Texas Common & Contract Carrier Report Form
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106-128
Do Not Staple or Paper Clip
(7-00)
b.
TEXAS COMMON & CONTRACT
Please do not write in space above
CARRIER REPORT
0123456789
Print your numerals
in boxes as shown
95100 Original report
95110 Amended report
a.
h.
c. Taxpayer number
d. Due date
e. Filing period
f.
Blacken this box if your address has changed.
1
Show changes by the preprinted information.
Taxpayer name and mailing address
g.
Blacken this box if you are no longer in
2
business and enter the
last business date
i.
j.
FM
INSTRUCTIONS FOR COMPLETING TEXAS COMMON AND CONTRACT CARRIER REPORT
WHO MUST FILE
SPECIFIC INSTRUCTIONS
Every common or contract carrier transporting gasoline or diesel fuel
Item 1- Complete the "Texas Schedule of Common and Contract
in Texas by truck. Failure to register with the comptroller or file a
Deliveries--Exports", (Form 06-134), to obtain the necessary
required quarterly report may result in the assessment of civil
information for this item and attach the schedule to this
penalty as prescribed by Chapter 153 of the Tax Code.
report.
WHEN TO FILE
Item 2- Complete the "Texas Schedule of Common and Contract
This report must be filed on or before the 25th day following the end
Deliveries--Imports", (Form 06-133), to obtain the necessary
of a calendar quarter for gasoline or diesel fuel transported during
information for this item and attach the schedule to this
the preceding quarter.
report.
GENERAL INSTRUCTIONS
Item 4- Enter the combined total gallons lost by handling, fire, theft,
Do not write in shaded areas.
or accident.
TYPE or PRINT.
Complete all applicable items that are not preprinted.
If you're interested in
If any preprinted information is not correct, please mark out the
ELECTRONIC TAX FILING
incorrect information and write in the correct information.
please call us at 1-800-442-3453, or
e-mail us at etf.cpa@cpa.state.tx.us
ROUND ALL GALLONAGE FIGURES TO WHOLE GALLONS.
ENTER WHOLE GALLONS
1. Total gallons of gasoline and diesel fuel loaded at a Texas terminal or bulk plant
1.
and delivered to another state.
(from attached Schedule for EXPORTS, Form 06-134)
2. Total gallons of gasoline and diesel fuel loaded at a location outside
2.
of Texas and delivered into Texas.
(from attached Schedule for IMPORTS, Form 06-133)
3. Total gallons of gasoline and diesel fuel loaded at a Texas terminal or
3.
bulk plant and delivered to a Texas location.
(
)
4.
4. Loss
5. Total gallons of gasoline and diesel fuel transported.
5.
(Total of Items 1, 2, and 3 minus Item 4)
I declare that the information in this document and any attachments is true and correct to the best of my
knowledge and belief.
Taxpayer or duly authorized agent
Mail to: COMPTROLLER OF PUBLIC ACCOUNTS
111 E. 17th Street
Austin, Texas 78774-0100
Daytime phone (Area code and no.)
Date
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.
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