Terminal Operators Schedule Of Disbursements
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Terminal Operators Schedule Of Disbursements Form. This is a Indiana form and can be use in Department Of Revenue Statewide.
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Tags: Terminal Operators Schedule Of Disbursements, Schedule 501B, Indiana Statewide, Department Of Revenue
Schedule 501B
Terminal Operator’s Schedule of Disbursements
SF# 49091
(R3 \ 12-08)
Terminal Operator Name
License Number
FEIN
Terminal Code
Month/Year
You may photocopy this blank schedule for future filings. Attach additional sheets if necessary.
Please see the product code matrix on the Web site at www.in.gov/dor/reference/files/code-matrix.pdf
Position Holder Information
Transporter Information
(1)
Name
(2)
FEIN
(4)
(3)
Mode Destination
State
(5)
Name/
Address
(6)
FEIN
(7)
Document
Date
(8)
Document
Number
(9)
Net
Gallons
(12)
(11)
Position Hold- Position
(10)
er’s Customer Holder’s
Gross
Customer
Name
Gallons
FEIN
Total
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J
R
B
PL
=
=
=
=
Truck
Rail
Barge
Pipeline
S = Ship (Great Lakes or Ocean Vessel)
ST = Stock Transfer
BA = Book Adjustment
Columns 11 and 12: Enter the position holders customer name and Federal Employer’s Identification Number
(FEIN).
Column 10: Enter the gross gallons disbursed.
Note: You must subtotal by position holder on the Schedule-501B and carry these subtotals to Schedule 501I,
column 5.
Column 9: Enter the net gallons received. The grand total of all Schedule-501B, Column 9, should be carried
to the FT-501, Terminal Operator’s Monthly Return.
The Position Holder is the person who owns/leases storage space in the terminal.
Columns 5, 6, 7 and 8: Enter the position holder’s information as well as the shipping document date and
number.
Column 4: Enter the destination state to which the fuel was transported.
Column 3: Enter the mode of transport: One of the following codes should be used for each entry.
Columns 1 and 2: Enter the name and Federal Employer’s Identification Number (FEIN) of the company that
transports the fuel. This may be you.
Column Instructions:
Enter your identifying information as it is reflected on your Indiana Fuel Tax License.
(Be certain to complete a separate schedule for each fuel product type that you circle.)
Before You Begin:
Instructions for Completing
Terminal Operator’s Schedule of Disbursements
Schedule 501B
