Form Ft-941 - Terminal Operator'S Monthly Report Of Diesel Motor Fuel And Motor Fuel Inventory

FT-941

New York State Department of Taxation and Finance

Terminal Operator’s Monthly Report of

(6/12)

Diesel Motor Fuel and Motor Fuel Inventory

For the month of

,

.

This report is due the 25th of the following month.

(month)

(year)

Type or print clearly. Read instructions, Form FT-941/941.1-I, carefully.

Name of terminal operator

Federal employer identification number (FEIN)

Business address

Address of facility

(street)

(street)

City, state and ZIP code

City, state and ZIP code

A

............... Mark an X in this box if you are registered under Article 12-A as a motor fuel distributor, a diesel motor fuel distributor, a retailer of non-highway diesel motor fuel

only, or a distributor of kero-jet fuel only, and you store only your own fuel. If so, you do not have to complete Form FT-941, lines 1 through 4, or Form FT-941.1.

B

...... Enter the number of Form(s) FT-941.1, Terminal Operator’s Individual Reconciliation, attached.

Type of fuel stored

(in gallons)

Kerosene

No. 2 fuel oil

Diesel fuel

Gasoline

Other fuel

Total gallons

1 Tot al book inventory

) ........................

(totals from attached Forms FT-941.1

2 Physical inventory .................................................................................

3 Inventory difference

(subtract line 2 from line 1 and explain below; enter

......................................................................

any loss in brackets ( [ ] ))

4 Date of physical inventory

.........................................................

(mm-dd)

Explain the inventory difference amount reported on line 3:

Mail this form and all required attachments to: NYS TAX DEPARTMENT, PETROLEUM TRACKING UNIT, PO BOX 5500, ALBANY NY 12205-0500.

For information about private delivery services, see instructions.