Form 06-186 - Amended Schedule Of Tax-Free Sales Of Dyed Diesel Fuel Sold On A Signed Statement

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06-186
-- AMENDED --
(Rev.3-06/3)
b.
07147
Diesel Fuel
a.
DO NOT WRITE IN SHADED AREAS
TYPE or PRINT
TEXAS SCHEDULE OF TAX-FREE SALES OF DYED
c. Taxpayer number
d. Filing period
DIESEL FUEL SOLD ON A SIGNED STATEMENT
(Item 18)
f.
e. Taxpayer name
1. Purchaser name
2. Product type
3. Purchaser signed statement number
LOCATOR NUMBER
4. Invoiced gallons
1. Purchaser name
2. Product type
3. Purchaser signed statement number
LOCATOR NUMBER
4. Invoiced gallons
LOCATOR NUMBER
1. Purchaser name
2. Product type
3. Purchaser signed statement number
4. Invoiced gallons
1. Purchaser name
2. Product type
3. Purchaser signed statement number
LOCATOR NUMBER
4. Invoiced gallons
1. Purchaser name
2. Product type
3. Purchaser signed statement number
LOCATOR NUMBER
4. Invoiced gallons
1. Purchaser name
2. Product type
3. Purchaser signed statement number
LOCATOR NUMBER
4. Invoiced gallons
1. Purchaser name
2. Product type
3. Purchaser signed statement number
LOCATOR NUMBER
4. Invoiced gallons
LOCATOR NUMBER
1. Purchaser name
2. Product type
3. Purchaser signed statement number
4. Invoiced gallons
1. Purchaser name
2. Product type
3. Purchaser signed statement number
LOCATOR NUMBER
4. Invoiced gallons
1. Purchaser name
2. Product type
3. Purchaser signed statement number
LOCATOR NUMBER
4. Invoiced gallons
LOCATOR NUMBER
1. Purchaser name
2. Product type
3. Purchaser signed statement number
4. Invoiced gallons
1. Purchaser name
2. Product type
3. Purchaser signed statement number
LOCATOR NUMBER
4. Invoiced gallons
TOTAL INVOICED GALLONS
(Sum of Item 4)
FOR THIS PAGE ONLY

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