Terminal Operators Schedule Of Receipts {Schedule 501A}

State Form 49088 10-03 Schedule 501A Terminal Operator's Schedule of Receipts License Number FEIN Terminal Code Month/Year Terminal Operator Name You may photocopy this blank schedule for future filings. Attach additional sheets if necessary. Product Code/Type (Check One) For Use with Reporting Special Fuel 142 Kerosene 161 Low Sulphur Diesel #1 - undyed 167 Low Sulphur Diesel #2 - undyed 226 High Sulphur Diesel - dye added 227 Low Sulphur Diesel - dye added 231 No. 1 Diesel - dye added 284 Biodiesel - undyed 290 Biodiesel - dye added OTH Other For Use with Reporting Gasoline/Oil Inspection 065 Gasoline 124 Gasohol 125 Aviation Gasoline 130 Jet Fuel Gasoline 142 Kerosene 150 #1 Fuel Oil - undyed 161 Low Sulphur Diesel #1 - undyed 231 No. 1 Diesel - dye added 241 Ethanol 243 Methanol 282 #1 High Sulphur Diesel - undyed OTH Other Transporter Information Position Holder Information (1) Name (2) FEIN (3) Mode (4) Name/ Address (5) FEIN (6) Document Date (7) Document Number (8) Net Gallons Total American LegalNet, Inc. www.FormsWorkflow.com Instructions for Completing Terminal Operator's Schedule of Receipts Schedule 501A Before You Begin: Enter your identifying information as it is reflected on your Indiana Fuel Tax License. (Be certain to complete a separate schedule for each fuel product type that you check.) Column Instructions: Columns 1 and 2: Enter the name and Federal Employer's Identification Number (FEIN) of the company that transports the fuel. This may be you. Column 3: Enter the mode of transport. One of the following codes should be used for each entry. J R ST S = = = = Truck Rail Stock Transfer Ship (Great Lakes or Ocean Vessel) P L = Pipeline B = Barge BA = Book Adjustment Columns 4, 5, 6 and 7: Enter the position holder's information as well as the shipping document date and number. The Position Holder is the person who owns/leases storage space in the terminal. Column 8: Enter the net gallons received. The grand total of all Schedule 501A, Column 8, should be carried to the FT-501, Terminal Operator's Monthly Return. For product types 142, 161, 167, 226, 227, 231, 284, and 290, carry this total to Line 2, Column A of the FT-501. For product types 065, 124, 125, 241, and 243, carry this total to Line 2, Column B of the FT-501. For product types 130, 142, 150, 161, or Other, carry this total to Line 2, Column C of the FT-501. NOTE: You must subtotal by position holder on the Schedule 501A and carry these subtotals to Schedule FT-501I, Column 4. American LegalNet, Inc. www.FormsWorkflow.com