_____ Date of shipment.
_____Date of delivery or tender of delivery.
_____Date charges were paid.
_____Car initials.
_____Car number.
_____Origin.
_____Destination.
_____Route.
_____Commodity.
_____Weight.
_____Rate.
_____Amount.
_____Refund (or monies due)
on basis of Commission's decision.
______ Charges paid under subection a.
The Commission shall consider such statement in its entry of order thereupon.
-names and addresses of the customer for whom collection is to be waived.
-certification that all railroads (if more than one is involved in the movement) concur in the waiver.
-amount to be waived.
-information identifying the original case to which the rate adjustment applies.
-a brief statement or justification for the intended waiver.
This statement, together with the paid freight bills on the shipments or true copies thereof, shall then be forwarded to the carrier which collected the charges for verification and certification as to its accuracy. All discrepancies, duplications, or other errors in the statements shall be adjusted by the parties and corrected agreed statements submitted to the Commission.
This statement will be certified by all parties and submitted to the Commission for consideration in entry of its order.
W. Va. Code R. § 150-12-3