Form Pet 368 - Blender'S Return Page 3

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TAX MONTH _________________
_______________________________________________
RETURN LINE NO. _____________
ACCOUNT NAME
COLUMN ____________________
_______________________________________________
PRODUCT
BLENDER'S TAX RETURN SCHEDULE (Attach to PET 368)
ACCOUNT NO.
PURCHASES
SHIPPING
VENDOR
PURCHASED
DATE
PAPER NO.
PURCHASED FROM:
ORIGIN
DESTINATION
CARRIER
PRODUCT
GALLONS
Total Gallons Purchased (Carry to Line 2)
RV-F1400801
INTERNET (4-03)

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