Claim For Refund Form - City Of Golden Sales Tax Division
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1City of Golden
Sales Tax Division
911 10th Street
Golden, CO 80401
(303) 384-8023
CLAIM FOR REFUND
Name of Claimant:
City Account #:
Mailing Address:
Contact Name:
Phone Number:
(
)
Type of Refund (Please check one):
Sales Tax
Consumer Use Tax
Building Use Tax
Auto Use Tax
Amount of Refund Requested:
$
Explanation Of Claim (Please attach relevant documentation):
By my signature below, I declare, under the penalty of perjury, that the statements made
herein are to the best of my knowledge true and correct.
Signature of Claimant:
Title:
Date:
****************************************************************************************************************
(FOR CITY USE ONLY)
Auditor:
A/P Vendor #
Amount Denied:
Amount Approved
$
Reason/Comments:
#0100001199
Account Number
Authorization
Date Approved
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Parent category: Financial