Welcome to Florence, Alabama

Florence, AL, USA

43°F

Menu

Welcome to Florence, Alabama

STATEMENT OF MOTOR FUEL SALES

STATE OF ALABAMA

COUNTY OF LAUDERDALE

1

In compliance with the Revenue Laws of the City of Florence Alabama, I

2

Tax Field (copy)

Tax Agent for and on behalf of the

Tax Agent for and on behalf of the

I do hereby certify, under oath, that during the calendar month of

I do hereby certify, under oath, that during the calendar month of

I do hereby certify, under oath, that during the calendar month of

, the following amounts of motor fuel sold by said Company upon which the tax provided for in your Revenue Laws are paid by check handed you herewith:

WITHIN CORPORATE LIMITS

Layout

Gallons of motor fuel @ 2 cents per gallon $ 1

Gallons of motor fuel @ 2 cents per gallon $

Gallons of motor fuel @ 2 cents per gallon $ 1

Layout (copy)

Gallons of motor fuel @ 2 cents per gallon $ 2

Gallons of motor fuel @ 2 cents per gallon $

Gallons of motor fuel @ 2 cents per gallon $ 2

Signature

Signature

SIGNATURE

Sworn to and subscribed before me on this the day of

Sworn to and subscribed before me on this the

day of

day of

NOTARY PUBLIC

NOTARY PUBLIC