Form St11 - Sales And Use Tax Refund Request And Multiple Period Amended Return

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ST11
Sales and Use Tax Refund Request
and Multiple Period Amended Return
Business name
Minnesota tax ID
Address
Period covered by this request
From
Through
City
State
ZIP code
Main business address in Minnesota (if different from above)
City
State
ZIP code
Name of person to contact about this request
Title
Phone
Email
Type of request you are filing (select all that apply):
Purchaser refunds
Sales tax paid in error to a vendor
Construction exemptions for special projects under M.S. 297A.71
Project Type from statute
Greater Minnesota Job Expansion
Job Opportunity Building Zone (JOBZ)
Qualified Data Center
Capital equipment refund
Multiple period amended return
Worksheet
Create and attach a supporting worksheet for each type of request (see pages 2 - 5 of the instructions).
Describe your business and the reason for your request.
Total Refund or Amount Due
Refund requested
Additional tax due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
I declare that this form and supporting documentation is correct and complete to the best of my knowledge and belief.
A request for refund filed by a corporation must bear the original signatures and titles of the officers having the authority to
sign for the corporation.
Signature of taxpayer or authorized representative
Title
Date
Phone
Preparer signature
Preparer Minnesota tax ID number
Date
Preparer Phone
Send us Form ST11, your worksheet(s), and supporting documents:
Mail:
Minnesota Revenue
525 Lake Avenue South, Suite 405
Duluth, MN 55802
Email: salesuse .claim@state .mn .us
Rev. 5/17

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