Form 72a170 - Monthly Terminal Report
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272A170 (7-07)
MONTHLY TERMINAL REPORT
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
Name of Terminal
MM/YY
Terminal Code
Location of Terminal
Name
FEIN
License Number
Address
City
State
ZIP Code
Phone Number
Net Gallons
Schedule No.
Gasoline Products
Special Fuels
1. Beginning inventory ......................................................
15A
2. Total receipts (Form 72A180) .......................................
3. Total gallons available ...................................................
4. Total disbursements (Form 72A181) .............................
15B
5. Gallons available (less disbursements) ........................
6. Stock gains and losses .................................................
7. Actual Ending Inventory ................................................
8. Allowance for actual loss (.0075 times line 3 but not to be
greater than line 6) ........................................................
9. Excessive actual loss not allowed (line 6 minus line 8)
Signature of Terminal Operator
Title
Date
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Parent category: Financial