to the seller
does not equal the total purchase price, include an explanation. Attach an additional sheet if necessary.
Col. 2
Col. 3
Col. 4
Col. 6
Col. 7
Col. 8
Col. 9
Col. 10
Col. 11
Col. 12
Col. 1
Col. 5
Description
Purchase
0.1%
0.5%
County
Total
5%
of Goods
Reason
Price
0.5%
Baseball
Football
Name
Amount
Wisconsin
or Services
Before
Stadium
Stadium
(if appli-
You
Purchase
Purchase
Invoice
Date
State
County
Purchased
Exempt
Date
Number
Paid
Tax
Tax
Tax
Tax
cable)
Paid
Tax
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
(Add the amounts in Columns 7, 8, 9 and 10 and enter the totals here. Add these totals
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
TOTALS
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
together and include the result on line 2, Section 1, on the reverse side of this page.)
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
I, the undersigned Buyer, certify that all the information contained in the above schedule, or included as an attachment, is true and correct to the best of my knowledge and belief. I am
authorized to execute this schedule and claim the exemptions indicated.
Print Buyer’s Name
Title
Address
Buyer’s Signature
Date

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