Form Fp-331 - Claim For Refund Sales And Use Tax
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1*013310110000*
*013310110000*
GOVERNMENT OF THE DISTRICT OF COLUMBIA
OFFICE OF TAX AND REVENUE
CLAIM FOR REFUND
FP-331
SALES AND USE TAX
CLAIM # _________________
NAME OF TAXPAYER
TRADE NAME
FEDERAL EMPLOYER IDENTIFICATION NO./SSN
STREET ADDRESS
CITY
STATE
ZIP CODE
PHONE #
FAX #
NOTE: FOR TAX PAID ON MORE THAN ONE RETURN, LIST EACH ON A SEPARATE LINE
PERIOD
TOTAL TAX
DATE OF
AMOUNT OF
EXPLANATION OF OVERPAYMENT
ENDED
PAID
PAYMENT
REFUND CLAIMED
TOTAL
(FOR ADDITIONAL SPACE, USE OTHER SIDE)
Under penalties of law the duly authorized applicant(s) do solemnly swear or affirm that the foregoing
statements are correct to the best of my (our) knowledge.
AUTHORIZED SIGNATURE
TITLE
DATE
OFFICIAL USE
INITIAL
DATE
AMOUNT
APPROVED
DENIED
(12/01)
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Parent category: Financial