Form Tc-55a - Claim For Refund Of Fees Or Sales Tax For Motor Vehicles
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Utah State Tax Commission
TC-55A
Rev. 5/11
Claim for Refund of Fees or Sales Tax for Motor Vehicles
Division of Motor Vehicles · PO Box 30412, Salt Lake City, UT 84130 · Telephone 801-297-7780 or 1-800-368-8824
Get forms online - tax.utah.gov
Applicant name
License plate, permit, or assigned number
Address
Vehicle/Hull Identification Number (VIN/HIN)
City
State
Zip code
Daytime telephone number
1. Amount of sales tax or fees paid
$
$
2. Correct amount of sales tax or fees as computed by taxpayer
3. Amount claimed as a refund (subtract amount on line 2 from line 1)
$
I am submitting this claim for the following reasons: (use reverse side if needed)
Applicant signature
Date
For Office Use Only
Returned Decal #: _________________
Registration month/year: ______________
Returned plate #: _________________
TXID: ______________
Transaction #: ___________________________________________________________
Total amount of refund
Motor vehicle fees
Sales/Use tax
$
$
as computed by the Utah
$
eligible for refund
eligible for refund
State Tax Commission
Breakdown of refund by account
Motor Vehicle
Watercraft/Off-highway
Indicate for each account listed below the amount of the refund approved by the examining agent.
Account type
Amount of refund
Account type
Amount of refund
Registration canceled?
Registration Fee
$
Title Fee
$
Yes
No
$
Sales/Use Tax
$
Driver's Education
Date canceled: ____________________
$
Insurance Database
$
IRP Registration Fees
TXID: ______________
DUI Penalty
$
$
Corridor Fee
Impound Fee
$
$
Title canceled?
Plate Fee
Personalized Plate Fee
Insurance Revocation
$
$
Yes
No
RPS/Internet Fall-Outs
Postage Fee
$
$
Date canceled: ____________________
Other: ____________
Other: ____________
$
$
TXID: ______________
Preliminary approval/denial
Date
Final DMV Accounting approval/denial
Date
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