OIL ADJUSTMENT STATEMENT __________________________________________________________ Premises:__________________________________ Fuel Oil Adjustment: ______________________________________________ FUEL OIL ADJUSTMENT The fuel tank on the premises as of____/____20 contains________________ gallons of oil. A fuel adjustment in the amount of $_____________________ must be paid by Tenant prior to: ____/____20 Tenant's occupancy: _______________________________________________ Check one: Owner _____will ____will not be responsible to reimburse tenants for fuel upon vacating. _________________________________________ Manager