2610
A
D
R
LABAMA
EPARTMENT OF
EVENUE
Consumers Use Tax Return
Date of Purchase: _____/_____/_____
Phone Number: (______) ________________
Name: ______________________________________
1-1/2%
2%
4%
Tax Rate
Address:_____________________________________
Total Purchase Price
___________________________________________
TAX DUE
(Multiply By Tax Rate)
___________________________________________
TOTAL AMOUNT REMITTED
Social Security Number: _________ — ______ — _________
.
$
Signature: ____________________________________________
Date: _______________________________
00002610000000000000