Form 06-161 - Texas Schedule Of State Diversions Of Undyed Diesel Fuel/gasoline
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1
206-161
(Rev.3-06/2)
b.
PRINT
<choose one>
a.
DO NOT WRITE IN SHADED AREAS
TYPE or PRINT
c. Taxpayer number
d. Filing period
TEXAS SCHEDULE OF STATE DIVERSIONS OF
UNDYED DIESEL FUEL/GASOLINE
(Item 21)
f.
d. Taxpayer name
1. Transporter name
2. Transporter taxpayer number
3. Purchaser name
4. Purchaser taxpayer number
5. Product type
6. Mode
7. Original destination
8. Revised destination
9. Diversion number
10. Date removed
11. Shipping doc. no.
12. Terminal control number
13. Invoiced gallons
1. Transporter name
2. Transporter taxpayer number
3. Purchaser name
4. Purchaser taxpayer number
5. Product type
6. Mode
7. Original destination
8. Revised destination
9. Diversion number
10. Date removed
11. Shipping doc. no.
12. Terminal control number
13. Invoiced gallons
1. Transporter name
2. Transporter taxpayer number
3. Purchaser name
4. Purchaser taxpayer number
5. Product type
6. Mode
7. Original destination
8. Revised destination
9. Diversion number
10. Date removed
11. Shipping doc. no.
12. Terminal control number
13. Invoiced gallons
1. Transporter name
2. Transporter taxpayer number
3. Purchaser name
4. Purchaser taxpayer number
5. Product type
6. Mode
7. Original destination
8. Revised destination
9. Diversion number
10. Date removed
11. Shipping doc. no.
12. Terminal control number
13. Invoiced gallons
1. Transporter name
2. Transporter taxpayer number
3. Purchaser name
4. Purchaser taxpayer number
5. Product type
6. Mode
7. Original destination
8. Revised destination
9. Diversion number
10. Date removed
11. Shipping doc. no.
12. Terminal control number
13. Invoiced gallons
1. Transporter name
2. Transporter taxpayer number
3. Purchaser name
4. Purchaser taxpayer number
5. Product type
6. Mode
7. Original destination
8. Revised destination
9. Diversion number
10. Date removed
11. Shipping doc. no.
12. Terminal control number
13. Invoiced gallons
TOTAL INVOICED GALLONS
TOTAL INVOICED GALLONS
FOR ALL PAGES
(Sum of Item 13)
(Enter on Item 21 of
FOR THIS PAGE ONLY
Texas Fuels Tax Report, Form 06-168)
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