CITY OF LEEDS
Monthly Gas Tax Return
1040 Park Drive
LEEDS, AL 35094
PHONE - 205-699-2585 FAX - 205-699-6558
CITY OF LEEDS
Monthly Gas Tax Return
1040 Park Drive
LEEDS, AL 35094
PHONE - 205-699-2585 FAX - 205-699-6558
For the Month of :
Year
June
DecemberNovember
MayApril
OctoberSeptember
MarchFebruary
AugustJuly
January
For the Month of :
Year
December
JuneMay
NovemberOctober
AprilMarch
SeptemberAugust
February January
July
Note: This return must be postmarked by the 20th of the following month to be considered timely and avoid late penalties.
Total Gallons Fee Rate Gross Tax Due
Penalty & Interest
10% Penalty, 12% interest per annum
$1.00 minimum
Total Tax Due
1 Cent/Gallon
I declare, under penalty of perjury, that this return (and any accompanying schedules) has been examined by me and to the best of my knowledge is
true, correct and complete.
Total Gallons Fee Rate Gross Tax Due
Penalty & Interest
10% Penalty, 12% interest per annum
$1.00 minimum
Total Tax Due
1 Cent/Gallon
Business Name
Account Number
Note: This return must be postmarked by the 20th of the following month to be considered timely and avoid late penalties.
I declare, under penalty of perjury, that this return (and any accompanying schedules) has been examined by me and to the best of my knowledge is
true, correct and complete.
Signature Date
FEINPrint Name
Email
Signature Date
Print Name FEIN
TelephoneEmail
Telephone
Business Name
Account Number
Total Taxes Due
Total Taxes Due
