Business Tax Refund Application Form - Department Of Finance
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1
2BUSINESS TAX REFUND APPLICATION
For Office Use Only
City of Chicago
City of Chicago
Department of Finance
File #
Tax Division – Refund Unit
Date Rec’d: _______________
333 South State Street
Initials: ___________________
Suite 300
Chicago, Illinois 60604
Business Name: ______________________________________________________________________________________________
Business Address: ____________________________________________________________________________________________
City, State, Zip: _______________________________________________________________________________________________
Mailing Address (for refund if different from business address): _________________________________________________________
City, State, Zip: _______________________________________________________________________________________________
Account Number:
Site:
FEIN:
IBTN:
-
-
Are you currently or have you ever been audited by the Chicago Department of Finance
?
Yes
No
If yes, you must provide a copy of the audit notice, audit assessment, or settlement agreement.
TYPE OF REFUND
Note: REVIEW FILING INSTRUCTIONS BEFORE COMPLETING THIS APPLICATION.
Check the appropriate box below (Note: you must file a separate refund application for each tax).
Airport departure (8500)
Hotel accommodations (7520)
Telecommunications (7501)
Amusement (7510)
Liquor (7573)
Transaction / lease (7550)
Cigarette (7506)
Motor vehicle lessor (7575)
Use (non-titled property 8402, 8403)
Employer’s expense (7540)
Natural gas occupation (7571)
Use (titled property 8400)
Foreign fire insurance (7505)
Parking lot/garage (7530)
Vehicle fuel (7577)
Fountain soft drink (7590)
Real property transfer (7551)
Bottled Water Tax (1904)
Ground transportation (7595)
Tire Fee (BA94)
Electricity infrast. maint. fee (7576)
Emergency teleph. syst. surcharge – wireless (2906)
Gas use (7574)
Other ________________________
Emergency teleph. syst. surcharge – net based (2908)
Electricity use (7578)
Tax refund period: ___________________________________
Amount of tax refund requested: ________________________
Please state in detail below the reason(s) for refund request (attach additional sheet if necessary):
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Note:
All refunds must be properly substantiated with cancelled checks and supporting documentation. See filing
instructions for required supporting documentation.
Under penalty of perjury, I certify that the information contained in this application and the attached supporting documents are true and correct.
_________________________________________________________________________________________________________________________
Signature
Print Name
Date
_________________________________________________________________________________________________________________________
Title
Phone
Fax Number
PLEASE SEE REVERSE SIDE FOR INSTRUCTIONS
FOR OFFICE USE ONLY
Audited by: ___________________________
Title: __________________________
Date: ________
Telephone Number: _______________
Approved
Denied
Authorized by: ___________________________________
Date: ___________________________________
Voucher #
Date to comptroller:
____/____/____
Approved Amount
Tax
Check #
Date from comptroller: ____/____/____
Interest
Total
Certified Mail #
Date to comptroller:
____/____/____
Processor Signature: _____________________________________________________________
Date: ___________________________________
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