Form Ft-941.1 - Terminal Operator'S Individual Account Reconciliation Page 2
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1
2FT-941.1 (5/07) (back)
Type of fue
l (in gallons)
Part 3 — Summary of withdrawals
*
Kerosene
No. 2 fuel oil
Diesel fuel
Gasoline
Other fuel
Product code
Total
(attach additional sheets, if necessary)
gallons
Withdrawals by truck or tank wagon (
) ...................................
enter the totals on this line
Withdrawals by all other methods
............................
(barge, pipeline, book transfer, etc.)
Month and
Mode of
Carrier’s name
Carrier’s FEIN
day of
withdrawal
withdrawal
(list each separately)
Total withdrawals
(Add each column. Be sure to include the gallons withdrawn by truck
........................................................
or tank wagon. Transfer totals to the front of the form, Part 1, line 4.)
*
From Publication 902, Product Codes for Fuels
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