Form 06-171 - Amended Schedule Of Dyed Diesel Fuel Purchased Tax-Free From Other License Holders

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06-171
-- AMENDED --
PRINT
(Rev.3-06/3)
b.
07153
Diesel Fuel
a.
DO NOT WRITE IN SHADED AREAS
TYPE or PRINT
TEXAS SCHEDULE OF DYED DIESEL FUEL
c. Taxpayer number
d. Filing period
PURCHASED TAX-FREE FROM OTHER
LICENSE HOLDERS
(Item 1)
f.
e. Taxpayer name
1. Transporter name
2. Transporter taxpayer number
LOCATOR NUMBER
3. Seller name
4. Seller 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. Seller name
4. Seller 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. Seller name
4. Seller 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. Seller name
4. Seller 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. Seller name
4. Seller 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. Seller name
4. Seller 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. Seller name
4. Seller 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

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Parent category: Financial
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