Refund Of Taxes Paid To The State Of Texas

Download a blank fillable Refund Of Taxes Paid To The State Of Texas in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Refund Of Taxes Paid To The State Of Texas with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

89-100
CLEAR FORM
PRINT FORM
(Rev.9-11/7)
2.
Employer Application for
Refund of Taxes Paid to the State of Texas
NOTE: Complete a separate form for each eligible employee,
Temporary Assistance for Needy Families (TANF)
to be filed ONLY on or after January 1, 2012 and
before April 1, 2012 (for wages paid in 2011).
1. T code
58100
TWC #1098
Employer Information
3. Texas taxpayer number
Period of claim
m
m d
d
y
y
m
m
d
d
y
y
Begin date
End date
4.
5.
6. Taxpayer name
Blacken this box if your
8.
1
FM
address has changed ..........
7. Address
9. FOR COMPTROLLER USE ONLY
City
S tate
ZIP code
2
3
INV
SD
Contact person
Telephone (area code and number)
Contact person street address (if different from above)
City
S tate
ZIP code
NOTE: If this form is being completed by an agent of the taxpayer, a power of attorney must be attached to this form.
Employee Information / Release Authorization
10. Name (Last)
11. First
12. Middle initial
13. Social Security number
14. Employment start date
15. Employment termination date (if applicable)
I hereby give my permission to the Texas Workforce Commission to certify to this employer or to the Texas Comptroller of Public Accounts that I was a
recipient of financial assistance under TANF or MEDICAID any month within 6 months of my beginning date of employment.
16. Employee’s signature
17. Date
Refund Calculation
18. Total Wages paid DURING Claim Period in Items 4 and 5 above .................................................................................... 18.
___________________
19. Eligible Wages [Multiply Item 18 by 20% (.20)] ................................................................................................................ 19.
___________________
$2,000.00
20. Maximum Claim allowed per employee ....................................................................................20. ___________________
21. Refunds previously claimed for this employee .......................................................................21. ___________________
22. Maximum eligible refund for employee (Item 20 minus Item 21) .............................................22. ___________________
23. Refund claimed for 2011 (Enter the smaller of Item 19 or Item 22) ................................................................................. 23.
___________________
NOTE: The refund issued for all employees will not exceed net taxes paid and postmarked for state sales and use, franchise, boat and boat motor,
inheritance, PUC gross receipts, hotel and/or manufactured housing after any applicable credits, in the calendar year that this claim covers.
Employer’s Statement Regarding Insurance
I certify that this taxpayer/employer provides to and pays for the benefit of this employee a part of the cost of health insurance provided under:
24.
Check all that apply:
HMO Plan
Self-Funded or Self-Insured ERISA Plan
Health Plan approved by Commissioner of Insurance
HEALTH INSURANCE PROVIDER
25.
27.
Name
Group no.
26.
28.
Street address
Policy no. and effective date
29.
City, State, ZIP code
Telephone (area code and number)
I further certify under penalty of perjury that the information I have provided on this application is true and complete to the best of my knowledge and belief.
30. Employer or authorized person
Date
ALL RECORDS ARE SUBJECT TO AUDIT REVIEW. Employer must maintain records to support all information. If supporting documentation is needed to verify your claim, you will
be contacted.
TWC Certification
I hereby certify that the above named individual was a recipient of TANF or Medicaid any month within 6 months of the start date.
31. Authorized TWC Employee
Date

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Cst-af2 - West Virginia Claim For Refund Or Credit Of Sales Or Use Tax Paid To The State Tax Department Instructions Form Cst-af2 - West Virginia Claim For Refund Or Credit Of Sales Or Use Tax Paid To The State Tax Department Instructions Financial
Schedule C Individual - Credit For Taxes Paid To The United States, Its Possessions And Foreign Countries - Commonwealth Of Puerto Rico - 2004 Schedule C Individual - Credit For Taxes Paid To The United States, Its Possessions And Foreign Countries - Commonwealth Of Puerto Rico - 2004 Financial
Schedule C Individual - Credit For Taxes Paid To The United States, Its Possessions And Foreign Countries - 2006 Schedule C Individual - Credit For Taxes Paid To The United States, Its Possessions And Foreign Countries - 2006 Financial
Schedule C Individual - Credit For Taxes Paid To The United States, Its Possessions And Foreign Countries - 2009 Schedule C Individual - Credit For Taxes Paid To The United States, Its Possessions And Foreign Countries - 2009 Financial
Schedule C Individual - Credit For Taxes Paid To The United States, Its Possessions And Foreign Countries - 2005 Schedule C Individual - Credit For Taxes Paid To The United States, Its Possessions And Foreign Countries - 2005 Financial
Schedule C Individual - Credit For Taxes Paid To The United States, Its Possessions And Foreign Countries - 2008 Schedule C Individual - Credit For Taxes Paid To The United States, Its Possessions And Foreign Countries - 2008 Financial
Schedule C Individual - Credit For Taxes Paid To The United States, Its Possessions And Foreign Countries Schedule C Individual - Credit For Taxes Paid To The United States, Its Possessions And Foreign Countries Financial
Schedule C Individual - Credit Taxes Paid To The United States, Its Possessions And Foreign Countries - 2003 Schedule C Individual - Credit Taxes Paid To The United States, Its Possessions And Foreign Countries - 2003 Financial
Schedule C Corporation And Partnership - Credit For Taxes Paid To The United States, Its Possessions And Foreign Countries Schedule C Corporation And Partnership - Credit For Taxes Paid To The United States, Its Possessions And Foreign Countries Financial
Schedule C Individual - Credit For Taxes Paid To The United States, Its Possessions And Foreign Countries - 2007 Schedule C Individual - Credit For Taxes Paid To The United States, Its Possessions And Foreign Countries - 2007 Financial

Related Categories

Parent category: Financial
Download
Go
Page of 2