Request For Sales/use/cigarette Tax Refund - Wyoming Department Of Revenue
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1Wyoming Department of Revenue
Excise Tax Division
122 W. 25th Street, Herschler Bldg.
Cheyenne, Wyoming 82002-0110
(Please Print or Type the following information)
Name: Individual or Business
(Wyoming Sales Tax License Number)
Mailing Address
Contact Phone Number(s)
FAX Number(s)
A refund of Wyoming (please check one)
Sales tax
Use tax
Cigarette tax
Is being made in the amount of $________________________________ for the following reason(s):
Supporting Documentation Required for Cigarette Tax Refunds
1.
Manufacturers affidavit of unsaleable or returned cigarettes.
Supporting Documentation Required for Sales/Use Tax Refunds
1.
A copy of all purchase invoices or bill of sale issued by the seller or dealer.
2.
A copy of all receipts issued for the payment of sales/use tax.
3.
A copy of "Affidavit of Delivery" of a motor vehicle, if applicable.
4.
A copy of "Proof of Residency" at the time of purchase. if applicable.
5.
A copy of your tribal enrollment of one of the two tribes residing on the Wind River Indian
Reservation, if applicable.
Signature of Claimant
Date
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