Form 06-174 - Texas Schedule Of Gallons Imported Tax-Free
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1
206-174
-- AMENDED --
(Rev.3-06/3)
b.
PRINT
a.
<choose one>
DO NOT WRITE IN SHADED AREAS
TYPE or PRINT
TEXAS SCHEDULE OF GALLONS
c. Taxpayer number
d. Filing period
IMPORTED TAX-FREE
(Items 4 & 5)
f.
e. Taxpayer name
1. Transporter name
2. Transporter taxpayer number
LOCATOR NUMBER
3. Seller name
4. Seller taxpayer number
5. Prod. type
6. Mode
7. Origin
8. Import number
9. Date removed
10. Shipping doc. no.
11. Terminal control number
12. Invoiced gallons
13. Bulk plant name and address
1. Transporter name
2. Transporter taxpayer number
LOCATOR NUMBER
3. Seller name
4. Seller taxpayer number
5. Prod. type
6. Mode
7. Origin
8. Import number
9. Date removed
10. Shipping doc. no.
11. Terminal control number
12. Invoiced gallons
13. Bulk plant name and address
LOCATOR NUMBER
1. Transporter name
2. Transporter taxpayer number
3. Seller name
4. Seller taxpayer number
5. Prod. type
6. Mode
7. Origin
8. Import number
9. Date removed
10. Shipping doc. no.
11. Terminal control number
12. Invoiced gallons
13. Bulk plant name and address
1. Transporter name
2. Transporter taxpayer number
LOCATOR NUMBER
3. Seller name
4. Seller taxpayer number
5. Prod. type
6. Mode
7. Origin
8. Import number
9. Date removed
10. Shipping doc. no.
11. Terminal control number
12. Invoiced gallons
13. Bulk plant name and address
1. Transporter name
2. Transporter taxpayer number
LOCATOR NUMBER
3. Seller name
4. Seller taxpayer number
5. Prod. type
6. Mode
7. Origin
8. Import number
9. Date removed
10. Shipping doc. no.
11. Terminal control number
12. Invoiced gallons
13. Bulk plant name and address
TOTAL INVOICED GALLONS
(Sum of Item 12)
FOR THIS PAGE ONLY
TOTAL INVOICED GALLONS OF
DYED DIESEL FUEL
FOR THIS PAGE ONLY
TOTAL INVOICED GALLONS OF
UNDYED DIESEL FUEL/GASOLINE
FOR THIS PAGE ONLY
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