Schedule is for (check one): Name and address of government entity 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19.
Motor Fuel Aviation Fuel
Account number: _________________ Account name: Manifest number Shi p date Invoice number Gross gal lons Month: ________________ Net gal lons
TC-110G Rev. 6/94
This column for internal use only
Report both the gross gall ons and net gallons on this schedul e. Enter onl y the total gal lons ( 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 Tax Commi ssion
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TC-110G.CDR