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FT-941 / 941.1-I (9/98) (back)

– Enter identifying information requested for both the

– The name of the transporter from the facility.

terminal operator and the individual account, and include

– The importing /exporting transporter’s federal employer

the account identiﬁcation numbers.

identiﬁcation number (EIN).

– Enter the information in Parts I, II and III (in gallons), by

– The number of gallons of each type of fuel withdrawn

type of fuel.

and total gallons removed from inventory. Total each

column of this part for each account and transfer these

Part I – Reconciliation for Each Type of Fuel

totals to Part I , line 4. Be sure to include the gallons

Line 1 — Enter the book inventory at the beginning of

withdrawn by truck or tank wagon reported on the top

month. If different from the prior month’s ending inventory

line.

attach an explanation.

Need Help?

Line 2 — Enter the total receipts as shown in Part II.

Telephone Assistance is available from 8:30 a.m. to 4:25 p.m.

Line 3 — Add lines 1 and 2 and enter the totals.

(eastern time), Monday through Friday. For tax information, call

Line 4 — Enter the total withdrawals as shown in Part III.

toll free 1 800 225-5829. To order forms and publications, call

toll free 1 800 462-8100. From areas outside the U.S. and

Line 5 — Subtract line 4 from line 3 and enter the balance

outside Canada, call (518) 485-6800.

in each column.

Fax-on-Demand Forms Ordering System - Most forms are

Line 6 — Enter any adjustments to this account and

available by fax 24 hours a day, 7 days a week. Call toll free from

indicate any loss in brackets.

the U.S. and Canada 1 800 748-3676. You must use a Touch

Line 7 — If line 6 is a gain, add lines 5 and 6 and enter

Tone phone to order by fax. A fax code is used to identify each

the total. If line 6 is a loss, subtract line 6 from line 5 and

form.

enter the result. Include these amounts in the book

inventory for the facility reported on Form FT-941, line 1.

Internet Access -

Access our website for forms, publications, and information.

Part II – Summary of Receipts

Hotline for the Hearing and Speech Impaired - If you have

A. Intrastate truck or tank wagon receipts:

access to a telecommunications device for the deaf (TDD), you

can get answers to your New York State tax questions by calling

A single combined entry may be used for intrastate truck

toll free from the U.S. and Canada 1 800 634-2110. Assistance is

or tank wagon receipts (if no importation into New York

available from 8:30 a.m. to 4:15 p.m. (eastern time), Monday

State is involved and the same transporter is used). If

through Friday. If you do not own a TDD, check with independent

you elect to combine receipts, you must enter the

living centers or community action programs to ﬁnd out where

number of individual deliveries in the Method of delivery

machines are available for public use.

column (example: T /T (8)) and enter the total gallons of

each type of fuel.

Persons with Disabilities - In compliance with the Americans

with Disabilities Act, we will ensure that our lobbies, ofﬁces,

B. For all other receipts into this account during the month,

meeting rooms, and other facilities are accessible to persons with

the following information must be entered:

disabilities. If you have questions about special accommodations

for persons with disabilities, please call the information numbers

– The month and day of delivery.

listed above.

– The method of delivery (barge, pipeline, book

transfer, etc.).

Mailing Address - If you need to write, address your letter to:

NYS Tax Department, Taxpayer Assistance Bureau, W A Harriman

– The Uniform Manifest number (Form FT-960 or

Campus, Albany NY 12227.

FT-970) assigned to the delivery.

– The name of the transporter making the delivery.

Privacy Notiﬁcation

– The importing/exporting transporter’s federal

The right of the Commissioner of Taxation and Finance and the

Department of Taxation and Finance to collect and maintain

employer identiﬁcation number (EIN) if motor fuel is

personal information, including mandatory disclosure of social

being imported into New York State.

security numbers in the manner required by tax regulations,

– The number of gallons of each type of fuel received

instructions, and forms, is found in Articles 8, 12-A, 13-A, 21, and

and the total gallons of each delivery. Total each

21-A of the Tax Law and 42 USC 405(c)(2)(C)(i).

column of this part and transfer these totals to Part I,

line 2.

The Tax Department will use this information primarily to

determine and administer the gas and diesel motor fuel,

petroleum, highway use, and fuel use taxes under Articles 12-A,

Part III – Summary of Withdrawals

13-A, 21, and 21-A of the Tax Law, and for any other purpose

Withdrawals by truck or tank wagon

authorized by law.

Enter the total gallons for each type of fuel and the total

Failure to provide the required information may result in civil or

gallons withdrawn from the account by truck or tank wagon

criminal penalties, or both, under the Tax Law. In some cases,

during the month.

failure to provide the required information may result in denial,

cancellation, or suspension of a registration as a distributor of

Withdrawals by all other methods

motor fuel or of a license as a terminal operator or importing/

For all other withdrawals (barge, pipeline, book transfer,

exporting transporter.

etc.), enter the following information for each withdrawal:

This information will be maintained by the Director of the

– The month and day the fuel was withdrawn from the

Registration and Data Services Bureau, NYS Tax Department,

account.

Building 8 Room 924, W A Harriman Campus, Albany NY 12227;

– The method of withdrawal (barge, pipeline, book transfer,

telephone 1 800 225-5829. From areas outside the U.S. and

etc.).

outside Canada, call (518) 485-6800.

Instructions For Forms Ft-941 And Ft-941.1 - Terminal Operator'S Monthly Report Of Diesel Motor Fuel And Motor Fuel Inventory And Terminal Operator'S Individual Account Reconciliation Page 2

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