Form Rt113 - Motor Fuel And Petroleum Products Transporter'S Report printable pdf download

Form Rt113 - Motor Fuel And Petroleum Products Transporter'S Report

STATE OF NEW HAMPSHIRE

DEPARTMENT OF SAFETY

ROAD TOLL BUREAU

Motor Fuel and Petroleum Products Transporter’s Report

Complete and attach enclosed schedules

License Number

Report Period:

FOR OFFICE USE

FEIN

Licensees’ Name and Location Address

Licensee’s Mailing Address

MUST BE FILED EVERY MONTH

Total gross gallons of all deliveries of fuel from out-of-state

locations toinside the state (imports). (Attach Schedule 14B)

RSA 260:42 Motor Fuel and Petroleum Products Transporter:

“I. Every person not registered as a distributor who transports motor fuel or products subject to the fees stipulated

in RSA 146-A, to a point or points within the state from a point or points outside the state, every common carrier or

contract carrier who transports motor fuel or petroleum products, and every licensed distributor who transports

motor fuel or petroleum products exclusive of the carrier's own product shall be licensed with the commissioner as

a motor fuel and petroleum products transporter.

V. The transporter shall report to the commissioner on forms prescribed by the commissioner, not later than the

twentieth of the succeeding calendar month, subject to prosecution for unsworn falsification, all deliveries of motor

fuel and petroleum products made to points within the state during the previous calendar month. Such reports shall

contain sufficient information to identify the quantities delivered, the consignor, the consignee and such additional

information as the commissioner may require. A report shall be filed for any month in which no activity occurs.

VI. Any person who fails, neglects, or refuses to file the monthly report required by this section shall be assessed a

penalty of $500. Such penalty shall immediately accrue and shall bear interest as specified in RSA 260:40-a.”

DUE DATE-On or before the 20

of the month

___________________________________ ______________________

______________________________ ______________

Authorized Signature

Telephone Number

Signature of preparer other than taxpayer

Telephone Number

______________________________________

_________________________

_________________________________

________________

Title

Date

Address

Date

“This application is signed under the penalty of unsworn falsification pursuant to RSA 641:3”

RT113 (REVISED 10/06)

Form Rt113 - Motor Fuel And Petroleum Products Transporter'S Report

Related Articles

Related forms

Related Categories