Form Au-726 - Motor Vehicle Fuels Exporter Monthly Report

Download a blank fillable Form Au-726 - Motor Vehicle Fuels Exporter Monthly Report in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Au-726 - Motor Vehicle Fuels Exporter Monthly Report with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Department of Revenue Services

Form AU-726

Excise Unit

25 Sigourney Street

Motor Vehicle Fuels Exporter Monthly Report

Hartford CT 06106-5031

(Rev. 03/06)

Report for month ending

Connecticut Tax Registration Number

FEIN

Due on or before

DRS Use Only

Schedule of Motor Vehicle Fuel Purchased in Connecticut for Export

Gallons Purchased

FEIN

Name of supplier

State of Destination

Diesel

Motor Vehicle Fuels

Total

I declare under penalty of law that I have examined this report (including any accompanying schedules and statements) and, to the best of my knowledge

and belief, it is true, complete, and correct. I understand the penalty for willfully delivering a false report to DRS is a fine of not more than $5,000, or

imprisonment for not more than five years, or both. The declaration of a paid preparer other than the taxpayer is based on all information of which the

preparer has any knowledge.

Taxpayer Signature

Title

Date

Print Taxpayer Name

Telephone Number

Taxpayer SSN

Paid Preparer Signature

Preparer’s Address

Preparer’s SSN or PTIN