105 IAC 5-1-16 - Monetary adjustments

Authority: IC 8-1-1-3

Affected: IC 8-3-1-3; IC 8-3-1-8

Sec. 16.

The claim for seeking monetary adjustments shall be substantially in the following form:

Claim of __________ under decision of the public service commission of Indiana in Docket No. _________.

Date of shipment

Date of delivery or tender of delivery

Date charges were paid

Car initials

Car number

Origin

Destination

Route

Commodity

Weight

Rate

Amount

Rate

Amount

Refund (or monies due) on basis of commission's decision

Charges paid by (1)

Claimant hereby certifies that this statement includes claims only on shipments covered by the findings in the docket above described and contains no claim for refund (or monies due) previously filed with the commission by or on behalf of claimant or, so far as claimant knows, by or on behalf of any person, in any other proceedings, except as follows: (here indicate any exceptions, and explanations thereof).

___________________________

(Claimant)

By: ________________________

___________________________

(Address)

___________________________

(Date)

Total amount of refund (or monies due) $ _____ . The undersigned hereby certifies that this statement has been checked against the records of this company and found correct.

Date _____ concurred (2) in: _____ Company _____ Company. Defendant Collecting Carrier, Defendant (3) _____.

By _____, Auditor. By _____ Auditor.

(1) Here insert name of person paying charges in the first instance, and state whether as consignor, consignee, or in other capacity.

(2) For concurring certificate in case the collection carrier is not a defendant.

(3) If not a defendant, strike out the word "defendant".

Notes

105 IAC 5-1-16

Indiana Department of Transportation; 105 IAC 5-1-16; filed May 18, 1983, 2:18 p.m.: 6 IR 1209; readopted filed Nov 7, 2001, 3:20 p.m.: 25 IR 899; readopted filed Jun 14, 2007, 2:45 p.m.: 20070627-IR-105070237RFA; readopted filed Oct 2, 2013, 11:39 a.m.: 20131030-IR-105130295RFA Readopted filed 10/4/2019, 9:49 a.m.: 20191030-IR-105190422RFA

Transferred from Department of Transportation ( 100 IAC 6-1-16) to Indiana Department of Transportation (105 IAC 5-1-16) by P.L. 112-1989, SECTION 5, effective July 1, 1989.