Form 353 - Agricultural Purposes Clam For Refund - Tennessee Department Of Revenue
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353
TENNESSEE DEPARTMENT OF REVENUE
AGRICULTURAL PURPOSES CLAIM FOR REFUND
.
OATH OF TAXPAYER
Under penalties of perjury, I declare that I have examined this claim, and to the best of my knowledge and belief, it is true, correct,
and complete.
Name ___________________________________________
Title ___________________________________________
(Signature of Taxpayer, Officer, or Authorized Representative)
FOR OFFICE USE ONLY
CHECKED BY
DATE
APPROVED
REASON FOR REDUCTION
REFUND NO.
REDUCED
PROCESS COMPLETION DATE
INCREASED
APPROVAL
Approved Amount $ ______________
__________________________________________
________________________________________
_____________
Director or Designate
Commissioner of Revenue or Designate
Date
RV-R0008301
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