Step 2: Complete the following to support your other deductions
(Cont.)
Reason for deduction
Reference or
Date
Number of ounces
invoice number
6
_______________________________________________
_______________
___/___/___
____________________
Month Day
Year
_____________________________________________________
_____________________________________________________
7
_______________________________________________
_______________
___/___/___
____________________
Month Day
Year
_____________________________________________________
_____________________________________________________
8
_______________________________________________
_______________
___/___/___
____________________
Month Day
Year
_____________________________________________________
_____________________________________________________
9 _______________________________________________
_______________
___/___/___
____________________
Month Day
Year
_____________________________________________________
_____________________________________________________
10 _______________________________________________
_______________
___/___/___
____________________
Month Day
Year
_____________________________________________________
_____________________________________________________
11 _______________________________________________
_______________
___/___/___
____________________
Month Day
Year
_____________________________________________________
_____________________________________________________
12 _______________________________________________
_______________
___/___/___
____________________
Month Day
Year
_____________________________________________________
_____________________________________________________
13 _______________________________________________
_______________
___/___/___
____________________
Month Day
Year
_____________________________________________________
_____________________________________________________
14 _______________________________________________
_______________
___/___/___
____________________
Month Day
Year
_____________________________________________________
_____________________________________________________
*294F02110*
TP-17 (N-12/12)
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