N.H. Admin. Code § Saf-C 311.26

Current through Register No. 50, December 12, 2024
Section 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.

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.