Form 06-168-A - Texas Fuels Tax Report
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406-168-A
PRINT FORM
CLEAR FIELDS
AAAA
(Rev.8-11/6)
b.
06110 Gasoline Supplier
*** AMENDED ***
a.
Please do not write in space above
Do Not Staple or Paper Clip
TEXAS FUELS TAX REPORT - Page 1
--For 2004 and later
h.
c. Taxpayer number
d. Due date
e. Filing period
f.
Taxpayer name and mailing address
Blacken this box if your address has changed.
g.
1
Show changes by the preprinted information.
Blacken this box if you are no longer in
2
business and enter the
last business date
i.
You have certain rights under Chapters 552 and 559, Government Code, to review, request and correct
information we have on file about you. Contact us at the address or phone number listed on this form.
ENTER WHOLE GALLONS
SECTION I - RECEIPTS (See instructions)
1. Gallons of dyed diesel fuel purchased
tax-free from other license holders
1.
(from attached Schedule, Form 06-145)
2. Gallons removed from IRS Registered Terminal Texas tax paid to
licensed supplier
2.
(from attached Schedule, Form 06-146)
3. Gallons purchased in Texas for blending
(from attached Schedule, Form 06-147)
3.
4. Gallons of dyed diesel fuel imported tax-free
(from attached Schedule, Form 06-148)
4.
5. Gallons of undyed diesel fuel/gasoline imported tax-free
(from attached Schedule, Form 06-148)
5.
6. Gallons imported Texas tax-paid
(from attached Schedule, Form 06-149)
6.
7. Taxable blending materials
7.
(from attached Schedule, Form 06-150)
8. Tax exempt blending materials - diesel fuel
(from attached Schedule, Form 06-151)
8.
9. TOTAL FOR SECTION I
(Add Items 1 through 8)
9.
( * * * Proceed to Page 2, Item 10. * * * )
( * * * Proceed to Page 2, Item 10. * * * )
06-168-A
(Rev.8-11/6)
* * * DO NOT DETACH * * *
33. Total tax due
$
(same as Page 2, Item 32)
33.
34. Penalty
$
34.
(If report is filed or tax paid after due date, see instructions.)
35. Interest
$
35.
(If any tax due is unpaid 61 days after due date, see instructions.)
$
36. TOTAL AMOUNT DUE AND PAYABLE
(Item 33 plus Items 34 and 35)
36.
Taxpayer name
l.
m.
T Code
Taxpayer number
Period
If you're interested in
ELECTRONIC TAX FILING
Make the amount in Item 36 payable to: STATE COMPTROLLER
please call us at (800) 442-3453 or
email us at etf.cpa@cpa.state.tx.us
Mail to: COMPTROLLER OF PUBLIC ACCOUNTS
P.O. Box 149357
Austin, TX 78714-9357
111 A
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