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Get Motor Fuels Claim For Refund GAS-1201ME Special Mobile ... - Dor State Nc

L in applicable circles: Trade Name Address has changed since prior refund claim First time filing Gas-1201ME refund claim Street Address Amended refund claim County Final refund claim for closed business Mailing Address FEIN or SSN City State Name of Contact Person Phone Number ( 99 Zip Code (First 5 digits) Fax Number ) ( ) Refund for Quarter Ending September 30, 2012 December 31, 2012 Number of vehicles using motor fuel for which a refund is requested on Line 4: Part 1. Ga.

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