Request For Business Tax Or Fee Refund - City And County Of San Francisco

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CITY AND COUNTY OF SAN FRANCISCO
Office of the Treasurer & Tax Collector
REQUEST FOR BUSINESS TAX OR FEE REFUND
Use this Request for Business Tax or Fee Refund form to request a refund of an amount you paid that exceeds the
amount of any tax, fee, penalty, and interest. Before completing this form, please read and follow the instructions on
the back.
Submit this form and supporting documentation to:
OFFICE OF THE TREASURER & TAX COLLECTOR
Business Tax Section, Account Services, Mailing Address: P.O. Box 7425, San Francisco, CA 94120-7425
or send via email to:
IMPORTANT: THIS IS NOT A CLAIM FOR REFUND. DO NOT FILE THIS FORM WITH THE OFFICE OF THE
CONTROLLER. TO FILE A CLAIM FOR REFUND GO TO:
1. BUSINESS NAME:
DBA (if applicable):
Business Account Number:
Mailing Address:
Federal Tax I.D. or Social Security #:
2. PAYMENT INFORMATION
Date Paid
Amount Paid
Period
Covered
Applicable Tax/Fee
3. BASIS OF REQUEST:
State all facts and circumstances that support your
(check one)
request for a refund. Attach additional documentation if necessary.
Access Line Tax
Cigarette Litter Abatement Fee
Gross Receipts Tax
Moscone Expansion District Fee
Payroll Expense Tax
Parking Tax
Registration Fee
Stadium Operator Admission
Tax
Telephone Users Tax (TUT)
Tourism Improvement District
Fee
Transient Occupancy Tax
__________________________________________________________________
Utility Users Tax (other than
__________________________________________________________________
TUT)
4. REFUND AMOUNT REQUESTED: $
5. SIGNATURE:
I certify under penalty of perjury that I am the taxpayer or operator (including an officer, general partner, member
manager, executor, trustee, fiduciary, or other individual with the authority to bind the taxpayer or operator), and I
have examined the foregoing Request for Business Tax or Fee Refund, including any attachments, and the
information thereon is, to the best of my knowledge and belief, true, correct, and fully compliant with all the
requirements of the San Francisco Business and Tax Regulations Code. The undersigned is not an agent or the
taxpayer’s or operator’s attorney. Issuance of any refund does not waive the City’s right to audit at a later time.
Signature: X
Date:
Print Name:
Title:

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