Form 573 - South Dakota Marketer Refund Page 2
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1
2Reefer Storage Undyed Fuel Worksheet
On the worksheet below, list the gallons of reefer fuel sold for each date and indicate
the amount of sales tax you reported and remitted on your previous sales tax return.
Your total gallons for sales tax remitted should equal the amount recored on Line 5 on
the front of the refund form
Record your sales tax license number here:
-
Sales Tax Remitted:
$
Gallons Undyed Fuel:
1
Date (MM-YY):
-
$
Gallons Undyed Fuel:
Sales Tax Remitted:
2
Date (MM-YY):
-
$
Gallons Undyed Fuel:
Sales Tax Remitted:
3
Date (MM-YY):
-
$
Gallons Undyed Fuel:
Sales Tax Remitted:
4
Date (MM-YY):
-
$
Gallons Undyed Fuel:
Sales Tax Remitted:
5
Date (MM-YY):
-
Sales Tax Remitted:
$
Gallons Undyed Fuel:
6
Date (MM-YY):
-
$
Gallons Undyed Fuel:
Sales Tax Remitted:
7
Date (MM-YY):
-
Sales Tax Remitted:
$
Gallons Undyed Fuel:
8
Date (MM-YY):
-
$
Gallons Undyed Fuel:
Sales Tax Remitted:
9
Date (MM-YY):
-
Sales Tax Remitted:
$
Gallons Undyed Fuel:
10
Date (MM-YY):
-
$
Gallons Undyed Fuel:
Sales Tax Remitted:
11
Date (MM-YY):
-
Sales Tax Remitted:
$
Gallons Undyed Fuel:
12
Date (MM-YY):
-
$
Gallons Undyed Fuel:
Sales Tax Remitted:
13
Date (MM-YY):
Total Gallons Undyed Fuel:
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