06-181
-- AMENDED --
(Rev.3-06;3)
b.
07163
Diesel Fuel
a.
DO NOT WRITE IN SHADED AREAS
TYPE or PRINT
TEXAS SCHEDULE OF GALLONS OF DYED DIESEL FUEL
c. Taxpayer number
d. Filing period
SOLD TAX-FREE TO LICENSE HOLDERS OR REMOVED
FROM IRS REGISTERED TERMINAL (Item 13)
f.
e. Taxpayer name
1. Transporter name
2. Transporter taxpayer number
LOCATOR NUMBER
3. Purchaser name
4. Purchaser 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
LOCATOR NUMBER
3. Purchaser name
4. Purchaser 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
LOCATOR NUMBER
3. Purchaser name
4. Purchaser 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
LOCATOR NUMBER
3. Purchaser name
4. Purchaser taxpayer number
5. Product type
6. Mode
7. Date removed
8. Shipping doc. no.
9. Terminal control number
10. Invoiced gallons
LOCATOR NUMBER
1. Transporter name
2. Transporter taxpayer number
3. Purchaser name
4. Purchaser 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
LOCATOR NUMBER
3. Purchaser name
4. Purchaser 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
LOCATOR NUMBER
3. Purchaser name
4. Purchaser taxpayer number
5. Product type
6. Mode
7. Date removed
8. Shipping doc. no.
9. Terminal control number
10. Invoiced gallons
TOTAL INVOICED GALLONS
(Sum of Item 10)
FOR THIS PAGE ONLY