Form 5085 - Bulk Deliveries Of Agricultural Gasoline

Download a blank fillable Form 5085 - Bulk Deliveries Of Agricultural Gasoline in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 5085 - Bulk Deliveries Of Agricultural Gasoline with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Print Form

Reset Form

MISSOURI DEPARTMENT OF REVENUE

FORM

TAXATION DIVISION

5085

P.O. BOX 800, JEFFERSON CITY, MISSOURI 65105-0800

(573) 751-7671

TDD 1-800-735-2966

(REV. 03-2011)

Enter dates as mm/dd/yyyy.

BULK DELIVERIES OF AGRICULTURAL GASOLINE

COMPANY NAME

DATE

INVOICE/TICKET

NAME OF PURCHASER

PURCHASER’S ADDRESS

GALLONS

DELIVERED

NUMBER

TOTAL

I hereby certify the gallons listed above were sold as bulk deliveries of agricultural gasoline in quantities of one hundred gallons or more and delivered to farmers. I further certify that each farmer listed above completed an

Agricultural Gasoline Bulk Sales Exemption Certificate, which is retained in my files. All tickets and/or invoices indicating the purchaser’s name, date of delivery, and gallons purchased are also retained in my files.

SIGNATURE OF OWNER OR AUTHORIZED AGENT

DATE

This publication is available upon request in alternative accessible format(s).

MO 860-3053 (03-2011)