720-TO                                                                                                               OMB No. 1545-1734
 Form                                            Terminal Operator Report                                                   
(Rev. September 2010)
                                                  
Department of the Treasury
Internal Revenue Service                          For the month ending                 , 20   .                             Corrected   Void
                                                                                                                                         
 Part I          Terminal Operator
       
 Company name                                                                                      Employer identification number (EIN)

 Address (number, street, room or suite number)                                                    Form 637 registration number

City, state, and ZIP code

Contact person                          Daytime telephone number Fax number                         Email address
                                        (       )                (              )
                                                                                 
 Part II         Terminal
                  
Name  of terminal                                                                                  Terminal control number (TCN)

Terminal location

 Part III        Transactions for the Month
                  
                                                  Net Gallons (attach additional schedule(s) if needed)
                                                  Enter the transactions       for the period on Schedules A and B, then complete lines
                                                  1 through 7 for each product code (PC) (see the instructions).
                                                   
                                                          (a)                      (b)                      (c)                   (d)
                                                  PC:                  PC:                         PC:                        PC:  
                                                                                                                               
 1    Beginning inventory.
       
 2    Total receipts. Enter the total net
      gallons from Schedule(s) A, column
      (g), by PC.
       
 3    Total gallons available. Add lines 1
      and 2.
 4     Total disbursements. Enter the
      total net gallons from Schedule(s) B,
      column (f). If you have
      disbursements for more than one
      position holder for a PC, add the
      amounts from each position holder’s
      Schedule B and enter the combined
      total by PC.
       
 5    Subtract line 4 from line 3.
       
 6    Stock gains and losses. Show
      losses in (parentheses).
 7      Actual physical ending inventory at
      terminal.
       
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete.
 
Signature                                                 Title, if applicable                                           Date
                                                                                                                                
Type or print your name below signature.
 
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.               Cat. No. 73072W         Form 720-TO (Rev. 9-2010)

 Form 720-TO (Rev. 9-2010)                                                                                                           Corrected     Void                   Page2  
 Terminal operator name as shown on Form 720-TO                          EIN                TCN                                    For the month ending (enter MM/DD/YYYY)

 Schedule A             Terminal Operator Receipts
                         
                                                                                         Page                        of
 1    Product Code (PC).   Enter the PC (see instructions). A separate                     For more than one Schedule    A, for each different PC, number each sheet. For
      schedule is required for each PC                                                   example, 1 of 4, 2 of 4, etc.
 1a   Position Holder (PH) name.         Enter PH name for PCs Bxx, Dxx,         PH EIN  PH Form 637 registration number
      and Exx. Enter one name per page.                                                   
       
 2    Enter in the columns below the information requested for the PC on line 1 above.
                    (a)                           (b)                        (c)           (d)                       (e)                   (f)                  (g)
                   Carrier                        Carrier                Mode           Vessel official number      Document         Document                   Net
                   name                           EIN                    code           (required when mode code is date               number                  gallons
                                                                                        B, S, IB, IS, EB, or ES)                                                
                                                                                         
 3    Total. Add amounts in column (g) and enter the total. If there is more than one page for a PC, add the amounts from each page
      and enter the result on the last page of Schedule A for that PC. Do not enter page subtotals. Enter the amount from column (g) on
      Form 720-TO, Part III, line 2, in the column for the applicable PC                                                                                3
                                                                                                                                                    
                                                                                                                                                   Form 720-TO (Rev. 9-2010)
                                                                                                                                                                 

 Form 720-TO (Rev. 9-2010)                                                                                                                  Corrected      Void                     Page3  
 Terminal operator name as shown on Form 720-TO                     EIN                        TCN                                           For the month ending (enter MM/DD/YYYY)

 Schedule B         Terminal Operator Disbursements by Position Holder
                     
  Position Holder name. Enter one name per page.                          PH EIN             PH Form 637 registration number Page                          of
                                                                                                                              For more than one Schedule B, for each different PC, DS, or
                                                                                                                             MC, number each sheet. For example, 1 of 4, 2 of 4, etc.
      Complete lines 1 through 4 for each PC.                                                                                 
 1     Product Code (PC). Enter the PC (see instructions). A separate schedule is required for each PC                                                                   1
   2                                                                                                                                                                      
      Destination State (DS). Enter the DS for each PC (see instructions). A separate schedule is required for each PC by state. PC 167 destined for Virginia
      (VA) and Maryland (MD) requires two schedules                                                                                                                      2
                                                                                                                                                                          
 3    Mode Code (MC). Enter the MC (see instructions) for each PC for each DS. PC 167 destined for VA by truck and rail and destined for MD by truck and
      rail would require four separate schedules: (1) PC 167, VA, rail; (2) PC 167, VA, truck; (3) PC 167, MD, rail; and (4) PC 167, MD, truck                           3
                                                                                                                                                                          
      Example. ABC Terminal is preparing Schedule B for disbursements made by position holder XYZ. XYZ disburses gasoline (PC 065), diesel fuel #2 low sulphur undyed
      (PC 167), and jet fuel (PC 130) during the month destined for two states by truck. ABC must prepare six Schedules B to report XYZ’s transactions (3 PCs x 2 DSs). A
      further breakdown by MC is not needed because only truck was used.
 4    Enter  in the columns below the information requested for the PC on line 1 above.
                     (a)                          (b)                     (c)                  (d)      (e)                                          (f)                   (g)
                   Carrier                       Carrier        Vessel official number       Document  Document                                      Net                  Gross
                   name                           EIN       (required when mode code is       date     number                                    gallons                  gallons
                                                                B, S, IB, IS, EB, or ES)                                                                                   
                                                                 
 5    Totals. Add all amounts in columns (f) and (g) for each PC, DS, or MC. If there are two MCs for a product destined for one
      state, or if a product is destined for two states, then two Schedules B and totals are required. If there is more than one Schedule
      B for a PC, DS, or MC, add the amounts from each schedule and enter the result on the last page of Schedule B for each
      different PC, DS, or MC. Do not enter page subtotals. Enter the amount from column (f) for each PC on Form 720-TO, Part III,
      line 4, in the column for the applicable PC                                                                                        5(f)                      5(g)
                                                                                                                                   
                                                                                                                                                           Form  720-TO (Rev. 9-2010)