Form Pet 371 - End User Claim For Refund Page 3
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4TENNESSEE DEPARTMENT OF REVENUE
END USER CLAIM FOR REFUND (PET 371)
SCHEDULE A: BULK PURCHASES
Claimant: ___________________________
Claim Period: ________________________
Type of Nontaxable Use: ______________
Cost of Fuel
Diesel Tax
Undyed Diesel:
Price Per
(Gallons times
Paid
Date
Invoice No.
Gallons
Gallon
price per gallon)
(Per Invoice)
TOTALS:
Instructions:
Do not enter total in shaded areas. Attach additional sheets if necessary.
Calculate the average price per gallon: Begin by totaling the Cost of Fuel column for the period. Subtract the Total of the
Diesel tax Paid column for the period. Divide the remainder by the total of Undyed Diesel Gallons column for the
period. This answer is the average price per gallon for the period. Enter the average price per gallon: __________
RV-F1402301
INTERNET (11-05)
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Parent category: Financial