Claim For Refund Form - City Of Wheat Ridge, Colorado

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REFUND
CLAIM FOR
th
7500 W. 29
Avenue
Wheat Ridge, Colorado 80033
Tax Division (303) 235-2820
Claimant’s Name ________________________________________________________________________________
City Account Number (if applicable) ________________________________________________________________
Mailing Address Street _______________________________________________________ Unit ________________
Mailing Address City ______________________________________________ State ______ ZIP ________________
Contact Name __________________________________________________________________________________
Contact Phone ________________________________ Email ____________________________________________
Type of Refund
(Please select one)
Sales Tax
Consumer Use Tax
Building Use Tax
Lodging Tax
Amount of Refund Requested ___________________________________
Explanation of Claim (Please attach supporting documentation such as receipts, invoices or returns)
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
By signing below I declare under penalty of perjury that the statements made herein are true and correct to the best of
my knowledge and belief.
Signature of Claimant ____________________________________________________________________________
Title ______________________________________________________ Date _______________________________
FOR CITY USE ONLY
Notes:

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