N.H. Admin. Code § Saf-C 311.25

Current through Register No. 50, December 12, 2024
Section Saf-C 311.25 - Form RT 122G Road Toll Refund General Application - Gasoline Only
(a) An applicant shall submit the following on form RT 122G:
(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) Total gallons used on highway;
(12) Total gallons used off highway;
(13) Grand total of gallons used on and off highway; 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 sign the form.

N.H. Admin. Code § Saf-C 311.25

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

Renumbered From Saf-C 311.23 Volume XXXV Number 1, Filed January 8, 2015, Proposed by #10753, Effective 1/1/2015.