06-129-A
(7-00)
INSTRUCTIONS
b.
TEXAS SCHEDULE OF TAX FREE
PURCHASES FROM OTHER PERMIT HOLDERS
Gasoline Bonded Distributor
a.
06150 Original report
06153 Amended report
HP
c. Taxpayer number
d. Filing period
Diesel Fuel Bonded Supplier / Bonded User
07150 Original report
07153 Amended report
f.
e. Taxpayer name
PLEASE TYPE
GASOLINE PRODUCT TYPES
DIESEL FUEL PRODUCT TYPES
DO NOT WRITE
228 - Dyed diesel
072 - Dyed kerosene
065 - Gasoline
124 - Gasohol
125 - Aviation gasoline
130 - Jet fuel
IN SHADED AREAS
160 - Clear diesel
142 - Clear kerosene
1. Carrier name
2. Carrier
taxpayer
number
3. Seller name
HP
4. Seller
taxpayer
number
5. Prod.
6. Mode
7. Origin
9. Date
8. Dest.
type
removed
10. Shipping
11. Gross
12. Net
doc. no.
gallons
gallons
1. Carrier name
2. Carrier
taxpayer
number
3. Seller name
HP
4. Seller
taxpayer
number
5. Prod.
6. Mode
7. Origin
9. Date
8. Dest.
type
removed
10. Shipping
11. Gross
12. Net
doc. no.
gallons
gallons
1. Carrier name
2. Carrier
taxpayer
number
3. Seller name
HP
4. Seller
taxpayer
number
5. Prod.
6. Mode
7. Origin
8. Dest.
9. Date
type
removed
10. Shipping
11. Gross
12. Net
doc. no.
gallons
gallons
1. Carrier name
2. Carrier
taxpayer
number
3. Seller name
HP
4. Seller
taxpayer
number
5. Prod.
6. Mode
7. Origin
9. Date
8. Dest.
type
removed
10. Shipping
11. Gross
12. Net
doc. no.
gallons
gallons
1. Carrier name
2. Carrier
taxpayer
number
3. Seller name
HP
4. Seller
taxpayer
number
5. Prod.
6. Mode
7. Origin
9. Date
8. Dest.
type
removed
10. Shipping
11. Gross
12. Net
doc. no.
gallons
gallons
TOTAL NET GALLONS
TOTAL NET GALLONS
(Sum of Item 12)
FOR ALL PAGES
FOR THIS PAGE ONLY