Tax Computation Schedule Form - Departament Of Safety Road Toll Bureau, State Of New Hampshire

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STATE OF NEW HAMPSHIRE
ROAD TOLL BUREAU
“TAX COMPUTATION” SCHEDULE
ADJUSTMENT(S) SCHEDULE
CURRENT MONTH/YR ______________
DISTRIBUTOR NAME:_____________________________________________________
PAGE _____________ OF ___________
FEIN:__________________________________________________________________
GALLONS
DELIVERY
GIVE DETAILED EXPLANATION FOR ADJUSTMENT
PRODUCT
Additions
Deductions
DATE
TYPE
TOTALS->>
-WITHOUT DETAILED EXPLANATIONS, YOUR ADJUSTMENT(S) MAY BE DISALLOWED—
Total Additions->>
Note: There must be one (1) schedule submitted for each product type or it may be disallowed.
Total Deductions->>
GRAND TOTAL ADJUSTMENT TO LINE 23 ON MFD 1-S/AF >
(Additions should be shown as a positive number-Deductions should be shown
as a negative number in (Brackets))
Form Adjustments (Revised 07/05)

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