Form 87 - Nebraska Motor Fuels Terminal Operator Report
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1Nebraska Motor Fuels Terminal Operator Report
FORM
87
• Read instructions and complete necessary schedules
nebraska
department
PLEASE DO NOT WRITE IN THIS SPACE
of revenue
Federal Employer Identification
Reporting Month
Nebraska Identification Number
GALLONS
Gasoline
Diesel
Other Products
1 Beginning inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2 Total receipts (attach Nebraska Motor Fuels Terminal
2
Operator Schedule of Receipts, Form 87). . . . . . . . . . . . . . . .
3 Total gallons available (line 1 plus line 2) . . . . . . . . . . . . . . . .
3
4 Total disbursements (attach Nebraska Motor Fuels Terminal
Operator Schedule of Disbursements, Form 87) . . . . . . . . . . .
4
5 Gallons available (line 3 minus line 4) . . . . . . . . . . . . . . . . . . .
5
6 Stock gains and losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7 Ending inventory (line 5 plus line 6). . . . . . . . . . . . . . . . . . . . .
7
Under penalties of law, I declare that I have examined this report and schedules, and to the best of my knowledge and belief, they are correct and complete.
sign
(
)
(
)
here
Authorized Signature
Telephone Number
Signature of Preparer Other than Taxpayer
Telephone Number
Title
Date
Address
Date
INSTRUCTIONS
WHO MUST FILE. Every person operating a motor
LINE 4. All disbursements must be reported in gross
fuels pipeline terminal facility in Nebraska must file
gallons.
a Nebraska Motor Fuels Terminal Operator Report,
PENALTY. A penalty of $50 will be imposed on delinquent
Form 87, with the appropriate Schedule of Receipts and
reports filed within 10 days after the due date. An additional
Schedule of Disbursements. The required data must be
penalty of $100 will be imposed on reports filed more than 10
filed via electronic data interchange (EDI).
days after the due date.
WHEN TO FILE. This report and appropriate schedules
RECORDS. The records required to substantiate this report
must be transmitted by the 20th of the month following
must be retained and available for at least three years, or five
the month covered by this report.
years if the required reports are not filed.
SPECIFIC INSTRUCTIONS
TAXPAYER ASSISTANCE. For additional information,
please contact the Motor Fuels Division, P.O. Box 98904,
LINE 1. Total from line 7 of the previous month.
Lincoln, NE 68509-8904 or telephone 402-471-5730, toll
LINE 2. Receipts of products imported through pipeline
free 800-554-FUEL (3835), or e-mail us through our Web
and transport. Receipts are reported in net gallons.
site at:
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