Terminal Operators Monthly Tax Return {FT-501}

State Form 46291 (R5 / 11-13) Form FT-501 Indiana Department of Revenue Terminal Operator's Monthly Tax Return Due date is the 20th of the following month. For the month of: _________________ 20______ A Terminal Operator's Report Must Be Filed For Each Indiana Location Name of License Holder (as indicated on license) Mailing Address City or Town Federal 637 License Number State Zip Code License Number FEIN/SSN Telephone Number Terminal Information Name of Terminal Location Net Gallons From Schedule Column A Special Fuel (Dyed and Clear Diesel Fuel, Biodiesel, Blended Biodiesel) Column B Gasoline (Gasoline, Gasohol) Column C Other Products (Jet Fuel, Kerosene) Terminal Code Monthly Transactions for Owned/Leased Terminal Space 1. 2. 3. 4. 5. Beginning Physical Inventory Total Receipts Total Disbursements Stock Gains & Losses (select one) + Ending Physical Inventory (Line 1 plus Line 2 minus Line 3 plus/minus Line 4) 501A 501B Mail to: Indiana Department of Revenue P.O. Box 6080 Indianapolis, IN 46206-6080 I do hereby certify under penalty of perjury that, for the terminal location indicated above, the foregoing and attached schedules and reports are a true and correct statement to the best of my knowledge and is a complete and full presentation of all transactions from the best information available. Taxpayer or Authorized Agent Typed or Printed Name Date Signed Title Telephone Number Please Check If Last Filing American LegalNet, Inc. www.FormsWorkFlow.com Instructions for Completing Form FT-501 Who should file the return? Every person who operates a terminal location in Indiana must file this return. If you operate more than one terminal location in Indiana, a separate return must be filed for each location. A Licensed Supplier and/or Licensed Gasoline Distributor operating a terminal in Indiana, must also include their own activity on this report. When is this return due? The Terminal Operator's Monthly Return, Form FT-501 is due by the 20th day of the month following the month for which the return is being filed. Example: A return for the reporting period of January is due by the 20th of February. If the 20th day of the month falls on a Saturday, Sunday or a state or national holiday, the due date of the return is the next succeeding day that is not a Saturday, Sunday or such holiday. To be considered timely filed by the department, the return must be postmarked no later than the due date of the return. How do I complete the FT-501? Indicate at the top of the return, the reporting period for which you are filing. Enter your company's identifying information as it is reflected on your Indiana Fuel Tax License. Complete the terminal information section. A separate FT-501 and accompanying schedules must be completed for each terminal location. Line 1: Enter the actual beginning inventory for each fuel type listed, for the reporting period. This amount should agree with your ending inventory amount from Line 5 of your previous month's Terminal Operator Monthly Return, FT-501. Line 2: Enter the net gallons received into your terminal during the reporting period. This amount should come from Column 8 of your supporting Schedule(s) 501A. Line 3: Enter the net gallons disbursed from your terminal for reporting period. This amount should come from Column 9 of your supporting Schedule(s) 501B. Line 4: Enter any discrepancies that result from stock gains or losses. Be certain that you select either the "+/-" sign in the box to the left indicating a gain or a loss. Line 5: Enter your actual ending inventory for the reporting period. Note: Line 1, plus Line 2, minus Line 3, plus or minus Line 4 should equal Line 5. In a month to month comparison, the beginning inventory of this month (Line 1) should match the ending inventory (Line 5) from last month's report. Schedule 501A Schedule 501A details all receipt transactions, by position holder (the position holder is the person who owns or leases storage space in your terminal), that support the Schedule 501I summary. Schedule 501B Schedule 501B details all disbursement transactions, by position holder, that support the Schedule 501I summary. This schedule(s) provides detail to support the amount(s) shown as disbursements on the Terminal Operator's Return FT-501. Each disbursement of product should be listed on a separate line. A separate Schedule 501B should be completed for each product type. Fuel disbursements should be grouped together by position holder. Schedule 501I Schedule 501I summarizes, by position holder, the total terminal activity by product for the month. This schedule provides position holder detail to support the amount(s) shown as beginning/ending inventories, receipts, disbursements, and stock gains/losses on the Terminal Operator's Monthly Return, FT-501. To Obtain Forms To obtain forms visit our website at www.in.gov/dor/3512.htm. If you have additional questions: For assistance call (317) 615-2630 or email fetax@dor.in.gov. American LegalNet, Inc. www.FormsWorkFlow.com