Request For Business Tax Refund Form - San Francisco

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TTX Reference No. ___________________
CITY AND COUNTY OF SAN FRANCISCO
Office of the Treasurer & Tax Collector
REQUEST FOR BUSINESS TAX REFUND
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
Street Address: 1 Dr. Carlton B. Goodlett Place, Room 140, San Francisco, CA 94102
For questions, please call our Refund Unit at (415) 554-7393
IMPORTANT: THIS IS NOT A CLAIM FOR REFUND. DO NOT FILE THIS FORM WITH THE OFFICE OF THE CONTROLLER
1. BUSINESS NAME
:
(DBA)
Owner's Name:
DBA Address:
Mailing Address:
Business Phone: (
)
Federal Tax I.D. or Social Security #
2. OWNERSHIP:
Check One:
Individual
Partnership
Corporation
Other: __________
(specify)
3. TAX PAID INFORMATION
Certificate Number/
Paid By
Date Paid
Tax Collector's Cashier
Amount Paid
Period
BTS ID No.
Receipt Number
Covered
a.
b.
c.
Applicable Tax
4. BASIS OF REQUEST:
State all facts and circumstances that support your request for
(check one)
a tax refund.
 Payroll Tax
 Hotel Tax
 Parking Tax
 Access Line Tax
 Utility Users Tax
 Stadium Tax
 Registration Fee
 Other: _________
(specify)
5. REFUND AMOUNT REQUESTED: $
6. SIGNATURE OF REPRESENTATIVE:
I declare under penalty of perjury that the foregoing is true and correct. I am the taxpayer or other person determined
to be liable for the tax or said person’s guardian or conservator. I am not an agent or the taxpayer’s attorney. I
understand that issuance of any refund does not waive the City’s right to audit at a later time.
Signature: X
Date:
Print Name:
Title:
7. TAX COLLECTOR REVIEW: Approved: ________ Denied: _______ Date: __________
Rev. 10.07.2009

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