Form Rfd-1 - City And County Of San Francisco Affidavit For Refund

Form Rfd-1 - City And County Of San Francisco Affidavit For Refund - 2001

Reference No. _______________

CITY AND COUNTY OF SAN FRANCISCO

Affidavit for Refund

Business

Name (DBA):

Address:

Owner's Name:

TEL:

Ownership:

Individual

Partnership

Corporation

Other:

(Specify)

TAX PAID INFORMATION:

Certificate Number/

Tax Collector's

Period

BTS ID No.

Paid By

Date Paid

Receipt Number

Amount Paid

Covered

STATE OF CALIFORNIA

COUNTY OF SAN FRANCISCO

Ordinance Applicable

This refund affidavit, including any accompanying schedules, is true, correct and

(check one)

Business Tax; #63-01

complete to the best knowledge and belief of the undersigned and covers the named

Payroll Tax; #275-70

business and tax payment(s) listed above. Pursuant to the provisions of the City and

Hotel Tax; #87-61

County of San Francisco ordinance indicated, the undersigned claims a refund (cash

Parking Tax; #286-70

or credit) and that he or she is rightfully entitled to the refund for taxes:

Utility Tax; #287-70

paid more than once;

Stadium Tax; #356-70

erroneously or illegally collected;

and for the following reason(s):

(Specify)

Refund payable to:

Refund Amount: $

Mailing

Address:

(Address

City

State

Zip)

I declare under penalty of perjury that the foregoing is true and correct.

Signed:

Title:

Date:

Notarization

Subscribed and sworn to before me this

day of

(required if

located

Notary Public

In and for the county of

outside of

California):

State of

My commission expires

TO:

Controller, City and County of San Francisco

I certify the claim above made is legally allowable and recommend a refund of $

under authority of Ordinance No.

. Signed:

Tax Collector

Approved:

Not approved:

Signed:

Date:

Controller, City & County of San Francisco

Mail to: Treasurer/Tax Collector, Business Taxes Division, P.O. Box 7425, San Francisco, CA 94120-7425

1 Dr. Carlton B. Goodlett Place, City Hall, Room 140, San Francisco, CA 94102

Taxpayer Assistance: (415) 554-4400

Form No. RFD-1(Revised 05/01)

Form Rfd-1 - City And County Of San Francisco Affidavit For Refund - 2001

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