Form 06-170(Back)(Rev.3-06/2)
TEXAS SCHEDULE OF TAX-FREE
PURCHASES OF DYED DIESEL FUEL
Yo u hav e c e rtain rig hts under Ch. 559, Government Code, to review, request, and correct information
we have on file about you. Contact us at the address or toll-free number listed on this form.
WHO MUST FILE
Every dyed diesel fuel bonded user must file this schedule if they purchase dyed diesel fuel tax-free from other fuel license holders. Failure to file this schedule may result in collection action as prescribed by Title 2 of the Tax Code.
FOR ASSISTANCE
For assistance with any Texas Fuels tax questions, please contact the Texas State Comptroller's Office at 1-800-252-1383 toll-free nationwide, or call 512-463-4600.
GENERAL INSTRUCTIONS
Please write only in white areas.
TYPE or PRINT all information
Complete all applicable items that are not preprinted.
If any preprinted information is not correct, mark out the incorrect item and write in the correct information.
ROUND ALL GALLONAGE FIGURES TO WHOLE GALLONS.
SPECIFIC INSTRUCTIONS
Item 1 - Enter the name of the seller.
Item 2 - Enter the 11-digit taxpayer number of the seller of the fuel.
Item 3 - Enter the three-digit product type. 228 - Dyed Diesel Fuel
072 - Dyed Kerosene.
Item 4 - Enter the date, MM/DD/YY, as it appears on the Shipping Document/Bill of Lading. This is the date the fuel was PHYSICALLY REMOVED from a terminal or bulk plant. May be left blank if summarizing transactions. See item #5.
Item 5 - Enter the Shipping Document/Bill of Lading number. This is the identifying number from the document issued at the terminal or bulk plant when the product is removed. You may report the summary of multiple transactions when the seller and product type are the same. Enter the word 'SUM.' You must maintain detailed records of the transactions reported as a summary.
Item 6 - Enter invoiced gallons. You may report the summary of multiple transactions. See item #5.