Form Dr-462 - Application For Refund Of Ad Valorem Taxes

Form Dr-462 - Application For Refund Of Ad Valorem Taxes - 2002

DR-462

R. 12/02

For DOR Use Only

Refund Ordered

Denied

AI#:

Date

Department of Revenue

TPP:

Subject Matter Index Code:

Control Number:

RP:

Date Received:

Application for Refund of Ad Valorem Taxes

State of Florida

County of

Pursuant to Section 197.182 Florida Statutes,

(Payee)

(Mailing Address)

hereby makes application to the County Tax Collector for refund of $ ________________ for the tax year ________ of

(Amount)

moneys paid to the County Tax Collector and as justification therefor present the following facts: (State specific reason for

refund - See attachments.)

Under penalties of perjury, I declare that I have read the foregoing Application for Refund of Ad Valorem Taxes and that

the facts stated in it are true. If prepared by someone other than the Taxpayer, his/her declaration is based on all

information of which he/she has knowledge.

Signature and Title

Date

Applicant/Payee

Submitted by:

Tax Collector _______________________________________________ on _________________________ , ________

(year)

(Signature)

County of __________________________________________________ Florida.

(County)

Parcel #

Check No.:

Page/Line

Date:

Approved By:

Form Dr-462 - Application For Refund Of Ad Valorem Taxes - 2002