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T-1, r. 1 - Regulation respecting the application of the Fuel Tax Act

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SCHEDULE IV
(s. 10.2R2)
I, the undersigned _____________________________________________________________________
domiciled at _________________________________________________________________________
acting for ___________________________________________________________________________
situated at ___________________________________________________________________________
declare that the fuel described on the invoices submitted with this application is intended for Band management activities and was purchased for the consumption of an entity mandated by a Band that I represent.
Date: ______________________________________________________________________________
Signature: ___________________________________________________________________________
O.C. 1116-2007, s. 10.
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