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Get ME MRS GTR-PS 2012

End - EIN - 1. Entity Information (taxpayer business name and address) 00 *1140001* 2. OUT OF BUSINESS? Date closed: 3. OWNERSHIP OR NAME CHANGE? Date Explanation 4. ADDRESS CHANGE? Make corrections above and check here SOLD? Date Do Not Use Red Ink! Claim Information Requests for a refund must be made within 12 months of the date of purchase of the fuel. Refund Claim Gasoline Diesel (from reverse side) Refund Claim for period of July 1, 2011 to June 30, 2012 1.

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