Form T-126 - Refund Request - Registration, Title &/or Insurance Fees Page 2
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2Form T-126 (Rev. 11-2009)
Georgia Department of Revenue (DOR) Refund Request (Instructions)
General Information
•
Refunds are only authorized for the reasons listed on Form T-126.
•
A refund of fees paid a year or more before the refund is requested will not be made.
•
A refund of $10.00 or less will not be made.
•
Submit Form T-126 with the original payment receipt.
•
If a tag, registration or title was issued and should not have been, return the erroneously issued item(s) for cancellation.
Copies are not acceptable.
•
The DOR cannot refund taxes or tag agent fees.
•
Submit Form T-126 for fees paid directly to DOR to:
o
ATTN: Refund Request - Accounting & Audit Unit
Dept. of Revenue/Processing Center-Motor Vehicle
PO Box 740381
ATLANTA, GA 30374-0381.
•
Submit Form T-126 for fees paid directly to the County to the address printed on the original, payment receipt.
Section A
Vehicle Owner/Requestor Information
•
Print full, legal name of person or business requesting the refund and the date the request is made.
•
Print mailing address and daytime telephone number including area code of the person or business requesting the refund.
•
Print ‘Customer #1 ID Number:’ from original payment receipt.
•
Print social security number of the individual if the refund is for an individual and the fees were paid to DOR.
o
If the fees were paid to a County Tag Office, print the driver’s license number and state of issue if the refund is for
an individual.
•
Print EIN (employer identification number) if the refund is for a business.
Section B
Vehicle Information
•
Print vehicle year, vehicle make, current tag number and vehicle identification number (VIN).
Section C
Refund Request Amount and Reason(s) for Request
•
Print refund request amount next to applicable fee.
•
Print the name of the county from the original payment receipt.
•
Print date fees paid.
•
Check applicable reason(s) for refund request.
o
Any erroneously issued tag, registration and/or title must be submitted with refund request for reasons numbered 1,
2, 7, 8, 9 and 10.
o
If a title penalty fee is not due and the vehicle was purchased from an individual, submit the refund request with a
copy of the front and back of the cancelled check used to purchase the vehicle.
o
If a title penalty fee is not due and the vehicle was purchased from a dealer, submit the refund request with a copy of
the front and back of the cancelled check used to purchase the vehicle or dealer’s invoice.
o
If an insurance lapse fee or restoration fee should be refunded because the vehicle was not owned or driven while
the vehicle was uninsured, submit Form MV-18J with the refund request.
o
If an insurance lapse fee or restoration fee should be refunded because the vehicle was self-insured, insured under a
fleet insurance policy, a binder or declaration page, submit a copy of the self-insured insurance card and certificate
from the Insurance Commissioner, the fleet insurance card, the binder or the declaration page with the refund
request.
Section D
Signature
•
The person requesting the refund must sign the request.
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If the refund is for a business, print the name and title of the person signing Form T-126.
DOR/PC-MV- forms and information are available on the Internet at:
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