Form Rt-123 - Road Toll Refund Application Page 2

ADVERTISEMENT

GASOLINE USED FOR THE PERIOD OF ______________ YR_______ THROUGH _________________ YR ________
COLUMN 1
COLUMN 2
COLUMN 3
COLUMN 4
COLUMN 5
COLUMN 6
GALLONS USED
GALLONS USED
**TYPE
REG#/SERIAL #
MAKE
YEAR
ON
OFF
OF EQUIPMENT
(REQUIRED)
HIGHWAY
HIGHWAY
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
***PLEASE NOTE***
17 Non IFTA Totals
AN EQUIPMENT LIST WITH BREAKDOWN MAY BE
18
Line 2 (on front)
Line 3 (on front)
ATTACHED BUT LINES 17 THROUGH 20 AND THE
19 IFTA Totals
STOCK RECORD MUST BE COMPLETED.
20 Totals Used Lines 17 & 19, Col. 5 & 6*:
*
Line 20 must equal line 6 of stock record
STOCK RECORD MUST BE COMPLETED IF APPLICANT HAS STORAGE TANKS OR PURCHASES IN DRUMS
STOCK RECORD
GALLONS
1. ACTUAL INVENTORY FIRST DAY OF PERIOD
2. TOTAL GALLONS (AS PER ATTACHED INVOICES)
3. TOTAL GALLONS TO BE ACCOUNTED FOR (LINE 1 AND 2)
4. GALLONS USED: NON IFTA LICENSED EQUIPMENT
A. ON ROAD USAGE (column 5, line 17)
B. OFF ROAD USAGE (column 6, line 17)
5. GALLONS USED: IFTA LICENSED VEHICLES
A. ON ROAD USAGE (column 5, line 19)
B. OFF ROAD USAGE (column 6, line 19)
6. TOTAL LINES 4A and B, 5A and B
7. TOTAL GALLONS SOLD
8. BOOK INVENTORY LAST DAY OF THE PERIOD (LINE 3 LESS LINE 6 AND 7)
9. ACTUAL INVENTORY LAST DAY OF PERIOD (STICK READING)
10. STOCK RECORD-LOSS OR GAIN (DIFFERENCE LINES 8 MINUS 9)
11. TOTAL GALLONS ACCOUNTED FOR (TOTAL LINES 6,7,9, & 10 MUST EQUAL LINE 3)
FOR OFFICIAL USE ONLY:
**TRUCK, TRACTOR, CAR, STATIONARY MOTORS, ETC
*** LIST MOTOR VEHICLES, REGISTRATION NUMBER REGARDLESS OF TYPE.
APPLICANTS MAKING PURCHASES IN CANS (2, 5, 10 GALS.) OR BY DIRECT RECEIPT
INTO FUEL TANKS ARE NOT REQUIRED TO COMPLETE STOCK RECORD BUT MUST
COMPLETE COLS. 1 THROUGH 6.
RT-123 (10/2008)

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Rt 122d - Road Toll Refund Application Toll Paid On Special Fuel Only Form Rt 122d - Road Toll Refund Application Toll Paid On Special Fuel Only Legal
Form Rt 122g - Road Toll Refund Application Gasoline Only Form Rt 122g - Road Toll Refund Application Gasoline Only Legal
Form Rt115 - Road Toll Refund Application - Departament Of Safety Road Toll Bureau, State Of New Hampshire Form Rt115 - Road Toll Refund Application - Departament Of Safety Road Toll Bureau, State Of New Hampshire Legal
Form Rt125d - Road Toll Refund Application - Municipal And County - Tax Paid Diesel Only Form Rt125d - Road Toll Refund Application - Municipal And County - Tax Paid Diesel Only Legal
Form Rt125g - Road Toll Refund Application - Municipal And County - Gasoline Only Form Rt125g - Road Toll Refund Application - Municipal And County - Gasoline Only Legal
Form Rt126 - Road Toll Refund Application 2008 Form Rt126 - Road Toll Refund Application 2008 Legal
Form Rt127g - Road Toll Refund Application - Private School Bus Owner - Gasoline Only Form Rt127g - Road Toll Refund Application - Private School Bus Owner - Gasoline Only Legal
Form Rt127d - Road Toll Refund Application - Private School Bus Owner - Diesel Only Form Rt127d - Road Toll Refund Application - Private School Bus Owner - Diesel Only Legal
Form Fms 210 - Vehicle Registration Refund Application Form Fms 210 - Vehicle Registration Refund Application Legal
Form Mv347 - Document Fee Credit/refund Application Form Mv347 - Document Fee Credit/refund Application Legal

Related Categories

Parent category: Legal
Download
Go
Page of 2