Form 7 - Claim For Overpayment Of Sales And Use Tax printable pdf download

Claim for Overpayment of Sales and Use Tax

FORM

• Attach supporting documents.

• Read instructions on reverse side.

PLEASE DO NOT WRITE IN THIS SPACE

Nebraska Identification Number

Federal Employer ID or Social Security Number

Claim Period

RESET

Beginning ______________________ , ________ and Ending ______________________ , ________

NAME AND LOCATION ADDRESS OF CLAIMANT

NAME AND MAILING ADDRESS OF CLAIMANT

Name

Legal Name

Street Address

Street or Other Mailing Address

City

State

Zip Code

City

State

Zip Code

AMOUNT CLAIMED

PROVIDE BASIS FOR CLAIM AND ATTACH APPROPRIATE

1 Amount of Nebraska sales and

DOCUMENTATION (See Instructions)

use tax overpayment .............

2 Local sales and use tax overpayment:

Local Taxing Jurisdiction

Amount of Local Tax Overpayment

3 Total of line 2. . . . . . . . . . . . . .

4 Total of lines 1 and 3 . . . . . . . .

5 Select method of payment (Check One):

Issue refund (Your refund will be issued in four to six weeks after approval.)

Establish credit to sales or use tax account (Do not use credit until shown on return.)

6 Name of individual to be contacted regarding this claim:

(

)

Title

E-Mail Address

Daytime Telephone Number

Authorized Contact Person (Please Print)

I declare under penalties of law that I have examined this claim, and to the best of my knowledge and belief, it is correct and complete.

sign

I also declare that payment of this claim has not been previously made by the state, nor have I claimed or received a refund from the retailer.

(

)

(

)

here

Authorized Signature (Owner, Partner, Corporate Officer)

Telephone Number

Signature of Preparer Other Than Taxpayer

Telephone Number

Date

Address

Date

Title (See Instructions)

ACTION TAKEN BY THE NEBRASKA DEPARTMENT OF REVENUE

ACH ON FILE

APPROVED

COMMENTS:

YES

Code

Amount

DIRECT VOUCHER

TAX CAT. _________

REF. TYPE____________

FORCE CODE_________

DATE TO

FINANCE_____________

Total

APPROVED

CREDIT ACCOUNT

ISSUE WARRANT

APPROVED AS REVISED

DISAPPROVED

SEE COMMENTS

SEE LETTER DATED ___________

Authorized Signature

Date

Mail this claim and supporting documentation to: NEBRASKA DEPARTMENT OF REVENUE, P.O. BOX 98903, LINCOLN, NE 68509-8903

, (800) 742-7474 (toll free in NE and IA), (402) 471-5729

4-2010

Please make a copy of this form for your records.

6-063-1967 Rev.

Supersedes 6-063-1967 Rev. 2-2009

Form 7 - Claim For Overpayment Of Sales And Use Tax

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