Form Cot/st 205 - Sales And Use Tax Refund Application

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State of Maryland
Comptroller of the Treasury
Compliance Division
301 West Preston Street
Baltimore, Maryland 21201-2383
Sales and Use Tax Refund Application
Sales and Use Tax
Trade name
Registration No.
FEIN No. or Social
Owner name
Security No. of applicant
Mailing address
Telephone No.
City or town, state & zip code
The undersigned hereby requests the comptroller to refund sales and use tax in the amount of $____________,
less discount previously taken, if applicable, of $____________, for a net refund of $____________. This sum is
the amount of sales and use tax that has been improperly paid, or collected and subsequently refunded, by the
undersigned for the reasons described below:
Name
(List the names of the persons to whom you paid the
Date of
Amount of
Amount of
Date of tax
Amount of tax
tax. If you are a vendor who has refunded or credited
sale
sale
tax
refund/credit
tax to customers, list the customers’ names.)
refund/credit
*
*
If additional space is required, please attach additional sheets and provide the information using the same format.
Complete if you are a vendor who has refunded or credited tax to a customer.
*
NOTE: To expedite this application, non-returnable copies of records supporting the refund request should
accompany this form. These records should include, when appropriate, sales and purchase invoices or
journals, resale certificates, and cancelled checks corresponding to entries in this application. If it is
impractical to forward copies of all supporting documents, the records must be made readily available for
review by an employee of the Compliance Division, if requested.
I HEREBY CERTIFY under the penalties of perjury that I have
For Office Use Only
examined the information set forth in this application including any
accompanying schedules or statements and that said information is
Claim Code
Claim No.
true, accurate and complete to the best of my knowledge and belief.
Amount approved
Liabilities
Signature
Check issued
Amount credited
Print name
Approved by
Approved by
Title
Date
COT/ST 205 (Rev. 8/96)
Refund Supervisor: 410-767-1538
For the hearing impaired: MRS 1-800-735-2258
TDD 410-767-1967
!

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