Form 06-160 - Texas Schedule Of Tax-Free Sales Of Dyed Diesel Fuel Sold On A Signed Statement Page 2

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Form 06-160(Back)(Rev.3-06/2)
TEXAS SCHEDULE OF TAX-FREE SALES OF
DYED DIESEL ON A SIGNED STATEMENT
(Item 18)
You have certain rights under Chapters 552 and 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.
WHO MUST FILE
Every licensed supplier, permissive supplier, distributor, or distributor/aviation fuel dealer must report sales of tax-free dyed diesel
fuel to a purchaser with a signed statement on this schedule. Failure to file this schedule may result in collection action as
prescribed by Title 2 of the Tax Code.
FOR ASSISTANCE
For assistance with any Texas Fuels tax questions, please contact the Texas State Comptroller's Office at 1-800-252-1383
toll-free nationwide, or call 512-463-4600.
GENERAL INSTRUCTIONS
Please write only in white areas.
TYPE or PRINT all information
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.
SPECIFIC INSTRUCTIONS
Item 1 - Enter the name of the purchaser.
Item 2 - Enter the three-digit product type.
228 - Dyed Diesel Fuel
072 - Dyed Kerosene.
Item 3 -
Enter the purchaser's signed statement number with either an "AG" or "DD" prefix.
Enter the total invoiced gallons sold to the signed statement holder for the month.
Item 4 -

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