Form Sut205 - Sales And Use Tax Refund Application

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Sales and Use Tax
MARYLAND
For Office Use Only
FORM
Refund Application
SUT205
Claim Code ___ Claim No. ___________
Amount approved ___________________
FEIN Number or SSN of owner, officer or agent responsible for taxes
Liabilities _________________________
Check issued ______________________
Amount credited ___________________
Sales and Use Tax Registration Number
Approved by _______________________
Approved by _______________________
Legal Name of Entity owner
Trade name if different
Number and street
City / town
State
ZIP code
Telephone number
The undersigned hereby requests the comptroller to refund sales and use tax in the amount of $
, less discount
previously taken, if applicable, of
, for a net refund of $
. This sum is the amount of sales and
use tax that has been improperly paid, or collected and subsequently refunded, by the undersigned for the reasons described below:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Date
Name
Amount of
Date of
Amount of
Amount of
of tax
(List the names of the persons to whom you paid the
tax refund/
sale
sale
tax
refund/
tax. If you are a vendor who has refunded or credited
credit*
tax to customers, list the customers’ names.)
credit*
If additional space is required, please attach additional sheets and provide the information using the same format. *Complete if you
are a vendor who has refunded or credited tax to a customer.
NOTE: To expedite this application, non-returnable copies of records supporting the refund request should accompany this form.
These records should include, when appropriate, sales and purchase invoices or journals, resale certificates and cancelled checks
corresponding to entries in this application. If it is impractical to forward copies of all supporting documents, the records must be
made readily available for review by an employee of the Compliance Division, if requested.
I HEREBY CERTIFY under the penalties of perjury that I have examined the information set forth in this application including any
accompanying schedules or statements and that said information is true, accurate and complete to the best of my knowledge and
belief.
Signature
Print name
Date
Title
Direct inquiries and mail application to:
For more information email questions to:
CDSTREFUNDS@comp.state.md.us
Comptroller of Maryland
or call 410-767-1530.
Compliance Division
301 West Preston Street, Room 303
Maryland Relay (MRS) at 711
Baltimore, Maryland 21201-2383
COM/SUT205
06/17
17-49

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