Form 72a181 - Terminal Operator Schedule Of Disbursement

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72A181 (7-07)
Schedule 15B—Terminal Operator Schedule of Disbursement
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
Company Name
FEIN
Terminal Code
Product Code (See
Report Period MM/YY
instructions on page 2)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Carrier
Carrier
Mode
Dest.
Position Holder
Position Holder
Date
Document
Net
Gross
Name
FEIN
State
Name
FEIN
Shipped
Number
Gallons
Gallons
Total

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Parent category: Financial
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