N.H. Admin. Code § Saf-C 311.31 - Form RT 127G, Road Toll Refund Application - Private School Bus Owner - Gasoline Only
(a) An applicant shall
submit the following on form RT 127G:
(1)
Company name, address and telephone number;
(2) Federal employer identification number,
if applicable;
(3) List of
contracted school districts;
(4)
Period covered by month and year;
(5) Applicant's claim, including:
a. Total gallons per invoice;
b. Total miles used to transport contracted
school districts' students;
c.
Total gallons used to transport contracted school districts'
students;
d. Miles per gallon;
and
e. Dollar amount of refund
request;
(6) Equipment
listing;
(7) Year and make of
equipment;
(8) Registration
number;
(9) Itemized gallons used
as assessed;
(10) Itemized gallons
used as non-assessed;
(11) Total
gallons used as assessed;
(12)
Total gallons used as non-assessed;
(13) Grand total, assessed and non-assessed;
and
(14) Stock record, including:
a. Actual inventory;
b. Total gallons per invoice;
c. Total gallons to be accounted
for;
d. Total gallons
used;
e. Total gallons
sold;
f. Book inventory on the last
day of the period;
g. Actual
inventory on the last day of the period;
h. Stock loss or gain; and
i. Total gallons accounted for.
(b) The applicant shall
print his/her title and sign the form.
Notes
(See Revision Notes #1 and #2 at chapter heading for Saf-C 300) #10032, eff 11-22-11
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