Form Wv/char-6 - Application For Refund Of Corporation License Tax

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WV/CHAR-6
WEST VIRGINIA STATE TAX DEPARTMENT
Rev. 1/05
INTERNAL AUDITING DIVISION
P. O. BOX 1985
CHARLESTON, WEST VIRGINIA 25327
APPLICATION FOR REFUND OF CORPORATION LICENSE TAX
(WEST VIRGINIA CODE 11-12C)
West Virginia Identification Number ..............
Business Name ............................................
Address ........................................................
REQUEST REFUND OF: $
REPORT YEAR(S):
FOR THE FOLLOWING REASON(S):
CAUTION: Read this application before signing.
TAX COMMISSION USE ONLY
Presenting a fraudulent claim constitutes a felony.
Refund Class
I certify all information herein to be true and accurate
to the best of my knowledge.
Transaction Number
SIGNATURE
Report Year(s)
Amount of Refund $
TITLE
DATE
Sworn to and subscribed before me this ______ day of ________
Approved By
Seal of Officer
Date Approved
Taking Affidvit__________________________________________
Notary Public
Serial Number
County of _______________________ State of _______________

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