Schedule E - Tax Exempt Purchases
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1Account number: _________________
Schedule is for
Motor Fuel
(check one):
Account name:
Month:
Aviati on Fuel
Transporter's
Manifest
Invoice
Seller's
Sel ler's name
Account number
name
number
Ship date
number
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
Provi de a total for each separate sel
ler. Report both the gross gall
ons and net gallons on this schedul
e. Enter onl y the grand
total gallons
(gross or net)
you chose as your elected reporting basis to TC-109 or TC-109A. Attach this schedul
e to form
TC-109 or TC-109A
and fil e with the Utah State T
ax Commission.
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