06-151
PRINT
(Rev.8-09/4)
b.
07142
Diesel Fuel
a.
DO NOT WRITE IN SHADED AREAS
TYPE or PRINT
TEXAS SCHEDULE OF TAX-EXEMPT
c. Taxpayer number
d. Filing period
BLENDING MATERIALS - DIESEL FUEL
(Item 8)
f.
e. Taxpayer name
1. Transporter name
2. Transporter taxpayer number
3. Seller name
4. Seller taxpayer number
5. Product type
6. Gallons of blending materials
1. Transporter name
2. Transporter taxpayer number
3. Seller name
4. Seller taxpayer number
5. Product type
6. Gallons of blending materials
1. Transporter name
2. Transporter taxpayer number
3. Seller name
4. Seller taxpayer number
5. Product type
6. Gallons of blending materials
1. Transporter name
2. Transporter taxpayer number
3. Seller name
4. Seller taxpayer number
5. Product type
6. Gallons of blending materials
1. Transporter name
2. Transporter taxpayer number
3. Seller name
4. Seller taxpayer number
5. Product type
6. Gallons of blending materials
1. Transporter name
2. Transporter taxpayer number
3. Seller name
4. Seller taxpayer number
5. Product type
6. Gallons of blending materials
1. Transporter name
2. Transporter taxpayer number
3. Seller name
4. Seller taxpayer number
5. Product type
6. Gallons of blending materials
1. Transporter name
2. Transporter taxpayer number
3. Seller name
4. Seller taxpayer number
5. Product type
6. Gallons of blending materials
TOTAL INVOICED GALLONS
TOTAL INVOICED GALLONS
FOR ALL PAGES
(Sum of Item 6)
(Enter on Item 8 of
FOR THIS PAGE ONLY
Texas Fuels Tax Report, Form 06-168)