Form St11 -Pur - Purchaser Sales Tax Refund Claim And Schedule Page 4
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4ST11-PUR
page 2
Sample purchaser refund
Invoice
Invoice
Specify
Mo/yr
Purchase
Total
MN tax
Exempt
date
number
Vendor name
Equipment purchased
sales or
tax was
price
tax paid
refund
reason
use tax*
paid**
claimed
code
3/14/08
7026
XYZ Corporation
Lubricants
sales
3/08
$100
$6.50
$6.50
15
3/22/08
7050
XYZ Corporation
Product labels
sales
4/08
$250
$16.25
$16.25
15
2/21/09
1371
ABC of St. Paul
Brochures - 95% exempt - sent out of state
sales
2/09
$500
$32.50
$30.88
14
Total
$850
$55.25
$53.63
* Sales or use tax: Enter “sales” for sales
** Mo/yr paid:
tax paid to the vendor. PLEASE NOTE: Use
For sales tax, enter the month/year you paid
tax items accrued in error should not be
the vendor. PLEASE NOTE: Use tax should
requested on an ST11-PUR. If it is use tax
not be requested on an ST11-PUR. Please
accrued in error, the return/s in question
file amended returns for use tax items
should be amended.
accrued in error.
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