Form 06-160 - Texas Schedule Of Tax-Free Sales Of Dyed Diesel Fuel Sold On A Signed Statement

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06-160
PRINT
(Rev.3-06/2)
b.
a.
07145
Diesel Fuel
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
4. Invoiced gallons
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
4. Invoiced gallons
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
4. Invoiced gallons
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
4. Invoiced gallons
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
4. Invoiced gallons
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
4. Invoiced gallons
1. Purchaser name
2. Product type
3. Purchaser signed statement number
4. Invoiced gallons
TOTAL INVOICED GALLONS
TOTAL INVOICED GALLONS
FOR ALL PAGES
(Sum of Item 4)
(Enter on Item 18 of
FOR THIS PAGE ONLY
Texas Fuels Tax Report, Form 06-168)

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