Form 72a220 - Dyed Diesel Monthly Terminal Storage Report printable pdf download

72A220 (7-00)

DYED DIESEL

Commonwealth of Kentucky

See Instructions on Reverse

MONTHLY TERMINAL STORAGE REPORT

REVENUE CABINET

Name and Address of Dealer

License Number ______________________________________

Report for Month of ____________________________ , 20___

(

)

Telephone Number ____________________________________

Terminal Location

SCHEDULE A—Report of Special Fuels Stored

Detail Gallons

Total Gallons

1. Inventory on hand beginning of month ..........................................................................................................................................

2. Produced, refined, manufactured or compounded (adjusted to 60°) ..............................................................

3. Special fuels imported into Kentucky (Form 72A221) ..................................................................................

4. Special fuels received from terminal or refinery storage in Kentucky (Form 72A222) ...............................

5. Other receipts (attach statement of explanation) ............................................................................................

6. Total receipts (add lines 2 through 5) ..............................................................................................................................................

7. Total gallons to be accounted for ..................................................................................................................................................

8. Total withdrawals (Form 72A225) ..................................................................................................................................................

9. Balance in storage (book inventory) (line 7 minus line 8) ..............................................................................................................

10. Actual physical inventory at 60° on hand at end of month .............................................................................................................

11. Actual loss (if line 10 is less than line 9, enter difference; otherwise, enter zero) ........................................................................

12. Allowance for actual loss (.0075 times line 7 but not to be greater than the amount on line 11) ..................................................

13. Excessive actual loss not allowable (line 11 minus line 12) ...........................................................................................................

SCHEDULE B—Taxable Gallons Computation

14. Total withdrawals (Form 72A225) ..................................................................................................................................................

15. Gallonage withdrawals to licensed Kentucky special fuels dealers

(Form 72A223 in duplicate) ...........................................................................................................................

16. Gallonage withdrawals exported or sold for export (Form 72A224 in duplicate) ........................................

17. Total nontaxable withdrawals (add line 15 and line 16) .................................................................................................................

18. Taxable withdrawals (line 14 minus line 17) ................................................................................................................................

19. Gallons to be reported on licensed special fuels dealer’s schedule of dyed diesel (Form 72A200)

(add line 13 and line 18) ..................................................................................................................................................................

I, the undersigned, a principal officer of the above-named licensee, have examined this report and it is, to the best of my knowledge and belief, a true, correct

and complete report.

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Signature

Title

Date