N.H. Admin. Code § Saf-C 311.23

Current through Register No. 50, December 12, 2024
Section Saf-C 311.23 - Form RT 115, Road Toll Refund Application for Retail Dealer
(a) An applicant shall submit the following on form RT 115:
(1) Distributor's:
a. Name and address;
b. Telephone number; and
c. Federal employer identification number, if applicable;
(2) Retail dealer's:
a. Name and address;
b. Telephone number; and
c. Federal employer identification number, if applicable;
(3) Period covered;
(4) Mailing address for refund;
(5) Gross gallons purchased, by product type;
(6) Road toll rate;
(7) Amount paid;
(8) Refund rate;
(9) Amount of refund request;
(10) Total gasoline; and
(11) Total toll paid on diesel gallons.
(b) The retail dealer shall sign the form.
(c) The licensed distributor shall sign the form.

N.H. Admin. Code § Saf-C 311.23

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

Renumbered From Saf-C 311.21 Volume XXXV Number 1, Filed January 8, 2015, Proposed by #10753, Effective 1/1/2015.