Form Dr-26 - Application For Refund Page 5
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12DR-26
R. 07/06
Part 7B
o
o
Department of Revenue
County Tax Collector
Check the box next to the
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Other: _____________________________________________________
entity that collected the tax.
I paid nonrecurring intangible tax and believe I am due a refund because:
Part 7C
Check the box next
Documents were recorded more than once (p. 7)
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to the reason you are
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Tax was remitted to the Department of Revenue and the county tax collector (p. 7)
requesting the refund.
Refer to the page
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Duplicate payments were issued for the same transaction (p. 7)
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Overpayment was made due to bookkeeping errors (p. 7)
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Tax was paid on an exempt transaction (housing authority bond loan) (p. 7)
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Tax was paid on an exempt transaction (loan issued by a government credit union) (p. 7)
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Other (explain):
number indicated
I paid documentary stamp tax and believe I am due a refund because:
for appropriate
documentation
Documents were recorded more than once (p. 7)
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instructions.
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Tax was remitted to the Department of Revenue and the county tax collector (p. 7)
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Duplicate payments were issued for the same document (p. 7)
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Tax was paid on an exempt document (housing authority bond loan) (p. 7)
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Tax was paid on an exempt document (transfer of the marital home between spouses
pursuant to dissolution of marriage after July 1, 1997) (p. 8)
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Property was transferred due to threat of condemnation (p. 8)
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Overpayment was made due to bookkeeping errors (p. 8)
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Document was cancelled due to a court order (p. 8)
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Other (explain):
I am an individual or business and believe I paid too much tax when I purchased:
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Local telecommunications services (p. 8-9)
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Long distance telecommunications services (p. 8-9)
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Facsimile (fax) service (p. 8-9)
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Pager service (p. 8-9)
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Cellular phone service (p. 8-9)
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Residential phone service (p. 8-9)
I am a registered communications services tax dealer and believe I am due a refund
because of:
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A correction to a previously filed return (p. 8-9)
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A collection or accrual of tax on exempt items or items that were resold (p. 8-9)
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A duplicate payment (p. 8-9)
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A credit memo issued by the Department (p. 8-9)
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An overpayment of an audit assessment (p. 8-9)
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An overpayment of a tax warrant (p. 8-9)
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An overpayment of a bill (p. 8-9)
I am an individual or business and believe I am due a refund for taxes previously paid on
telecommunications services because:
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I am a government agency (p. 8-9)
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I am a religious and educational organization with 501(c)(3) status (p. 8-9)
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I purchased the services for resale (p. 8-9)
I am an individual or business and believe I am due a refund because:
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Other (explain):
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