Claim For Refund Of Fees Or Sales Tax For Motor Vehicles Tc55a

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Utah State Tax Commission
TC-55A
Division of Motor Vehicles • PO Box 30412 • Salt Lake City, UT 84130 • 801-297-7780 or 1-800-368-8824
Rev. 3/17
Claim for Refund of Fees or Sales Tax for Motor Vehicles
Get forms at tax.utah.gov/forms
Applicant name
License plate, permit or assigned number
Address
Vehicle/Hull Identification Number (VIN/HIN)
City
State
ZIP code
Daytime phone
1. Amount of sales tax or fees paid
$
2. Correct amount of sales tax or fees as computed by taxpayer
$
3. Amount claimed as a refund (subtract amount on line 2 from line 1)
$
I am submitting this claim for the following reasons (use reverse side if needed):
I understand that submitting a claim for refund does not guarantee the refund will be approved. I also understand that further
research will determine if the claim will be approved or denied.
Applicant signature
Date
For Office Use Only
___ ___ __
_ __ _ _
_ __ _ _ _
_______ _
Returned decal #:
Registration month/year:
User ID:
Returned plate #:
____________ ___ ___ __
_ ___ _ __ _ __ _ __ _
Account:
Period:
Total amount of refund
Motor vehicle fees
Sales/Use tax
as computed by the
$
$
$
eligible for refund
eligible for refund
Utah State Tax Commission
Motor Vehicle
Watercraft/Off-highway
Breakdown of refund by account
Indicate for each account listed below the amount of the refund approved by the examining agent.
Account type
Amount of refund
Account type
Amount of refund
Registration canceled?
Registration Fee
$
Title Fee
$
Yes
No
$
$
_ _ __ _ _
Driver’s Education
Sales/Use Tax
Date canceled:
$
$
Insurance Database
IRP Registration Fees
_ _ _ __ _ __ _
User ID:
$
$
Corridor Fee
DUI Penalty
$
$
Plate Fee
Impound Fee
Title canceled?
$
$
Yes
No
Personalized Plate Fee
Insurance Revocation
$
$
_ __ _ _ _
Date canceled:
Postage Fee
RPS/Internet Fall-Outs
$
$
______
_ ___ __
__ _ __ _ __ _
Other:
Other:
User ID:
Preliminary approval/denial
Date
Final DMV Accounting approval/denial
Date

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