Indiana Administrative Code
Title 105 - INDIANA DEPARTMENT OF TRANSPORTATION
Article 5 - RAILROADS
Rule 1 - Tariffs and Rates
Section 1-16 - Monetary adjustments
Current through March 20, 2024
Authority: IC 8-1-1-3
Affected: IC 8-3-1-3; IC 8-3-1-8
Sec. 16.
The claim for seeking monetary adjustments shall be substantially in the following form:
Claim of __________ under decision of the public service commission of Indiana in Docket No. _________ .
Date of shipment
Date of delivery or tender of delivery
Date charges were paid
Car initials
Car number
Origin
Destination
Route
Commodity
Weight
Rate
Amount
Rate
Amount
Refund (or monies due) on basis of commission's decision
Charges paid by (1)
Claimant hereby certifies that this statement includes claims only on shipments covered by the findings in the docket above described and contains no claim for refund (or monies due) previously filed with the commission by or on behalf of claimant or, so far as claimant knows, by or on behalf of any person, in any other proceedings, except as follows: (here indicate any exceptions, and explanations thereof).
___________________________
(Claimant)
By: ________________________
___________________________
(Address)
___________________________
(Date)
Total amount of refund (or monies due) $ _____ . The undersigned hereby certifies that this statement has been checked against the records of this company and found correct.
Date _____ concurred (2) in: _____ Company _____ Company. Defendant Collecting Carrier, Defendant (3) _____ .
By _____ , Auditor. By _____ Auditor.
(1) Here insert name of person paying charges in the first instance, and state whether as consignor, consignee, or in other capacity.
(2) For concurring certificate in case the collection carrier is not a defendant.
(3) If not a defendant, strike out the word "defendant".
Transferred from Department of Transportation ( 100 IAC 6-1-16 ) to Indiana Department of Transportation ( 105 IAC 5-1-16 ) by P.L. 112-1989, SECTION 5, effective July 1, 1989.
