Alameda County Utility User Tax Ordinance Nonresidential User Cap And Rebate - Section 2.12.100 Claim For Rebate Of Excess Tax Payment Form
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2ALAMEDA COUNTY UTILITY USER TAX ORDINANCE
NONRESIDENTIAL USER CAP AND REBATE – SECTION 2.12.100
CLAIM FOR REBATE OF EXCESS TAX PAYMENT
REFERENCE NO.
COUNTY OF ALAMEDA
TREASURER-TAX COLLECTOR'S OFFICE
BUSINESS LICENSE TAX SECTION
224 W. WINTON AVENUE, ROOM 169
HAYWARD, CA 94544
I herewith request a rebate in the amount of $___________, for payment of combined telephone, electric and gas
utility user taxes in excess of the sixteen thousand five hundred dollars ($16,500.00) cap within the fiscal tax year
_______.
___________________________________________________________________________________
NOTE: Attach evidence of payment of taxes for the periods indicated.
I declare under penalty of perjury that I am the claimant in the foregoing claim, that I have read the foregoing claim
and know the contents thereof, and that the same is true.
Claimant’s Name __________________________________________ Title _____________________
Signature _______________________________________ Date ____________________
PLEASE PRINT OR TYPE THE FOLLOWING
:
_______________________________________________________________________
Business Name
________________________________________________________________
Owner's Name/Attention
__________
______________________________________
__________
Address: Number
Street
Room _
____________________________________
______________________
_____________
City
State
Zip
DO NOT WRITE BELOW THIS LINE
======================================================================
TREASURER/TAX COLLECTOR'S ENDORSEMENT
[] Claim denied for the following reason(s): _______________________________________________________
__________________________________________________________________________________________
[] Claim approved, refund the following overpayment that was received by Tax Collector for the fiscal
year_______________
UUT Amount Paid
$__________________
Penalties/Interest
$__________________
Nonresidential User Cap $___(16,500.00)_____
Total Overpayment/Rebate
$__________________
DONALD R. WHITE, ALAMEDA COUNTY TREASURER-TAX COLLECTOR
By: ______________________________________, Deputy Tax Collector.
Date____________
AUDITOR'S USE ONLY
ABATE ACCOUNT: 419060
FUND: 10000
ORG NO: 130100
DEPT: 160100
$___________________PAY OK______________
PR REF (TYPE UUT NUMBER)
SHOW REFUND OF UTILITY USER TAX
UUTREBATE Rev.9/02
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