Form 156 - Fuel Tax Refund Program For Persons With Disabilities - 2002

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Ministry of
SIGNING AUTHORIZATION
Provincial Revenue
FUEL TAX REFUND PROGRAM
Consumer Taxation Branch
FOR PERSONS WITH DISABILITIES
pursuant to the Motor Fuel Tax Act
INSTRUCTIONS:
• Please complete this form in full.
• Information is also available on the Internet:
• Return to the Consumer Taxation Branch at:
PO Box 9442 Stn Prov Govt
Victoria BC V8W 9V4
Freedom of Information and Protection of Privacy Act – The personal
information requested is collected under the authority of and used for the
• This form will be kept on file for future reference.
purpose of administering the Motor Fuel Tax Act . Questions about how the
Freedom of Information and Protection of Privacy Act applies to this personal
• If you need additional information, call the
information can be directed to the Tax Analyst (250 356-7342), Consumer
Consumer Taxation Branch in Vancouver at
Taxation Branch, PO Box 9442 Stn Prov Govt, Victoria BC V8W 9V4.
604 660-4524 or outside Vancouver toll free
at 1 877 388-4440.
FILE REFERENCE
G
,
I,
Claimant’s Name
hereby authorize the below mentioned individual to sign refund application forms on my behalf for
the Fuel Tax Refund Program for Persons with Disabilities.
Name of Authorized Individual
Signature of Authorized Individual
Signature of Claimant
Date Signed
FIN 156 Rev. 2002 / 8 / 22
Clear Form

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