Form 4754 - Schedule Of Terminal Operator Receipts Page 2
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1
2INSTRUCTIONS FOR TERMINAL REPORT — SCHEDULE OF RECEIPTS
General Instructions
Terminal Operator Receipt Schedule — provides detail in support of the amount(s) shown as receipts on the terminal report.
Each receipt of product into the terminal should be listed on separate lines. Complete a separate schedule for each product type.
If you have questions or need assistance in completing this form, please call (573) 751-2611 or e-mail excise@dor.mo.gov. You may also access the department’s web site at
to obtain this form.
Identifying Information
Company name and FEIN:
Enter the name, schedule type and FEIN for the terminal operator shown on the terminal report.
Terminal Code:
Use the IRS Terminal Control Code.
Schedule Type:
Schedule TR — Gallons received in the terminal.
Schedule 2X — Gallons received per exchange agreement.
Column Instructions
Columns 1 and 2:
Carrier — Enter the name and FEIN of the company that transports the product into the terminal.
Column 3:
Mode of Transport — Enter the mode of transport into the terminal. Use one of the following:
J = Truck
R = Rail
B = Barge
PL = Pipeline
S = Ship (Great lakes or ocean marine vessel)
BA = Book Adjustment
ST = Stationary Transfer
Columns 4 and 5:
Supplier — Enter name and FEIN of company that owns the product as reflected on the records of the terminal operator.
Column 6:
Date Received — Enter the date on which the product was received into the terminal.
Column 7:
Document Number — Enter the identifying number from the document issued at the terminal when product is removed from the rack. In case of
pipeline or barge movements, enter the pipeline or barge ticket number.
Columns 8 and 9:
Net Gallons — Enter the net amount of gallons received into the terminal. Complete a different sheet for each product type. The total net gallons for
each product type should be entered on Line 2 of the terminal operator’s report.
MO 860-2833 (11-2006)
DOR-3008 (11-2006)
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Parent category: Financial