Account #:
                                    GRAND TOTAL DUE:
Tax Period:

                        7749                                           7049
                     Sales Tax                                       Sales Tax
             General           Auto                          General          Auto
 Gross:                                     Gross:
Deductions:                                 Deductions:
Taxable Amt:                                Taxable Amt:
Tax Rate:    1.0%              0.5%         Tax Rate:        1.5%             1.0%
Tax Due:                                    Tax Due:
 Penalty:                                   Penalty:

             Consumers Use Tax                               Consumers Use Tax
             General           Auto                          General          Auto
 Gross:                                     Gross:
Deductions:                                 Deductions:
Taxable Amt:                                Taxable Amt:
Tax Rate:    1.0%              0.5%         Tax Rate:        1.5%             1.0%
Tax Due:                                    Tax Due:
 Penalty:                                   Penalty:

             Sellers Use Tax                                 Sellers Use Tax
             General           Auto                          General          Auto
 Gross:                                     Gross:
Deductions:                                 Deductions:
Taxable Amt:                                Taxable Amt:
Tax Rate:    1.0%              0.5%         Tax Rate:        1.5%             1.0%
Tax Due:                                    Tax Due:
 Penalty:                                   Penalty:

             Rental Tax                                      Rental Tax
             General                                         General
 Gross:                                     Gross:
Deductions:                                 Deductions:
Taxable Amt:                                Taxable Amt:
Tax Rate:    1.0%                           Tax Rate:        1.0%
Tax Due:                                    Tax Due:
 Penalty:                                   Penalty:

             Business Name / Address

Signature:                                  Date:

3925-F Michael Boulevard P.O. Drawer 161009 Mobile, AL 36616 (251) 574-4800   FAX (251) 574-8103