Form 106 - Stop Payment Request

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STOP PAYMENT REQUEST
FORM
106
Revenue Administration Division
Refund Unit
Tax year
MD refund check dated
Amount
$
Primary Taxpayer’s printed name
Primary Taxpayer’s SSN
Primary Taxpayer’s signature*
Secondary Taxpayer’s printed name
Secondary Taxpayer’s SSN
Secondary Taxpayer’s signature*
Current Mailing Address - Street/P.O. Box
Current Mailing Address - City
State
Zip
Daytime Contact Number
* Signatures are matched to our master files. Electronic filers; attach a copy of your State issued
identification for verification. On jointly filed returns, both taxpayers must sign this request.
Please place a stop payment on the above referenced refund check and issue a replacement
check at the provided mailing address.
Submit Forms to the Refund Unit via Email, Fax or Mail:
Email:
RADREFUND@comp.state.md.us
Fax:
410-260-7890
Mail:
Comptroller of Maryland
Revenue Administration Division
Attn: Refund Unit
P.O. Box 1829
Annapolis, Maryland 21404-1829
COM/RAD-106
03/12
12-49

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