Form Rt-45 - Oil Discharge & Pollution Control Delivery Schedule - Departament Of Safety Road Toll Bureau, State Of New Hampshire

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Schedule Numbers
STATE OF NEW HAMPSHIRE
Month of ________, Yr._______
DEPARTMENT OF SAFETY
45-1=Receipts from locations outside NH
ROAD TOLL BUREAU
Schedule No._______________
33 Hazen Drive, Concord NH 03305
45-2=Receipts from locations within NH
License No.________________
(603) 271-2311
45-4=Sales and transfers out of state
OIL DISCHARGE & POLLUTION CONTROL
DELIVERY SCHEDULE
45-5= Tax Paid Purchases
Delivery
Origin
Customer/Purchaser
Product
Transporter Name
Supplier Name
Quantity
Date
(State)
Name-Address
Type
TOTAL:
RT 45 (REV. 02/04)
( SEE REVERSE SIDE FOR INSTRUCTIONS)

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