Form 06-167 - Texas Diesel Tax Prepaid User Inventory Tax Report
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106-167
(11-03)
b.
TEXAS DIESEL TAX PREPAID USER
Please do not write in space above
INVENTORY TAX REPORT
43100
a.
e.
c. Taxpayer number
d. Period ending
f. Due date
DECEMBER 31, 2003
0401
02-25-2004
g. Taxpayer name and mailing address
h.
i.
WHO MUST FILE
Every diesel tax prepaid user who owes tax as calculated below, is required to file this report and pay tax of 20 cents per gallon on the gallons of
tax-free undyed (CLEAR) diesel fuel held in inventory at the close of business on December 31, 2003.
WHEN TO FILE
This report and payment must be filed on or before February 25, 2004. Do NOT file a report unless additional tax is due.
GENERAL INSTRUCTIONS
TYPE or PRINT all information in white areas only.
Complete all applicable items that are not preprinted.
If any preprinted information is not correct, mark out the incorrect item and write in the correct information.
ROUND ALL GALLONAGE FIGURES TO WHOLE GALLONS.
Submit payment by check or money order. Electronic payments are not available for this Inventory Tax Report.
You have certain rights under Ch. 559, Government Code, to review, request, and correct information
we have on file about you. Contact us at the address or toll-free number listed on this form.
1. Total gallons of tax-free undyed (clear) diesel fuel inventory
1.
on hand December 31, 2003
(Enter whole gallons)
2,000
2. Deduction of 2,000 gallons
2.
3. Taxable gallons
3.
(Item 1 minus Item 2; if less than zero, enter zero)
4. TAX DUE
4.
(Multiply Item 3 x .20)
06-167 (11-03)
5. Penalty
[IF REPORT IS FILED OR TAX PAID AFTER DUE DATE, enter penalty.
1-30 days late, enter 5% of Item 4. More than 30 days late, enter 10% of Item 4. (Minimum penalty is $1)]
5.
6. Interest
(If any tax due is unpaid 61 days after the due date, enter interest calculated on the amount in Item 4 at the rate published
online at < , or call the Comptroller's office toll free at 1-877-44RATE4 for the applicable rate.)
6.
$
7. TOTAL DUE
7.
(Item 4 plus Items 5 and 6)
Taxpayer name
j.
k.
T Code
Taxpayer number
Period
I declare that the information in this document and all attachments is true and correct
to the best of my knowledge and belief.
Authorized agent
Preparer's name (Please print)
Make the amount in Item 7 payable to STATE COMPTROLLER. The
mailing address is 111 E. 17th Street, Austin, TX 78774-0100.
Daytime phone
Date
(Area code & number)
If you have any questions regarding fuels tax, you may contact the Texas State
Comptroller's field office in your area or call 1-800-252-1383 toll free, nationwide. The
Austin number is 512/463-4600. If you are calling from a Telecommunications Device
for the Deaf (TDD), the toll free number is 1-800-248-4099, or in Austin, 512/463-4621.
111 A
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