Form Dr-26 - Application For Refund 1998
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1Florida Department of Revenue
Mail to:
DR-26
Florida Department of Revenue
Application for Refund
R. 01/98
Refund Process
5050 W. Tennessee Street
Tallahassee FL 32399-0100
If more than one tax or account number is involved, a separate application must be filed for each tax type and/or
account number. (For property taxes use form DR-462.) Please type or print clearly.
1.
Amount of Refund Requested: $___________________________
2.
Type of tax paid: (check one)
Sales & Use Tax (01)
3.
Name of Payee:
Surtax (05)
Corporate Income (02)
4.
Mailing Address:
Intangible Tax (03)
Motor Fuel (10)
Diesel Fuel (07)
City
State
Zip
Documentary Stamps (19)
5.
Location Address:
Insurance Premium (16)
(If other than above)
Other (please specify)
City
State
Zip
6.
Telephone Number(s) (
)
(
)
Area Code
Home Phone
Area Code
Business Phone
7.
Identification Number of Applicant (fill in all applicable numbers)
Sales Tax Registration Number __ __ - __ __ - __ __ __ __ __ __ - __ __/__
Federal Employer Identification Number __ __ - __ __ __ __ __ __ __
Fuel Tax License Number __ __ - __ __ __ __ __ __ __
For Joint Filers, Spouse's Social
Social Security Number __ __ __ - __ __ - __ __ __ __
Security Number __ __ __ - __ __ - __ __ __ __
8.
Payment for Tax Period(s): ____________________________________________
Date(s) Paid
to
Paid To
Name of State Agency/Department/Company
9.
Explanation of Refund Request (See instructions on back. Attach appropriate documentation; use additional sheets,
if necessary.)
Signature:
Date:
Print Name:
(DOC TYPE 76)
For Department of Revenue Use Only
Refund Approval
Audit Refund Amount
Authorized By
Date
Refund Review Amount
Approved By
Date
Voucher Date
Voucher #
Warrant Amount
Warrant #
Date Warrant Sent
By
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