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CITY OF TUSCUMBIA
ACCOUNTING DEPARTMENT
P. O. BOX 29
TUSCUMBIA, AL 35674
Phone: (256) 383-5463 Ext 12
Monthly Gasoline and Diesel Tax Return
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Reporting Month |
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Company’s Name |
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Address |
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Phone
No. |
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Gallons of Gasoline sold in the City @$0.03 |
$ |
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Gallons of Gasoline sold in the Police Jurisdiction @$0.015 |
$ |
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Gallons of Diesel Fuel sold in City @$0.03 |
$ |
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Gallons of Diesel Fuel sold in the Police Jurisdiction
@$0.015 |
$ |
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Late Penalty of 20 percent If Paid After the Fifteenth Day
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Total
Amount Due: |
$ |
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THE
INFORMATION FURNISHED HEREIN SHALL BE CONSIDERED
CONFIDENTIAL, AND SHALL NOT BE DEVULGED TO ANYONE OTHER THAN
THE CITY COUNCIL, CITY ATTORNEY, CITY CLERK, CITY ACCOUNTANT
AND LICENSE INSPECTOR. |
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I
certify that the information has been examined by me and is
true and correct. |
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Owner
or Manager
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Date
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