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                                                                                                                                                             Document Locator Number
               Form
                   Distributor’s Schedule of Disbursements
               587
                                                                                                                                       Page ____ of ____

 Distributor’s Name                                                            License Number                      Federal Employers Identification Number (FEIN)  Schedule Type    Month and Year
                                                                                                                                                                                    __ __ /__ __ __ __

               5.  Gallons of dyed fuel sold for taxable purposes
               5W.  Gallons of tax-exempt product blended tax and fees unpaid                                                          r 065 - Gasoline             r 228 - Dyed Diesel Fuel
               7A.  Gallons exported to state of ___________________ (destination state tax paid) (Original and 1 copy)                r 123 - Alcohol              r 284 - Bio-Diesel – Undyed B100
               7B.  Gallons exported to state of ___________________ (Missouri tax paid) (Original and 1 copy)                         r 241 - Ethanol              r 285 - Soy Oil
               10A.  Gallons of tax-exempt product blended fees unpaid                                                                 r 124 - Gasohol              r 290 - Bio-Diesel – Dyed B100
               10G. Gallons of other authorized tax-exempt sales (alcohol, Bio-Diesel – Undyed B100)                                   r 125 - Aviation Gasoline    r 224 - Compressed Natural Gas (CNG)
               10J.  Gallons of undyed kerosene delivered to filling stations (barricaded pumps only)                     Product Type   142 - Clear Kerosene
                                                                                                                                       r 
                                                                                                                                                                    r 
 Schedule Type 10K.  Gallons delivered to airlines (Not applicable to CNG, LNG, and Propane)                                           r 130 - Jet Fuel               225 - Liquefied Natural Gas (LNG)
               10R.  Gallons delivered for use as bunker fuel in vessels (Not applicable to CNG, LNG, and Propane)                     r 072 - Dyed Kerosene        r 054 -  Propane
               10U.  Gallons fees exempt (CNG, LNG, and Propane only)                                                                                               r 122 -  Blending Components 
                                                                                                                                       r 160 - Clear Diesel Fuel
               10Y.  Gallons delivered to railroads (Not applicable to CNG, LNG, and Propane)                                                                         (Identify) _________________

                                                                       Point of
               Name of Carrier Carrier’s FEIN   Mode                                                  Sold To           Purchaser’s FEIN Date           Document      Net Gallons   Gross        Invoiced 
                                                                 Origin        Dest.                                                     Shipped             Number                 Gallons       Gallons

                                                                                                                                                        Page Total
Mail to:  Taxation Division                     Phone: (573) 751-2611                                 Visit                                             Schedule Total
                  P.O. Box 300                  Fax:  (573) 522-1720                 http://www.dor.mo.gov/business/fuel/
                  Jefferson City, MO 65105-0300 TTY:  (800) 735-2966                          for additional information.                                                           Form 587 (Revised 09-2017)
                                                E-mail:  excise@dor.mo.gov

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 excise@dor.mo.gov.  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.
Instructions
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.)