Form Terminal Operator Report OMB No. 1545-1734

(Rev. January 2004)

Department of the Treasury

Internal Revenue Service For the month ending , 20 .

Company name Employer Identification Number (EIN)

Address (number, street, room or suite number)

Terminal

Beginning inventory.

For Privacy Act and Paperwork Reduction Act Notice, see page 5 of the instructions. Form 720-TO (Rev. 1-2004)

1

Cat. No. 73072W

720-TO

Part III

Part I

Part II

City, state, and ZIP code

Contact person

Terminal Operator

Name of terminal

Terminal location

Transactions for the Month

Form 637 Registration Number

Email address

Terminal Control Number (TCN)

Total receipts. Enter the total net

gallons from Schedule(s) A, column

(f), by product code.

2

Total gallons available. Add lines 1

and 2.

3

Total disbursements. Enter the total

net gallons from Schedule(s) B,

column (e). If you have disbursements

for more than one position holder for a

product code, add the amounts from

each position holder’s Schedule B and

enter the combined total by product

code here.

4

5 Subtract line 4 from line 3.

Stock gains and losses. Show

losses in (parentheses).

6

Actual physical ending inventory at

terminal.

7

Under penalties of perjury, I declare that I have examined this return and accompanying schedules, and, to the best of my knowledge and belief, they are true, correct,

and complete.

Signature  Title, if applicable  Date 

Enter the transactions for the period on Schedules A and B, then complete lines

1 through 7 for each product code (PC). See page 6 of the instructions for the

product codes.

Daytime telephone number Fax number

() ()

Net Gallons (attach additional schedule(s) if needed)

(a)

PC:

(b)

PC:

(c)

PC:

(d)

PC:

Type or print your name below signature.

Corrected Void
product code from page 6 of the

e is required for each PC 

20-TO

(b)

Carrier

EIN

(c)

Mode of

transportation

(d)

Document

date

(e)

Document

number

(f)

Net

gallons

Page 2

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

umn (f) for each different PC. If there is more than one page for a PC, add the amounts from each

e last page of Schedule A for that PC. Do not enter page subtotals. Also, include the amount from

 2, in the column for the applicable PC 

ator Receipts

Form 720-TO (Rev. 1-2004)

Corrected Void

PageFor more than one Schedule A, for each different PC, number each sheet. Forexample, 1 of 4, 2 of 4, etc.

of

e information requested for the PC on line 1 above.

3

1
20-TO

ator Disbursements by Position Holder

e name per page. PH EIN PH Form 637 Registration Number

Page 3

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

mns (e) and (f) for each PC, DS, or MT. If there are two modes of transportation for a product

uct is destined for two states, then two Schedules B and totals are required. If there is more than

MT, add the amounts from each schedule and enter the result on the last page of Schedule B for

ot enter page subtotals. Also include the amount from column (e) for each PC on Form 720-TO,

ble PC 

(c)

Document

date

(d)

Document

number

(e)

Net

gallons

(f)

Gross

gallons

product code from page 6 of the instructions. A separate schedule is required for each PC 

(b)

Carrier

EIN

Form 720-TO (Rev. 1-2004)

Corrected Void

aring Schedule B for disbursements made by position holder XYZ. XYZ disburses gasoline (PC 065), diesel fuel #2 low sulphur undyed

uring the month destined for two states by truck. ABC must prepare six Schedules B to report XYZ’s transactions (3 product codes x 2

akdown by mode of transportation is not needed because only truck was used.

 Enter the mode of transportation (see page 3 of the instructions) for each product code for each destination state.

k and rail and destined for Maryland by truck and rail would require four separate schedules: (1) PC 167, VA, rail;

MD, rail; and (4) PC 167, MD, truck 

Page of

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

the destination state for each product code from page 7 of the instructions. A separate schedule is required for

for Virginia (VA) and Maryland (MD) requires 2 schedules 

formation requested for the product code on line 1 above.

1

2

3

ch product code.

5e 5f