Form Wv/char-3 - Application For Refund Of Corporation License Tax printable pdf download

Form Wv/char-3 - Application For Refund Of Corporation License Tax

WEST VIRGINIA

WV/CHAR-3

DEPARTMENT OF TAX & REVENUE

Orig. 5/98

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):

TAX COMMISSION USE ONLY

CAUTION: Read this application before signing.

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 _______________

Form Wv/char-3 - Application For Refund Of Corporation License Tax