Form E-585e - State Agency Claim For Refund County Sales And Use Taxes
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1State Agency Claim for Refund
E-585E
County Sales and Use Taxes
12 - 03
North Carolina Department of Revenue
Complete all of the information in this section.
State Agency Name (First 32 Characters) (USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)
Account ID
Mailing Address
Federal Employer ID Number
Interoffice or Courier Mailing Address
Quarter Beginning (MM-DD-YY)
City
State
Zip Code
County
Quarter Ending (MM-DD-YY)
Name of Person We Should Contact if We Have Questions About This Claim
Contact Telephone
(
)
Name of Taxing County
1.
(If more than one county, see instructions on reverse and attach Form E-536)
County
2.
Total Purchases of Tangible Personal Property for Use on Which County Sales or Use Tax
,
,
.
Has Been Paid Directly to Retailers
(Do not include tax paid, purchases for resale, or items described in 3 below)
3.
Amount of County Sales and Use Tax Paid Directly to Retailers on Purchases for Use
,
,
.
(The tax is stated on the sales receipt or invoice. Do not include tax paid on any
of the following:
- electricity, piped natural gas, or telephone services
- the purchase, lease, or rental of motor vehicles
- local occupancy or local prepared food and beverage taxes
- scrap tire disposal or white goods disposal taxes)
,
,
.
4.
Amount of County Sales and Use Tax Paid Indirectly on Building Materials and
Supplies as Shown on Contractors’ Statements
Amount of County Use Tax Paid Directly to the Department of Revenue by Your Agency
5.
,
,
.
(Do not include tax collected and remitted on taxable sales made by your agency)
$
,
,
.
6.
Total County Refund Requested (Add Lines 3, 4, and 5. County tax must be identified
by rate on Line 7)
7.
Allocation of County Tax on Line 6 (Enter the county tax paid at each applicable rate. If you paid more than one county’s tax, see
the instructions on reverse and attach Form E-536)
Mecklenburg
Food 2% Tax
County 2% Tax
County 2.5% Tax
Transit .5% Tax
,
.
,
,
.
,
,
.
,
.
Signature:
Date:
I certify that, to the best of my knowledge, this claim is accurate and complete.
Title:
Telephone:
MAIL TO: NC Department of Revenue, P.O. Box 25000, Raleigh, NC 27640-0001
For Departmental Use Only
Refund Approved:
County Tax
As Filed
By:
,
,
.
As Corrected
Date:
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Parent category: Financial