Claim For Refund Form - City Of Aurora, Colorado Finance Department
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1City of Aurora
TAX & LICENSING DIVISION
Finance Department
15151 E. Alameda Parkway
Aurora, Colorado 80012
Phone Number:303-739-7800
Fax Number: 303-739-7753
Tax Exempt No
CLAIM FOR REFUND
License Number
PLEASE PRINT OR TYPE
Name of Claimant:
DBA or Trade Name:
Street Address:
City:
State:
Zip:
Phone Number:
Fax Number:
The undersigned certifies that this statement is made on behalf of himself or the taxpayer named, the facts given
below are true and complete, and avers that the claim should be allowed for the reasons stated below.
1
Dates of Payment
2
Amount of Tax Paid
3
Correct Amt. of Tax Liability
4
Amount to be refunded
REASONS FOR CLAIM:
Claim for refund of a specific tax must be made within the time limits and be supported by the required documents all in accordance with
the provisions of the particular ordinance relating to such tax. Your refund will be processed in 90 days or less.
Signature of Claimant
Date
Name of Firm
Date
BELOW THIS LINE FOR INTERNAL USE ONLY
I certify that I have made an examination of the claim and facts submitted and recommend that the amount indicated herein be refunded
Refund amount claimed:
Case No:
Refund amount adjusted:
Type of tax refunded:
Refund amount approved:
Fund/Account No:
Refund interest allowed:
Fund/Account No Int:
25112-66450
Total Refund Issued:
Examined by:
Title:
Date:
I hereby authorize the total refund as recommended in the report by the examining officer of
$
Signature:
Title:
Date:
F:\Dept\Finance\Tax Licensing Division\Audit\Refunds\Claim for Refund.xls
Revised:10/1/2003
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