Form Alc-82 - Application For Refund Of Cuyahoga County Taxes On Wine And Mixed Beverages, Beer Or Malt Beverages Paid In Excess Of Legal Requirements
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ALC 82
Rev. 7/13
P.O. Box 530
Columbus, OH
43216-0530
Application for Refund of Cuyahoga County Taxes on Wine and
Mixed Beverages, Beer or Malt Beverages Paid in Excess of Legal Requirements
Reporting Period
Account No.
For period of
, 20
to
, 20
, inclusive
File No.
1. Name
Print name of permit holder as shown on permittee’s license
2. Address
State File No.
City
State
ZIP
3.
If records are located at an address other than line 2, show on line 3.
4. Federal employer identifi cation number or, if none assigned for
Employer Identifi cation Account No.
Social Security No.
reporting federal taxes, please enter your social security number.
5. Reason for claim
Unsaleable product (do not destroy until you have received approval from this department)
Other – please explain
6. Amount of beer and/or malt
beverage tax requested:
X .16 = $
7. Amount of wine and mixed
beverage tax requested:
X .32 = $
8. Less discount, if applicable
(line 6 or 7 X .025)
9. Total amount requested
$
declare under penalties of perjury that this report, including any accompanying schedules
I
For Department Use Only
and statements, has been examined by me and, to the best of my knowledge and belief,
is a true, correct and complete return and report.
Voucher no.
Claimant
Title
Date
Instructions
A separate refund claim must be submitted for beer or malt beverage
In any event, applications can only be considered if fi led within three
tax and wine and mixed beverage tax. All refund applications must
years of the date of overpayment.
be fi led with the Tax Commissioner on the proper forms. Complete
All claims must be numbered in sequence starting with No. 1. Enter
records must be supplied supporting the information, otherwise the
the number in the fi le number space in the upper right corner of
claim may be denied. Claims fi led by distributors must be supported
this form.
by credit memoranda issued to customers indicating that the product
was returned and that the county tax was paid.
Send the original copy to the Department of Taxation, Attn: Excise
and Energy Tax Division, P.O. Box 530, Columbus, OH 43216-0530.
All applications for refund must be fi led within 90 days from the date
Retain the duplicate copy for your records.
it is ascertained that a refund is due.
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