Form 720-TO Terminal Operator Report

Form

720-TO

Terminal Operator Report

OMB No. 1545-1734

(Rev. September 2010)
Department of the Treasury
Internal Revenue Service

For the month ending

, 20

.

Corrected

Void

Terminal Operator

Part I
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

)

Terminal

Part II

Name of terminal

Terminal control number (TCN)

Terminal location

Transactions for the Month

Part III

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)
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.

(b)
PC:

(c)

(d)

PC:

PC:

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.

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 73072W

Form

720-TO

(Rev. 9-2010)

Form 720-TO (Rev. 9-2010)

Corrected

Terminal operator name as shown on Form 720-TO

Schedule A

EIN

TCN

Product Code (PC). Enter the PC (see instructions). A separate
schedule is required for each PC
1a Position Holder (PH) name. Enter PH name for PCs Bxx, Dxx,
and Exx. Enter one name per page.

2

Page
of
For more than one Schedule A, for each different PC, number each sheet. For
example, 1 of 4, 2 of 4, etc.

©

PH EIN

PH Form 637 registration number

Enter in the columns below the information requested for the PC on line 1 above.
(a)
Carrier
name

3

Page

Terminal Operator Receipts

1

2

Void

For the month ending (enter MM/DD/YYYY)

(b)
Carrier
EIN

(c)
Mode
code

(d)
Vessel official number
(required when mode code is
B, S, IB, IS, EB, or ES)

(e)
Document
date

(f)
Document
number

(g)
Net
gallons

Total. Add amounts in column (g) and enter the total. If there is more than one page for a PC, add the amounts from each page
and enter the result on the last page of Schedule A for that PC. Do not enter page subtotals. Enter the amount from column (g) on
©
Form 720-TO, Part III, line 2, in the column for the applicable PC
Form

3

720-TO

(Rev. 9-2010)

Form 720-TO (Rev. 9-2010)

Corrected

Terminal operator name as shown on Form 720-TO

Schedule B

EIN

TCN

Void

Page

3

For the month ending (enter MM/DD/YYYY)

Terminal Operator Disbursements by Position Holder

Position Holder name. Enter one name per page.

PH EIN

PH Form 637 registration number

Page

of

For more than one Schedule B, for each different PC, DS, or
MC, number each sheet. For example, 1 of 4, 2 of 4, etc.

1
2
3

Complete lines 1 through 4 for each PC.
Product Code (PC). Enter the PC (see instructions). A separate schedule is required for each PC

©

1

Destination State (DS). Enter the DS for each PC (see instructions). A separate schedule is required for each PC by state. PC 167 destined for Virginia
©
(VA) and Maryland (MD) requires two schedules

2

Mode Code (MC). Enter the MC (see instructions) for each PC for each DS. PC 167 destined for VA by truck and rail and destined for MD by truck and
©
rail would require four separate schedules: (1) PC 167, VA, rail; (2) PC 167, VA, truck; (3) PC 167, MD, rail; and (4) PC 167, MD, truck

3

Example. ABC Terminal is preparing Schedule B for disbursements made by position holder XYZ. XYZ disburses gasoline (PC 065), diesel fuel #2 low sulphur undyed
(PC 167), and jet fuel (PC 130) during the month destined for two states by truck. ABC must prepare six Schedules B to report XYZ’s transactions (3 PCs x 2 DSs). A
further breakdown by MC is not needed because only truck was used.
4

Enter in the columns below the information requested for the PC on line 1 above.
(a)
Carrier
name

5

(b)
Carrier
EIN

(c)
Vessel official number
(required when mode code is
B, S, IB, IS, EB, or ES)

(d)
Document
date

(e)
Document
number

Totals. Add all amounts in columns (f) and (g) for each PC, DS, or MC. If there are two MCs for a product destined for one
state, or if a product is destined for two states, then two Schedules B and totals are required. If there is more than one Schedule
B for a PC, DS, or MC, add the amounts from each schedule and enter the result on the last page of Schedule B for each
different PC, DS, or MC. Do not enter page subtotals. Enter the amount from column (f) for each PC on Form 720-TO, Part III,
©
line 4, in the column for the applicable PC

(f)
Net
gallons

(g)
Gross
gallons

5(f)

5(g)
Form

720-TO

(Rev. 9-2010)