N.H. Admin. Code § Saf-C 311.26 - Form RT 122D Road Toll Refund Application - Toll Paid on Special Fuel Only

(a) An applicant shall submit the following on form RT 122D:

(1) Applicant's name, address and telephone number;

(2) Federal employer identification number, if applicable;

(3) Applicant's claim, including:

a. Total gallons per invoice;

b. Total gallons consumed on public ways;

c. Total gallons consumed off public ways; and

d. Dollar amount of refund request;

(4) Type of operation;

(5) City or town and state where gallons were used;

(6) Period covered;

(7) Vehicle or equipment type, make and year;

(8) Registration number of vehicle or serial number of equipment;

(9) Itemized gallons used on highway;

(10) Itemized gallons used off highway;

(11) Grand total of non-IFTA, on and off highway;

(12) Grand total of IFTA, on and off highway; and

(13) Stock record, including:

a. Actual inventory;

b. Total gallons per invoice;

c. Total gallons to be accounted for;

d. Gallons used for non-IFTA on highway;

e. Gallons used for non-IFTA off highway;

f. Gallons used for IFTA on highway;

g. Gallons used for IFTA off highway;

h. Grand total of gallons used on and off highway;

i. Total gallons sold;

j. Book inventory on the last day of the period;

k. Actual inventory on the last day of the period;

l. Stock loss or gain; and

m. Total gallons accounted for.

(b) The applicant shall sign the form.

Notes

N.H. Admin. Code § Saf-C 311.26

(See Revision Notes #1 and #2 at chapter heading for Saf-C 300) #10032, eff 11-22-11

Renumbered From Saf-C 311.24 Volume XXXV Number 1, Filed January 8, 2015, Proposed by #10753, Effective 1/1/2015.