INDIANA DEPARTMENT OF REVENUE FT-501 Terminal Operator's Monthly Return SF# 46291 (R3 /12-08) Due date is the 20th of the following month. For the month of:_________________, 20_____ A Terminal Operator's Report Must Be Filed For Each Indiana Location License Number Name of License Holder (as indicated on license) Mailing Address Federal 637 License Number FEIN/SSN City or Town State Business Telephone Number Zip Code Terminal Information Terminal Code Name of Terminal Location Net Gallons From Schedule Monthly Transactions for Owned/Leased Terminal Space Column A Special Fuel (Dyed and Clear Diesel Fuel, Biodiesel, Blended Biodiesel) Column B (Gasoline, Gasohol) Column C Other Products (Jet Fuel, Kerosene) 1. Beginning Physical Inventory 2. Total Receipts 501A 3. Total Disbursements 501B 4. Stock Gains & Losses + - 5. Ending Physical Inventory (Line 1 plus Line 2 minus Line 3 plus/minus Line 4) Mail return to: Indiana Department of Revenue P.O. Box 6080 Indianapolis, IN 46206-6080 I do hereby certify under penalty of perjury that, for the terminal location indicated above, the foregoing and attached schedules and reports are a true and correct statement to the best of my knowledge and is a complete and full presentation of all transactions from the best information available. Taxpayer or Authorized Agent Typed or Printed Name Title Date Signed Telephone Number Please Check Box If Last Filing ❑ American LegalNet, Inc. www.FormsWorkflow.com Instructions for Completing Fuel Tax Terminal Operator’s Monthly Return (FT-501) Who should file the return? Schedule 501A Every person who operates a terminal location in Indiana must file this return. If you operate more than one terminal location in Indiana, a separate return must be filed for each location. A Licensed Supplier and/or Licensed Gasoline Distributor operating a terminal in Indiana, must also include their own activity on this report. Schedule 501A details all receipt transactions, by position holder (the position holder is the person who owns or leases storage space in your terminal), that support the Schedule 501I summary. When is this return due? The Terminal Operator's Monthly Return, Form FT-501 is due by the 20th day of the month following the month for which the return is being filed. Example: A return for the reporting period of January is due by the 20th of February. If the 20th day of the month falls on a Saturday, Sunday or a state or national holiday, the due date of the return is the next succeeding day that is not a Saturday, Sunday or such holiday. To be considered timely filed by the department, the return must be postmarked no later than the due date of the return. How do I complete the FT-501? Schedule 501B Schedule 501B details all disbursement transactions, by position holder, that support the Schedule 501I summary. This schedule(s) provides detail to support the amount(s) shown as disbursements on the Terminal Operator's Return FT-501. Each disbursement of product should be listed on a separate line. A separate Schedule 501B should be completed for each product type. Fuel disbursements should be grouped together by position holder. Schedule 501I Indicate at the top of the return, the reporting period for which you are filing. Enter your company’s identifying information as it is reflected on your Indiana Fuel Tax License. Complete the terminal information section. A separate FT-501 and accompanying schedules must be completed for each terminal location. schedule 501i summarizes, by position holder, the total terminal activity by product for the month. This schedule provides position holder detail to support the amount(s) shown as beginning/ending inventories, receipts, disbursements, and stock gains/losses on the Terminal Operator's Monthly Report, FT-501. Line 1 Enter the actual beginning inventory for each fuel type listed, for the reporting period. This amount should agree with your ending inventory amount from Line 5 of your previous month’s Terminal Operator Monthly Return, FT - 501. To Obtain Forms Line 2 Enter the net gallons received into your terminal during the reporting period. This amount should come from Column 8 of your supporting Schedule(s) 501A. Visit our web site on the Internet and download the forms you need. Our address is: www.in.gov/dor/. If you have additional questions: Line 3 Enter the net gallons disbursed from your terminal for reporting period. This amount should come from Column 9 of your supporting Schedule(s) 501B. If you have additional questions, you can call us at (317) 615-2630 or you can write the Department at: Line 4 Enter any discrepancies that result from stock gains or losses. Be certain that you circle the “+/-” sign in the box to the left indicating a gain or a loss. Indiana Department of Revenue P. O. Box 6080 Indianapolis, IN 46206-6080 Line 5 Enter your actual ending inventory for the reporting period. Note: Line 1, plus Line 2, minus Line 3, plus or minus Line 4 should equal Line 5. In a month to month comparison, the beginning inventory of this month (Line 1) should match the ending inventory (Line 5) from last month's report. American LegalNet, Inc. www.FormsWorkflow.com