Form Et185r - Application For Refund For Overpayment Of State Tax On Purchases Of Natural Gas Or Electricity Used Or Consumed By Manufacturers

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State of Arkansas
Department of Finance and Administration
Application for Refund for Overpayment of State Tax on Purchases of
Natural Gas or Electricity Used or Consumed by Manufacturers
1. Name of Business:
2. Complete Mailing Address:
3. Contact Person:
4. Telephone Number:
5. Sales Tax Permit Number:
6. Certificate Number Applicable to Refund Requested:
7. Total Time Period Refund Request Covers:
8. Type of Utility Purchased - Natural Gas or Electricity:
through
A.
B.
C.
D.
E.
F.
G.
H.
Meter #
Period Bill Covers
x Manufacturing
Manufacturing Portion
x .25 =
Refund Amount
(copies of bills must be attached)
Date Tax Paid
State Tax Amount
Use % =
- State Tax
0.00
0.00
x
% =
x .25 =
through
0.00
0.00
x
% =
x .25 =
through
0.00
0.00
x
% =
x .25 =
through
0.00
0.00
x
% =
x .25 =
through
0.00
0.00
x
% =
x .25 =
through
0.00
0.00
x
% =
x .25 =
through
0.00
0.00
x
% =
x .25 =
through
0.00
0.00
x
% =
x .25 =
through
0.00
0.00
x
% =
x .25 =
through
0.00
0.00
x
% =
x .25 =
through
0.00
0.00
x
% =
x .25 =
through
0.00
0.00
x
% =
x .25 =
through
9. Total Amount of Refund Request:
0.00
The undersigned purchaser agrees and certifies that this application is true, correct, and complete. This refund request is subject to audit verification.
___________________________________________________________
_______________________
Mail this request with attachments to:
Authorized Signature (Owner, Partner or Officer)
Date
Arkansas Sales and Use Tax Section
P. O. Box 3566
ET185R
REV 08/2007
Little Rock, AR 72203-3566

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