Fillable Printable Form 4785 - Missouri Department Of Revenue
Fillable Printable Form 4785 - Missouri Department Of Revenue
Form 4785 - Missouri Department Of Revenue
Supplier
Supplier
Federal Employer I.D. Number
Beginning
Inventory
Total
Receipts
Total
Disbursements
Gain (Loss) Ending Inventory
Document Locator Number
Form
4785
Missouri Department of Revenue
Schedule of Terminal Operator Inventories Schedule 1/7A
Product Type
r 065 - Gasoline r 124 - Gasohol r 142 - Kerosene r 228 - Dyed Diesel Fuel r 290 - Bio-Diesel – Dyed B100
r 123 - Alcohol r 125 - Aviation Gasoline r 072 - Dyed Kerosene r 284 - Bio-Diesel – Undyed B100
r 225 - Liquefied Natural Gas (LNG)
r 241 - Ethanol r 130 - Jet Fuel r 160 - Diesel Fuel r 285 - Soy Oil r 122 - Blending Components (Identify)
Terminal Operator Terminal Code License Number Federal Employer I.D. Number Month and Year
__ __ /__ __ __ __
Mail to: Taxation Division Phone: (573) 751-2611
P.O. Box 300 Fax: (573) 522-1720
Jefferson City, MO 65105-0300 TTY: (800) 735-2966
E-mail: [email protected]
Form 4785 (Revised 01-2016)
Visit http://dor.mo.gov/business/fuel/
for additional information.
Page Total
Schedule Total
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One
Supplier Information
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Terminal Operator Inventory Schedule
Provides detail in support of the amount(s) shown as beginning inventory and actual ending inventory on the terminal report.
Complete a separate schedule for each product type.
Identifying Information
Company Name and Federal Employer Identification Number (FEIN):
Enter the name, license number and FEIN for the terminal operator shown on the terminal report.
Terminal Code:
Use the Internal Revenue Service Terminal Control Code.
Instructions
Supplier
Enter name and FEIN of company that owns the product as reflected on the records of the terminal operator.
Beginning Inventory
Enter the gallons held by each supplier at the beginning of the month.
Receipts
Enter the total number of gallons received during the month for the account of each supplier.
Disbursements
Enter the total number of gallons withdrawn during the month for the account of each supplier.
Gain (loss)
Enter the number of gallons gained or lost during the month for the account of each supplier.
Ending Inventory
Add the Beginning Inventory and Receipts, subtract the Disbursements, plus or minus the Gain (loss).
Enter figure for ending inventory. This should agree with figure on Line 7 of the terminal operator report.
Form 4785 (Revised 01-2016)
Instructions
