This document is a schedule for reporting tax paid purchases of motor or aviation fuel. It lists columns for the seller's name and account number, manifest number, shipment date, seller's invoice number, gross gallons, net gallons, and destination. The schedule is to be attached to form TC-109 or TC-109A and filed with the Utah State Tax Commission, reporting either gross or net gallons as elected on the corresponding form.

1. Account number: _________________
Schedule is for Motor Fuel
Schedule B -Tax Paid Purchases TC-110B
(check one): Rev. 9/02
Aviation Fuel Account name: ________________________________________ Month: _____________
Manifest Seller's invoice Gross Net
Ship date Destination
Seller's name and account number number number gallons gallons
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Report both the gross gallons and net gallons on this schedule. Enter only the total gallons (gross or net) you chose as your elected reporting
basis on TC-109 or TC-109A. Attach this schedule to form TC-109 or TC-109A and file with the Utah State Tax Commission.
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