Form Com/att-001-1 - Claim For Refund
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1Comptroller of Maryland
MATT Regulatory Division
Alcohol and Tobacco Tax
P.O. Box 2999
Annapolis, Maryland 21404-2999
410-260-7314/888-784-0145
Fax# 410-974-3201
CLAIM FOR REFUND
(File in duplicate and in full detail)
Date:
Claim for tax refund is hereby made in the amount of $
.
This claim is itemized as follows:
Our reasons for filing claim are:
Name of Company
Street Address
City, State, Nine Digit Zip Code
Federal Identification #
-
AFFIDAVIT
I do solemnly declare and affirm under the penalties of perjury that the contents of the foregoing document
are true and correct to the best of my knowledge, information, and belief.
Signature
Title
COM/ATT-001-1
Revised 6/08
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Parent category: Financial