Form ST-111
                       Sales Tax Records Reduction – Retail Food Stores
                       Use this form if the Tax Commission granted your petition for sales tax records reduction (Form ST-110). 
                       You must have a Form ST-101, Sales Tax Resale or Exemption Certificate on file for each customer.

Retailer – Complete this section. Customer – Complete this section.
        Check One        Untaxed 
Date                              Business Name                    Seller’s Permit – Resale Only           Your Name
        or Both          Amount
                                                                                                 Print name
        Food
                       $                                                                         Signature
        Nonfood
                                                                                                 Print name
        Food
                       $                                                                         Signature
        Nonfood
                                                                                                 Print name
        Food
                       $                                                                         Signature
        Nonfood
                                                                                                 Print name
        Food
                       $                                                                         Signature
        Nonfood
                                                                                                 Print name
        Food
                       $                                                                         Signature
        Nonfood
                                                                                                 Print name
        Food
                       $                                                                         Signature
        Nonfood
                                                                                                 Print name
        Food
                       $                                                                         Signature
        Nonfood
                                                                                                 Print name
        Food
                       $                                                                         Signature
        Nonfood
                                                                                                 Print name
        Food
                       $                                                                         Signature
        Nonfood
EFO00221     06-10-2020