Form Cst-240 - Claim For Refund Or Credit Of Consumer Sales And Service Tax printable pdf download

CST-240

Claim for Refund or Credit of

West Virginia

State Tax

Consumer Sales and Service Tax

Rev. 2/14

Department

The following information refers to the person/entity submitting the application for refund or credit of sales tax paid to

vendors on purchases that are exempt or have been used in an exempt manner. If any part of the required information is

not provided, the claim will be rejected.

Please tyPe or Print clearly

1. West Virginia Account Identification Number:

2. Name of applicant:

3. Street Address: _____________________________________ 4. City, State, Zip Code: _________________________

5. Contact Name and Phone Number: __________________________________________________________________

6. Taxable periods covered by this claim:

YYYY

7. Amount of refund or credit:

A) WV State Sales Tax.................................................................................

B) Charleston Sales Tax...............................................................................

C) Harrisville Sales Tax................................................................................

D) Huntington Sales Tax...............................................................................

E) Quinwood Sales Tax................................................................................

F) Rupert Sales Tax......................................................................................

G) Wheeling Sales Tax.................................................................................

H) Williamstown Sales Tax...........................................................................

i) Grand total of claim for refund or credit.............................

8. Check the appropriate box:

Refund

Credit

**Failure to choose will result in issuance of a credit to be used against future sales tax due the State.**

9. State the basis for claiming refund or credit:

______________________________________________________________________________________________

Under penalties of perjury, I declare that I have examined this return (including appropriate documentation) and to the best

of my knowledge and belief it is true and complete.

________________________________

___________________

(Signature)

(Date)

DePartment Use only

Date Completed: _________________________________

Amount Approved: _______________________________

Reviewed By: ___________________________________

Period credit applied to: ___________________________

*c15071401W*

Form Cst-240 - Claim For Refund Or Credit Of Consumer Sales And Service Tax

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