N.H. Admin. Code § Saf-C 311.30 - Form RT 126, Road Toll Refund Application - Farm Use

(a) An applicant shall submit the following on form RT 126:

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

(2) Federal employer identification number, if applicable;

(3) Period covered;

(4) Total gallons per invoice;

(5) Total gallons consumed on public ways;

(6) Total gallons consumed off public ways;

(7) Dollar amount of refund;

(8) Type of farming, such as:

a. Dairy;

b. Poultry;

c. Custom;

d. Orchard;

e. Truck; or

f. General;

(9) City or town and state;

(10) Type, year and make of equipment;

(11) Registration number;

(12) Itemized gallons used on highway;

(13) Itemized gallons used off highway;

(14) Total gallons used on highway;

(15) Total gallons used off highway;

(16) Grand total of gallons used on and off highway; and

(17) Stock record, including:

a. Actual inventory of gasoline or diesel fuel;

b. Total gallons of gasoline or diesel fuel per invoice;

c. Total gallons of gasoline or diesel fuel to be accounted for;

d. Total gallons sold of gasoline or diesel fuel;

e. Book inventory of gasoline or diesel fuel on the last day of the period;

f. Actual inventory of gasoline or diesel fuel on the last day of the period;

g. Stock loss or gain of gasoline or diesel fuel; and

h. Total gallons of gasoline or diesel fuel accounted for.

(b) The applicant shall sign the form.

Notes

N.H. Admin. Code § Saf-C 311.30

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

Renumbered From Saf-C 311.28 Volume XXXV Number 1, Filed January 8, 2015, Proposed by #10753, Effective 1/1/2015.