Looking for a Wv Tax Forms And Templates? Download it for free!

Form Sn-4 - Application For Refund Of Sparklers And Novelties Registration Fee - 2007

WV/SN-4

WEST VIRGINIA

REV 4-07

DEPARTMENT OF TAX AND REVENUE

INTERNAL AUDITING DIVISION

PO BOX 2666

CHARLESTON WV 25330

APPLICATION FOR REFUND OF SPARKLERS AND NOVELTIES REGISTRATION FEE

(WEST VIRGINIA CODE 11-12)

West Virginia Identification Number...................

Business Name.................................................

Address............................................................

Period for which Refund is requested:................................................

Note:

The Sparklers and Novelties Registration Period

YEAR

covers fiscal year: July 1 - June 30

Refund requested................................................................................

Reason for requesting refund:

PLEASE RETURN THE ORIGINAL CERTIFICATE TO SELL

SPARKLERS AND NOVELTIES WITH YOUR REFUND REQUEST

CAUTION: Read this application before signing.

TAX DEPARTMENT USE ONLY

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____________________________________

License Year _________________________________________

SIGNATURE

Amount of refund $_____________________________________

TITLE

DATE

Approved by _________________________________________

Sworn to and subscribed before me this _____day of_______

Seal of Officer

Taking Affidavit_____________________________________

Date Approved _______________________________________

Notary Public

Serial Number_________________________________________

County of_____________________ Sate of _____________

*B47010701W*

Form Sn-4 - Application For Refund Of Sparklers And Novelties Registration Fee - 2007