Form 106 - Stop Payment Request printable pdf download

Form 106 - Stop Payment Request

STOP PAYMENT REQUEST

FORM

106

Revenue Administration Division

Refund Unit

Tax year

MD refund check dated

Amount

Primary Taxpayer’s printed name

Primary Taxpayer’s SSN

Primary Taxpayer’s signature*

Secondary Taxpayer’s printed name

Secondary Taxpayer’s SSN

Secondary Taxpayer’s signature*

Current Mailing Address - Street/P.O. Box

Current Mailing Address - City

State

Zip

Daytime Contact Number

* Signatures are matched to our master files. Electronic filers; attach a copy of your State issued

identification for verification. On jointly filed returns, both taxpayers must sign this request.

Please place a stop payment on the above referenced refund check and issue a replacement

check at the provided mailing address.

Submit Forms to the Refund Unit via Email, Fax or Mail:

Email:

RADREFUND@comp.state.md.us

Fax:

410-260-7890

Mail:

Comptroller of Maryland

Revenue Administration Division

Attn: Refund Unit

P.O. Box 1829

Annapolis, Maryland 21404-1829

COM/RAD-106

03/12

12-49

Form 106 - Stop Payment Request