Form R-5385 - Terminal Operator Annual Report
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1TAXPAYER ACCOUNT ID
TAXPAYER NAME
ADDRESS 1
ADDRESS 2
CITY STATE ZIP
R-5385 (1/08) Batch Type 513 or 514
If your name has
If your address has
If amended return,
If final return,
O
O
O
O
changed, mark circle.
changed, mark circle.
mark circle.
mark circle.
TERMINAL OPERATOR ANNUAL REPORT
Mail to:
Louisiana Department of Revenue
P. O. Box 201
Baton Rouge, LA 70821-0201
(225) 219-7656 (225) 219-2114 (TDD)
FOR OFFICE USE ONLY.
Field flag
TOA
Filing
Period_____________________
FEIN__________________________
TCN_____________________
MM/YY
A
B
C
D
E
Computation of
Undyed
Dyed
Aviation
Unaccounted For Losses
Gasohol
Gasoline
Diesel Fuels
Diesel Fuels
Fuels
1
Actual beginning inventory
2
Total receipts (Sch. K – R-5386)
Stock gains (Sch. L – R-5387)
3
Gallons available
4
(Add Lines 1, 2, & 3.)
Fuel removed from terminal
5
across rack (Sch. M – R-5388)
Fuel removed from terminal as a
6
bulk transfer (Sch. M – R-5388)
Accounted for losses
7
(Sch. N – R-5389)
8
Stock losses (Sch. L – R-5387)
Disbursements
9
(Add Lines 5, 6, 7, & 8.)
Computed ending inventory
10
(Subtract Line 9 from Line 4.)
11
Actual ending inventory
12
Unaccounted for loss
13
Loss allowance (Line 9 X .005.)
14
Taxable unaccounted for loss
15
Tax due (Line 14 X $.20.)
00
00
00
Inspection fee due
16
00
00
00
00
00
(Line 14 X $.00125.)
Total Tax and Fee Due
17
00
00
00
00
00
(Add Line 15 and Line 16.)
18
Total Due (Add Columns A through E, Line 17.)
18 $
00
19
Penalty (See instructions.)
19 $
00
Interest (See instructions.)
20
20 $
00
Total Amount Due (Enter the total of Lines 18, 19, and 20.)
21
PAY THIS AMOUNT. 21 $
00
Make payment to: Louisiana Department of Revenue.
Do not send cash.
This report and payment are due on or before the last day of February and becomes delinquent on the first day thereafter. If the due date falls on a
weekend or legal holiday, the report is due the next business day.
Under the penalties of perjury, I declare that I have examined this return, including all accompanying documents, and to the best of my knowledge and
belief, it is true, correct, and complete. If the return is prepared by a person other than the taxpayer, his declaration is based on all the information
relating to the matters required to be reported of which he has any knowledge.
Date
Signature
Title
Telephone number
Date
Signature of preparer other than taxpayer
Preparer ID
Telephone number
Complete only if change in business status has occurred. Please print or type.
Date business discontinued
Date business sold
Name of purchaser
7623
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Parent category: Financial