Form Ga-110l/state Form 615 - Claim For Refund Page 2

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Form GA-110L Instructions
Complete a separate Form GA-110L for each tax type and location. Fill-in all blanks because any missing or incomplete
information may delay the processing of your Claim for Refund or may cause the Claim for Refund to be rejected
or denied. Make sure all missing returns have been filed.
•
Include the taxpayer’s name, address, and correct Taxpayer Identification Number with location number.
•
Check only ONE Tax Type.
○
Each tax type requires a separate GA-110L.
○
Refunds of the Surcharge tax are available to non-motor carriers who purchased special fuel (diesel,
biodiesel, compressed natural gas or liquified natural gas) in Indiana on or after July 1, 2017. Please limit
refund claims to one per quarter. The vehicle make, model and Vehicle Identification Number (VIN) must be
included, along with purchase receipts.
•
Attach ALL documentary evidence to support your claim. Failure to attach ALL documentation with your claim may
result in your claim being rejected or denied.
•
Include a complete explanation of why the refund is due.
•
Complete and attach a Power of Attorney (POA-1) form authorizing the department to discuss your claim and specific
tax type with someone other than the taxpayer.
•
Include each requested refund amount for the appropriate period(s) and the total requested refund amount.
•
Be sure to sign the GA-110L form and include a daytime phone number and email address.
○
Including a correct email address could help expedite the refund process.
Please allow 45 days for processing before contacting the department regarding the status of your claim.

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