Form St-12 - Claim For Refund - 2016 Page 2
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CLEAR
ST-12
Page 2
(Rev. 07/27/16)
PART B ALLOCATION OF LOCAL SALES & USE TAX ONLY
Instructions:
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Line 1, write in the total state refund tax amount from Page 1 of this form. If you have a refund due from the City of Atlanta, please
provide the applicable tax refund amount in Line 2. In the remaining lines, please write in your county refund allocations and include
Additional copies of Page 2 can be completed and submitted, if needed.
the corresponding county codes (one county per line).
Jurisdiction Name
Code
A. Refund Tax Amount
Jurisdiction Name Code
A. Refund Tax Amount
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000
24
2
City of Atlanta
999
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