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

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SCHEDULE III
(s. 10.2R2)
I, the undersigned ______________________________ domiciled at ______________________________, acting for the ______________________________ Band, domiciled at ______________________________ declare that the fuel described in the invoices submitted with this application was purchased for the consumption of the Band that I represent.
Date: _______________________________________________________________________________
Signature: ___________________________________________________________________________
O.C. 1876-87, s. 2.
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