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Form Smwa-1 - Application For Refund Of Vermont Sales & Use Tax, Meals & Rooms Tax, Withholding Tax

Vermont Department of Taxes, PO Box 547, Montpelier, VT 05601-0547

Phone: (802) 828-2551

Fax: (802) 828-5787

APPLICATION FOR REFUND

Form

SMWA-1

Vermont Sales & Use tax, Meals & Rooms tax, Withholding tax

Vermont Business

Period

Account

covered by

Refund

Number

claim

Amount

Name of

Telephone

Claimant

number

Address

City

State

Zip

Name of

Telephone

Representative (if any)

number

Address

City

State

Zip

Give a full explanation below (see instructions). Use additional sheets if necessary and submit all documents needed to properly

substantiate your claim.

______________________________________________________________________________________________________

I, the claimant named above, or partner, officer, or other authorized representative of such claimant, make application for

refund of Sales and Use tax, Meals and Rooms tax, or Withholding tax pursuant to 32 V.S.A. §9781 (SU), §9245 (MR),

and §5884 (WH). I certify all Vermont Sales and Use taxes, Meals and Rooms taxes, and Withholding taxes for which

this claim is filed, have been paid, and no portion of the tax has been refunded or credited to me by any vendor.

Signature

Title

Date

SEE INSTRUCTIONS ON THE BACK OF THIS FORM

Form SMWA-1

Rev. 7/03

Form Smwa-1 - Application For Refund Of Vermont Sales & Use Tax, Meals & Rooms Tax, Withholding Tax

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