Form 3781 (Schedule 15b) - Terminal Operator Schedule Of Disbursements Page 2
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23781, Page 2
102-TD
Instructions for Form 3781 for Schedule 15B - Terminal Operator Schedule of Disbursements
General Instructions
Schedule 15B provides detail in support of the amount(s) shown as disbursements on the Terminal Operator Monthly Report (Form 3716) for all position holders.
Michigan Terminals: Position Holders at in-state terminals must be licensed with the State of Michigan as Suppliers to store and disburse fuel.
Out-of-State Terminals: Position Holders at out-of-state terminals must be licensed with the State of Michigan as Suppliers or Permissive Suppliers to disburse
fuel destined for Michigan.
Identifying Information
Terminal Operator Name and FEIN - Enter the name and FEIN for the terminal operator shown on the Terminal Operator Monthly Report.
Terminal Control Number - Enter the Terminal Control Number (TCN) of the facility being reported. A separate Terminal Operator Monthly Report and schedules
are required for each terminal.
Report Period - Enter report period (example: 06/2001 or June 2001))
Product Codes - Enter the appropriate code on page 1. See the Terminal Operator Monthly Report instructions or Treasury's Web site for a list of product
codes.
Column Instructions
List each position holder separately and provide a subtotal for each. Information must be provided in each column.
Column (1) & (2):
Carrier/Transporter - Enter the name and FEIN of the company that transported the product from the terminal.
Column (3):
Mode of Transport - Enter the mode of transport from the terminal. Use one of the following:
PL = Pipeline
B = Barge
R = Rail
J = Truck
BA = Book Adjustment
S = Ship (Great Lakes or ocean marine vessel)
ST = Stationary Transfer
RT = Removal from terminal (other than by truck)
Column (4):
Destination State - Enter the state, province, territory or foreign country to which any motor fuel is directed for delivery into any storage
facility, receptacle, container, or any type of transportation equipment, for purpose of resale.
Column (5) & (6):
Position Holder/Receiving Exchange Partner - Enter the name and FEIN of the company that owns the product, or the supplier that
received the product on exchange, as reflected on the records of the terminal operator.
Column (7):
Date Shipped - Enter the date the carrier leaves the terminal with the product.
Column (8):
Document Number - Enter the bill of lading number from the document issued at the terminal when product is removed. In the case of
pipeline or barge movements, enter the pipeline, marine vessel or barge ticket number. The same Bill of Lading Number for BA and ST
transactions must be used for both Receipt and Disbursement schedules for each transaction.
Column (9):
Net Gallons - Enter the net gallons withdrawn from the terminal.
Column (10):
Gross Gallons - Enter the gross amount of gallons withdrawn from the terminal.
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