06-180
-- AMENDED --
(Rev.3-06/3)
b.
<choose one>
a.
DO NOT WRITE IN SHADED AREAS
TYPE or PRINT
TEXAS SCHEDULE OF GALLONS REMOVED FROM
c. Taxpayer number
d. Filing period
IRS REGISTERED TERMINAL INCLUDING DELIVERIES TO
COMPANY OWNED STORES -- TAX COLLECTED BY
SUPPLIER/PERMISSIVE SUPPLIER (Item 12)
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