Fillable Printable Form 587 - Distributor'S Schedule Of Disbursements
Fillable Printable Form 587 - Distributor'S Schedule Of Disbursements
Form 587 - Distributor'S Schedule Of Disbursements
Product Type
r 065 - Gasoline
r 123 - Alcohol
r 241 - Ethanol
r 124 - Gasohol
r 125 - Aviation Gasoline
r 142 - Clear Kerosene
r 130 - Jet Fuel
r 072 - Dyed Kerosene
r 160 - Clear Diesel Fuel
5. Gallons of dyed fuel sold for taxable purposes
5W. Gallons of tax-exempt product blended tax and fees unpaid
7A. Gallons exported to state of ___________________ (destination state tax paid) (Original and 1 copy)
7B. Gallons exported to state of ___________________ (Missouri tax paid) (Original and 1 copy)
10A. Gallons of tax-exempt product blended fees unpaid
10G. Gallons of other authorized tax-exempt sales (alcohol, Bio-Diesel – Undyed B100)
10J. Gallons of undyed kerosene delivered to filling stations (barricaded pumps only)
10K. Gallons delivered to airlines (Not applicable to CNG, LNG, and Propane)
10R. Gallons delivered for use as bunker fuel in vessels (Not applicable to CNG, LNG, and Propane)
10U. Gallons fees exempt (CNG, LNG, and Propane only)
10Y. Gallons delivered to railroads (Not applicable to CNG, LNG, and Propane)
r 228 - Dyed Diesel Fuel
r 284 - Bio-Diesel – Undyed B100
r 285 - Soy Oil
r 290 - Bio-Diesel – Dyed B100
r 224 - Compressed Natural Gas (CNG)
r 225 - Liquefied Natural Gas (LNG)
r 054 - Propane
r 122 - Blending Components
(Identify) _________________
Schedule Type
__ __ /__ __ __ __
Distributor’s Name License Number Federal Employers Identification Number (FEIN) Schedule Type Month and Year
Name of Carrier
Carrier’s FEIN
Mode
Origin Dest.
Point of
Sold To
Purchaser’s FEIN
Date
Shipped
Document
Number
Net Gallons
Gross
Gallons
Invoiced
Gallons
Page Total
Schedule Total
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 587 (Revised 09-2017)
Visit
http://www.dor.mo.gov/business/fuel/
for additional information.
Form
587
Missouri Department of Revenue
Distributor’s Schedule of Disbursements
Document Locator Number
Page ____ of ____
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Instructions
This schedule(s) provides detail in support of the amount(s) shown as disbursements on Form 4757, Distributor’s Monthly Tax Report.
Each disbursement of product should be listed on a separate line. Complete a separate schedule for each product type.
If you have questions or need assistance in completing this form, please call (573) 751-2611 or e-mail [email protected]. You may also access the Department’s
website at http://dor.mo.gov/forms/index.php?category=18 to obtain this form.
Name of Carrier Enter the name and FEIN of the company that transports the product.
Mode of Transport Enter the mode of transport from the terminal. Use one of the following:
J = Truck R = Rail B = Barge PL = Pipeline
BA = Book Adjustment ST = Stationary Transfer
Point of Origin and
Destination Enter the location the product was transported from and to. When disbursements are received from a terminal, use the IRS Terminal Control Code.
Sold To and FEIN Enter the name and FEIN or SSN of the purchaser.
Date Shipped Enter the date the product was sold.
Document Number Enter the identifying number from the document issued at the terminal when product is removed from the rack. In case of pipeline or barge
movements, enter the pipeline or barge ticket number.
Net Gallons Enter the net amount of gallons disbursed.
Gross Gallons Enter the gross amount of gallons disbursed.
Invoiced Gallons Enter the number of gallons billed (should equal either net or gross gallons).
(Use these figures to complete the worksheet on the reverse side of Form 4757, Distributor’s Monthly Tax Report.)
