Form Dr-26s - Application For Refund Sales And Use Tax - 2006
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1
2DR-26S
Application for Refund
R. 01/05
Sales and Use Tax
Please complete Parts 1 through 8 and attach appropriate documentation.
Type or print clearly.
Name of applicant/payee:
Part 1
Fill in name, address, and contact
Mailing address:
City, State, ZIP:
numbers.
Location address (other than above):
City, State, ZIP:
Business telephone number (include area code):
Home telephone number (include area code):
(
)
(
)
Fax number including area code (optional):
E-mail address (optional):
(
)
Signature of applicant/representative:
Date:
Part 2
Sign and date this form.
Print name:
Title:
Important - A Florida Department of Revenue Power of Attorney (Form DR-835) must be properly executed and included if the
refund request is submitted by the applicant’s representative.
Representative’s phone number: (__________________) _____________________________________________________
Part 3
$
,
,
.
Enter amount of refund requested.
Part 4
Sales and Use Tax
Surtax
Other (please specify): ______________
Check box next to the type of tax
you paid.
________________________________
Part 5
Contract Object Number:
Provide the identification number
-
of the applicant/payee. If you do
not have a Sales Tax Certificate
Sales Tax Certificate Number:
Number or Federal Employer
-
-
-
/
Identification Number, provide your
Social Security Number.
Federal Employer Identification Number:
Social Security Number:
-
-
-
Part 6
Collection period:
/
to
/
Enter the collection period shown
M
M
Y
Y
M
M
Y
Y
on the tax return(s) used to report
the tax and/or when it was paid.
Date paid:
/
/
to
/
/
M
M
D
D
Y
Y
M
M
D
D
Y
Y
Part 7A
Explain the reason for this refund (additional sheets may be added):
Clarify and speed up your refund
_______________________________________________________________________________________
claim by providing a brief
explanation.
_______________________________________________________________________________________
_______________________________________________________________________________________
Attach Documentation
Refund requests cannot be processed without complete documentation.
Important Note
Parts 7B and 7C (on reverse side) are designed to assist you in determining the
documentation needed for this refund request.
FOR FLORIDA DEPARTMENT OF REVENUE USE ONLY
DOC TYPE 76
Refund
Approval Amount
$ ____________________________________________ Authorized By _________________________________ Date _________________
Review
Refund Amount
$ ____________________________________________ Approved By __________________________________ Date _________________
3
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