Form 720-To - Terminal Operator Report
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3720-TO
Terminal Operator Report
OMB No. 1545-1734
Form
(Rev. September 2010)
Department of the Treasury
For the month ending
, 20
.
Corrected
Void
Internal Revenue Service
Part I
Terminal Operator
Company name
Employer identification number (EIN)
Address (number, street, room or suite number)
Form 637 registration number
City, state, and ZIP code
Contact person
Daytime telephone number
Fax number
Email address
(
)
(
)
Part II
Terminal
Name of terminal
Terminal control number (TCN)
Terminal location
Part III
Transactions for the Month
Net Gallons (attach additional schedule(s) if needed)
Enter the transactions for the period on Schedules A and B, then complete lines
1 through 7 for each product code (PC) (see the instructions).
(a)
(b)
(c)
(d)
PC:
PC:
PC:
PC:
1
Beginning inventory.
2
Total receipts. Enter the total net
gallons from Schedule(s) A, column
(g), by PC.
3
Total gallons available. Add lines 1
and 2.
4
Total disbursements. Enter the
total net gallons from Schedule(s) B,
column (f). If you have
disbursements for more than one
position holder for a PC, add the
amounts from each position holder’s
Schedule B and enter the combined
total by PC.
5
Subtract line 4 from line 3.
6
Stock gains and losses. Show
losses in (parentheses).
7
Actual physical ending inventory at
terminal.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete.
Signature
Title, if applicable
Date
Type or print your name below signature.
720-TO
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 73072W
Form
(Rev. 9-2010)
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