Form Dr-26 - Application For Refund 1999
ADVERTISEMENT
1Mail Original Application to:
DR-26
Florida Department of Revenue
Application for Refund
R. 09/99
Refund Subprocess
P.O. Box 6490
Tallahassee FL 32314-6490
Fax Number 850-410-2526
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.
2.
Type of tax paid: (check one)
1.
Amount of Refund Requested: $ ____________________________________
Sales and Use Tax (01)
Surtax (05)
3.
Name of Payee:
____________________________________________
Corporate Income (02)
Intangible Tax (03)
4.
Mailing Address:
____________________________________________
Motor Fuel (10)
____________________________________________
Diesel Fuel (07)
____________________________________________
Documentary Stamps (19)
City
State
ZIP
Insurance Premium (16)
Other (please specify)
5.
Location Address:
____________________________________________
(If other than above) ____________________________________________
____________________________________________
City
State
ZIP
6.
Telephone Number(s):(______)____________________
(______)____________________
Area Code
Home Phone
Area Code
Business Phone
(______)____________________
____________________________
Area Code
Fax #
Email Address
7.
Identification Number of Applicant (fill in all applicable numbers):
Sales Tax Certificate 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.): ________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
A Florida Department of Revenue Power of Attorney Form DR-835, must be properly executed and included if the refund
request is submitted by your representative. Representative's phone number: (______) __________________________
Signature: _________________________________________________
Date: _______________________________
Print Name: ________________________________________________
Title: _______________________________
Please make a copy of the completed application for your records
.
For Department of Revenue Use Only - Refund Approval Information
(DOC TYPE 76)
Audit Refund Amount _______________________
Authorized By _________________________
Date ____________________
Refund Review Amount ______________________
Approved By _________________________
Date ____________________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business