Form Boe-318 - Claim For Refund And Irrevocable Election To Apply Credits Against Qualified Sales And Use Tax - 2012 Page 2

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BOE-318 (BACK) REV. 1 (10-12)
SECTION III
PRIOR CLAIM PERIOD
AMOUNT
If you have previously filed a claim for refund for sales and use tax
(mm/dd/yy – mm/dd/yy)
PREVIOUSLY CLAIMED
based on the application of credits from the above referenced
certificate, enter the claim periods and amounts (attach a separate
$
.00
schedule if needed).
$
.00
$
.00
$
.00
$
.00
$
.00
If you have claimed credits from the above referenced certificate
INCOME TAX YEAR
CLAIMED AMOUNT
against franchise and income tax, enter the tax year claimed and
amount.
$
.00
$
.00
$
.00
$
.00
Balance of your unused credits from the above referenced certificate:
Note: Purchased credits attributable to an independent film may not be used to obtain a refund of sales and use taxes. No interest will
be paid on any amount refunded or credited.
By signing this form you are making a claim for refund of the amounts specified in Section II in accordance with
article 1 of chapter 7 of the Sales and Use Tax Law. In addition, by signing this form you are irrevocably
electing to apply the certified credits in Section II against qualified sales and use taxes.
NAME OF QUALIFIED TAXPAYER
FOR ASSIGNED CREDITS, NAME OF QUALIFIED TAXPAYER’S AFFILIATE
SIGNATURE OF CLAIMANT
DATE SIGNED
PRINT NAME (
name of person signing
)
TITLE
CLAIMANT’S SELLER’S PERMIT # OR CONSUMER USE TAX PERMIT #
CLAIMANT’S SOCIAL SECURITY # OR FEDERAL EMPLOYER IDENTIFICATION #
TELEPHONE NUMBER OF CONTACT PERSON
EMAIL ADDRESS OF CONTACT PERSON
(
)
CLEAR
PRINT

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