Form 72a170 - Monthly Terminal Report July 2007 printable pdf download

Form 72a170 - Monthly Terminal Report July 2007

72A170 (7-07)

MONTHLY TERMINAL REPORT

Commonwealth of Kentucky

DEPARTMENT OF REVENUE

Name of Terminal

MM/YY

Terminal Code

Location of Terminal

Name

FEIN

License Number

Address

City

State

ZIP Code

Phone Number

Net Gallons

Schedule No.

Gasoline Products

Special Fuels

1. Beginning inventory ......................................................

15A

2. Total receipts (Form 72A180) .......................................

3. Total gallons available ...................................................

4. Total disbursements (Form 72A181) .............................

15B

5. Gallons available (less disbursements) ........................

6. Stock gains and losses .................................................

7. Actual Ending Inventory ................................................

8. Allowance for actual loss (.0075 times line 3 but not to be

greater than line 6) ........................................................

9. Excessive actual loss not allowed (line 6 minus line 8)

Signature of Terminal Operator

Title

Date

Form 72a170 - Monthly Terminal Report July 2007