Form L-2120 - Tankwagon Importer Schedule Of Disbursements (Page 3 of 3) in pdf

Form L-2120 - Tankwagon Importer Schedule Of Disbursements Page 3

INSTRUCTIONS FOR L-2120

TANKWAGON IMPORTER SCHEDULE OF DISBURSEMENTS

Please note that the specific product code for biodiesel blends and gasohol must be indicated, i.e. E10-B20.

Complete a separate schedule for each schedule type and product type.

COLUMN 1 & 2: Carrier -

Not Required

COLUMN 3:

Mode of Transport - Not Required

COLUMN 4:

Point of Destination - Enter the name of the state of destination (abbreviations are acceptable).

COLUMN 5 & 6: Purchaser - Enter the name of the company that purchased the product and the federal identification

number if available.

COLUMN 7:

Date Shipped - Enter the date the product was shipped from the terminal or bulk plant.

COLUMN 8:

Document Number - Enter the identifying number from the document issued at the terminal where the

product was removed over the rack. For bulk plant imports use the invoice number or the delivery

ticket number.

COLUMN 9:

Billed Gallons - Enter the number of gallons billed to the customer. The total from column 9 will be the

amount you need to enter on the proper line on the user fee return.

45351012

L-2120 I

(Rev. 11/3/11) 4535

Form L-2120 - Tankwagon Importer Schedule Of Disbursements Page 3