Form 14-202 - Texas Claim For Refund Of Motor Vehicle Tax, B. Diesel Motor Vehicle Surcharge, And/or Commercial Vehicle Registration Surcharge -
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1
214-202
(Rev.11-04/13)
TEXAS CLAIM FOR REFUND OF MOTOR VEHICLE TAX,
b.
DIESEL MOTOR VEHICLE SURCHARGE, AND/OR
COMMERCIAL VEHICLE REGISTRATION SURCHARGE
• BEFORE SUBMITTING, SEE INSTRUCTIONS ON BACK.
58900
a. T code
c. Claimant’s Social Security or FEI number
d. Motor vehicle identification number shown on Tax Collector’s receipt
e. Claimant’s name and mailing address
FM
f. Blacken this box if your
1
address has changed ...........................
g.
FOR COMPTROLLER USE ONLY
INV
SP
SS
2
3
4
Daytime phone (Area code and number)
A TAX RECEIPT AND SIGNED BUYER’S ORDER
month
date
year
h. Tax receipt
i. Reason code for refund
FOR COMPTROLLER USE ONLY
OR PURCHASE INVOICE MUST BE SUBMITTED
date
claim (See code list
WITH ALL CLAIMS FOR REFUND. PLEASE
in instructions)
j.
ALLOW 6-8 WEEKS FOR PROCESSING.
l. Document number from title application receipt
k. County Tax Collector’s tax receipt number
m.PM
SECTION I - MOTOR VEHICLE TAX and/or DIESEL MOTOR VEHICLE SURCHARGE
n.
14
o.
17
Motor Vehicle Tax
Diesel MV Surcharge
COLUMN A
COLUMN B
1. Amount of motor vehicle tax / penalty paid to Texas in Column A and
Diesel Motor Vehicle Surcharge, if applicable, in Column B ................................. 1a.
_______________
1b.
_______________
2. Motor vehicle sales price ........................................................................................ 2a.
_______________
2b.
_______________
3. Trade-in or rebate ................................................................................................... 3a.
_______________
3b.
_______________
4. Taxable value (Item 2a minus Item 3a) .................................................................. 4a.
_______________
4b.
_______________
5a. Motor vehicle tax due (See instructions) ................................................................ 5a.
_______________
5b. Diesel motor vehicle surcharge due (For model years prior to 1997, multiply Item 1b by 2.5%.
For model years 1997 and after, multiply Item 1b by 1%.) .................................................................................. 5b.
_______________
6. Tax paid to another state ........................................................................................ 6a.
_______________
7. Amount of tax due (Item 5a minus Item 6a) or surcharge due .............................. 7a.
_______________
7b.
_______________
8. Amount of penalty if due (See instructions, Item i, Reason code I) ...................... 8a.
_______________
8b.
_______________
9. Total amount due (Item 7a plus Item 8a, and Item 7b plus Item 8b) ..................... 9a.
_______________
9b.
_______________
10. Amount of refund requested (Item 1a minus Item 9a and Item 1b minus Item 9b) 10a.
_______________
10b.
_______________
11. TOTAL REFUND FOR SECTION I - (Item 10a plus Item 10b) ........................................................................... 11.
_______________
SECTION II - COMMERCIAL VEHICLE REGISTRATION SURCHARGE
21
p.
12. Amount of commercial vehicle registration surcharge refund requested
(See instructions, Reason Codes R, S, T, and U.) .............................................................................................. 12.
_______________
AFFIDAVIT: I declare that the information in this document and any attachments is true and correct to the best of
Complete the claim and mail to:
my knowledge and belief.
COMPTROLLER OF PUBLIC ACCOUNTS
Purchaser
111 E. 17th Street
Austin, TX 78774-0100
Business phone / Daytime phone
(Area code and number)
If you have any questions about this claim, contact your local
Seller
Comptroller field office, or call 1-800-252-1382, toll free
nationwide. The number in Austin is 512/463-4600. If you’re
calling from a Telecommunications Device for the Deaf, the toll-
Business phone / Daytime phone
free number is 1-800-248-4099, or in Austin, 512/463-4621.
(Area code and number)
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