06-147
(Rev.3-06/2)
b.
<choose one>
a.
DO NOT WRITE IN SHADED AREAS
TYPE or PRINT
TEXAS SCHEDULE OF GALLONS
c. Taxpayer number
d. Filing period
PURCHASED IN TEXAS FOR BLENDING
(Item 3)
f.
e. Taxpayer name
1. Transporter name
2. Transporter taxpayer number
3. Seller name
4. Seller taxpayer number
5. Product type
6. Mode
7. Date removed
8. Shipping doc. no.
9. Terminal control number
10. Invoiced gallons
1. Transporter name
2. Transporter taxpayer number
3. Seller name
4. Seller taxpayer number
5. Product type
6. Mode
7. Date removed
8. Shipping doc. no.
9. Terminal control number
10. Invoiced gallons
1. Transporter name
2. Transporter taxpayer number
3. Seller name
4. Seller taxpayer number
5. Product type
6. Mode
7. Date removed
8. Shipping doc. no.
9. Terminal control number
10. Invoiced gallons
1. Transporter name
2. Transporter taxpayer number
3. Seller name
4. Seller taxpayer number
5. Product type
6. Mode
7. Date removed
8. Shipping doc. no.
9. Terminal control number
10. Invoiced gallons
1. Transporter name
2. Transporter taxpayer number
3. Seller name
4. Seller taxpayer number
5. Product type
6. Mode
7. Date removed
8. Shipping doc. no.
9. Terminal control number
10. Invoiced gallons
1. Transporter name
2. Transporter taxpayer number
3. Seller name
4. Seller taxpayer number
5. Product type
6. Mode
7. Date removed
8. Shipping doc. no.
9. Terminal control number
10. Invoiced gallons
1. Transporter name
2. Transporter taxpayer number
3. Seller name
4. Seller taxpayer number
5. Product type
6. Mode
7. Date removed
8. Shipping doc. no.
9. Terminal control number
10. Invoiced gallons
TOTAL INVOICED GALLONS
TOTAL INVOICED GALLONS
FOR ALL PAGES
(Sum of Item 10)
(Enter on Item 3 of
FOR THIS PAGE ONLY
Texas Fuels Tax Report, Form 06-168)