Claim For Refund - City Of Montrose Finance Department printable pdf download

Claim For Refund - City Of Montrose Finance Department

CITY OF MONTROSE

FINANCE DEPARTMENT

P.O. Box 790

Montrose, CO 81402

Type or Print:

Name of Person/Business/Organization requesting refund:________________________________________

Mailing Address

Physical Address

Name of Person/Business/Organization who collected and remitted sales tax to the City of Montrose:

Name __________________________________

City Sales Tax Account # ______________________

Mailing address _________________________

Physical Address _____________________________

_________________________

_____________________________

Refund should be payable to: Name

______________________________________________________

Address

______________________________________________________

The undersigned certifies that this statement is made on behalf of himself or the taxpayer named, that the facts given

below are true and complete, and avers that the claim should be allowed for the reasons stated below.

Date(s) of transaction(s)

Period(s) Filed

Character or Kind of Tax

Amount of Tax Paid

Correct Amount of Tax Liability

Amount to be Refunded

Reason for Claim:

(Attach letter size sheets if space is not sufficient)

Claims for disputed City of Montrose Sales or Use Tax Code 5-15-9, must be supported by affidavit of

purchaser accompanied by original paid invoice or sales receipt and certified by the seller.

I/We declare under the penalties of perjury, that this claim (including any accompanying schedules and statements) has been

examined by me/us, and to the best of my knowledge and belief is a true, correct, and complete return mad in good faith, for the

under authority thereof.

purposes stated pursuant to the ordinances of the City of Montrose and the Regulations issued

(Signature of person, other than taxpayer, preparing return)

(Signature of Taxpayer)

(Name of firm or employer, if any)

(Date)

Claim For Refund - City Of Montrose Finance Department