Form Dr 0137b - Colorado Claim For Refund Of Tax Paid To Vendors Page 2

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DR 0137B Claim for Refund of Sales or Use Tax Overpayment
Store Name (Only one vendor per sheet)
Store's Address (street, city, state) and Store Number (if available) Where Product Was Purchased
Vendor's Sales Tax Number
FEIN
Type of Tax
Date of
Invoice
Amount
State
County
City
Special
A brief description of the item being claimed and how product is used.
Purchase
Number
of Sale
Sales/Use
Sales/Use
Sales/Use
District
Pretax
Tax
Tax
Tax
Sales/Use
Tax
Total
$
$
$
$
$
Tax

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