Form Tc-62pr - Application For Refund Of Utah Sales And Use Tax - 2013
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1Utah State Tax Commission
TC-62PR
Application for Refund of Utah Sales and Use Tax
Rev. 9/13
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A. Purchaser Information
Name/Business name
Utah sales tax account number (if any)
Address
City
State
ZIP Code
Contact person’s name
Telephone number
Fax number
Email address
B. Refund Claim Information
In the space below, identify the title(s), chapter(s) and section(s) in Utah Code that authorize an EXEMPTION from sales tax for the item(s), or describe how
the item(s) qualifies for an EXCLUSION based on Utah law (attach additional sheets if needed):
1. Refund request amount. . . . . . . . . . . . . . $ _ _ __ __ _ ___
2. Total number of invoices/purchases . . .
__ _ __ _ __ __
3. Time covered by this request . . . . . . . . .
__ _ __ _ __ ___ _ _
__ _ _ _______ _ _
From
To
Sign here after printing to elect this method.
4. Sign here if your total invoices/purchases on line 2 are 500 or more AND you elect a sampling review method: _____________________
C. Seller’s Information
If there is more than one seller, attach additional sheets with the information in this section for each seller.
Business name
Address
City
State
ZIP Code
D. Representative’s Information
(if any)
Business name
Contact name
Relationship to purchaser
Address
Email address
Power of Attorney attached dated:
City
State
ZIP Code
Telephone number
E. Certification and Signature(s)
Under penalties of perjury, I, the purchaser, declare the refund of Utah sales and use tax I am requesting has NOT been refunded or credited to me, either
by the seller to whom the sales tax was originally paid, or by the Tax Commission. I also declare I will not request a refund or credit from the seller. I will
immediately send payment for refund, plus any interest, to the Utah State Tax Commission if I receive a duplicate refund or interest. I have included all the
required information and documents (in the required formats) as explained in the instructions.
____ __ __ _ _ _ _ _ _____ __ _ __ _ __ __ _ _ _
_ __ ____ ___ ____ ___ _
__ ___ ___ _ _ _ _ _ _ _ _
Purchaser’s authorized signature
Title
Date
____ __ __ _ _ _ _ _ _____ __ _ __ _ __ __ _ _ _
_ __ ____ ___ ____ ___ _
Authorized signature name printed
Telephone number
____ __ __ _ _ _ _ _ _____ __ _ __ _ __ __ _ _ _
_ __ ____ ___ ____ ___ _
__ ___ ___ _ _ _ _ _ _ _ _
Representative's signature
Title
Date
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Parent category: Financial