Qualified Business Claim Form For Refund Of State Tax
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100-106
(Rev.5-02/3)
TEXAS ENTERPRISE ZONE
QUALIFIED BUSINESS CLAIM FOR REFUND OF STATE TAX -
INVOICES OR CONTRACTS SUPPLEMENT
Page ______ of ______
Claimant ID number
Period of claim
Begin date
End date
Claimant name and mailing address
Under Ch. 559, Government Code, you are
entitled to review, request, and correct
information we have on file about you, with
limited exceptions in accordance with Ch. 552,
Government Code. To request information for
review or to request error correction, contact us
at 1-800-252-5555, extension 3-4545.
NOTE: List only invoices or contracts on which Texas state sales and use tax has been paid.
INVOICE OR CONTRACT
DOLLAR AMOUNT
AMOUNT OF
PURCHASE DATE
DESCRIPTION OF EQUIPMENT / MATERIALS
(Not including
NUMBER
TAX PAID
sales tax)
$
$
Totals of this page
$
$
Attach additional pages if necessary and enter the totals
TOTALS OF ALL SUPPLEMENT PAGES
of all supplement pages on the final page only.
$
$
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