Form R-5389 - Schedule N - Terminal Operator - Annual Return Reconciliation Schedule Of Accounted For Losses

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R-5389 (8/07)
Terminal Operator - Annual Return
Schedule N
Reconciliation Schedule of
Accounted for Losses
Company Name
LA Revenue Account Number
TCN
Filing Period
Month
Gasohol
Gasoline
Undyed Diesel Fuels
Dyed Diesel Fuels
Aviation Fuels
January
February
March
April
May
June
July
August
September
October
November
December
Total
This schedule is a summary of the losses reported during the reporting period that were previously reported to the Department and claimed on Line 4 of the Terminal Operator Monthly Return.

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