Form Ft-941.1 - Terminal Operator'S Individual Account Reconciliation

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FT-941.1
New York State Department of Taxation and Finance
Terminal Operator’s Individual Account Reconciliation
(5/07)   
,
.
For the month of
(month)
(year)
Type or print clearly.  Read instructions on Form FT-941/941.1-I carefully.  Attach this reconciliation to Form FT-941.
 
Name of terminal operator 
Federal employer identification number (FEIN)
 Account name 
Federal employer identification number (FEIN) 
 
 Terminal location 
 Street address 
City, state and ZIP code
(street and city)
Part 1 — Reconciliation for each type of fuel
Type of fue
 
l (in gallons)
Kerosene
No. 2 fuel oil
Diesel fuel
Gasoline
Other fuel
Total
gallons
1  Opening inventory ........................................................................................................................
2 Total receipts 
 .............................................................................................................
(from Part 2)
3 Subtotal 
  . ............................................................................................................
(add lines 1 and 2)
4 Total withdrawals 
 .......................................................................................................
(from Part 3)
5 Balance on hand at end of month
..........................................................
(subtract line 4 from line 3)
6 Adjustments 
.....................................................................................
(enter any loss in brackets [  ])
7 Net inventory 
  . ........................................................
(include these amounts in line 1 of Form FT-941)
Part 2 — Summary of receipts
Type of fuel
 
 (in gallons)
(attach additional sheets, if necessary)
*
Month and
Mode
Carrier’s name
Carrier’s FEIN
Kerosene
No. 2 fuel oil
Diesel fuel
Gasoline
Other fuel
Product code
Total
day of
of
gallons
delivery
delivery
Total receipts 
 ...................
(add each column; transfer these totals to Part 1, line 2, above)
*
 From Publication 902, Product Codes for Fuels

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