Form 3008 - Schedule Of Terminal Operator Disbursements 2015
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Document Locator Number (Department Use Only)
Form
3008
Missouri Department of Revenue
Schedule of Terminal Operator Disbursements
Terminal Operator
Terminal Code
r
Federal Employer Identification Number (FEIN)
Schedule Type
TD - Gallons Disbursed
Month and Year
Page
r
6X - Gallons Delivered per Exchange Agreement
___ ___ / ___ ___ ___ ___
of
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Select One Per Sheet:
r
r
r
123 - Alcohol
160 - Diesel Fuel
065 - Gasoline
r
r
r
125 - Aviation Gasoline
228 - Dyed Diesel Fuel
130 - Jet Fuel
r
r
r
290 - Bio-Diesel - Dyed B100
072 - Dyed Kerosene
142 - Kerosene
r
r
r
284 - Bio-Diesel – Undyed B100
241 - Ethanol
285 - Soy Oil
r
r
r
122 - Blending Components (Identify) __________________________________
124 - Gasohol
225 - Liquefied Natural Gas (LNG)
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8 Supplier’s
9 Date
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Document
Name of
Carrier’s
Exchange
Exchange
Supplier
FEIN
Shipped
Net
Gross
Dest.
Mode
Number
Carrier
FEIN
Part. FEIN
Partner
(MM/DD/YYYY)
Gallons
Gallons
State
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Page Total
Schedule Total
Form 3008 (Revised 04-2015)
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Parent category: Financial