Form Tc-55a - Claim For Refund Of Fees Or Sales Tax For Motor Vehicles
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1
2Utah State Tax Commission
TC-55A
Rev. 10/13
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 plate #: _________________ Returned Decal #: _________________
Registration month/year: ______________
User ID: ______________
Account: _________________________________
Period: _________________________________
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
$
Driver's Education
$
Sales/Use Tax
Date canceled: ____________________
$
Insurance Database
$
IRP Registration Fees
User ID: ______________
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: ____________
$
$
User ID: ______________
Preliminary approval/denial
Date
Final DMV Accounting approval/denial
Date
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