Form 4925 - Schedule A-Marine Fuel Purchases By County - Division Of Taxation And Collection Of Missouri Department Of Revenue

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MISSOURI DEPARTMENT OF REVENUE
FORM
DIVISION OF TAXATION AND COLLECTION
4925
PO BOX 800, JEFFERSON CITY, MISSOURI 65105-0800
(573) 751-7671
TDD 1-800-735-2966
(REV. 11-2003)
SCHEDULE A — MARINE FUEL PURCHASES BY COUNTY
INSTRUCTIONS: Please enter gallons of fuel purchased (rounded to the nearest gallon) for marine use in each county listed. Fuel
purchased for marine use in all other counties should be entered on the line following Wayne County. List total gallons purchased on
Line 4 of the Motor Fuel Refund Claim Form (DOR-4923).
Gallons
Gallons
Barry
Monroe
Benton
Morgan
Butler
Ozark
Camden
Polk
Cedar
Ralls
Clay
Reynolds
Clinton
St. Clair
Dade
Stone
Henry
Taney
Hickory
Wayne
Total gallons purchased
in all other counties not
Miller
listed:
Add total gallons of fuel purchased for marine use. (Enter this amount on
Line 4 of Form 4923, Motor Fuel Refund Claim.)
If you have questions or need assistance in completing this form, please call (573) 751-7671 (TDD 1-800-735-2966)
or e-mail excise@dor.mo.gov. You may also access this form from the Department’s web site:
This publication is available upon request in alternative accessible format(s).
MO 860-2975 (11-2003)

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