Form Et185r_4.5-4 - Application For Refund For Overpayment Of State Tax On Purchases Of Natural Gas Or Electricity Used Or Consumed By Manufacturers

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State of Arkansas
Department of Finance and Administration
Application for Refund for Overpayment of State Tax on Purchases of
Click Here For Applicable Rates With Dates
Natural Gas or Electricity Used or Consumed by Manufacturers
Select Applicable Rate :
1. Name of Business:
3. Contact Person:
2. Complete Mailing Address:
4. Telephone Number:
5. Sales Tax Permit Number:
6. Certificate Number Applicable to Refund Requested:
7. Total Time Period Refund Request Covers:
through
8. Type of Utility Purchased-Natural Gas or Electricity:
A.
B.
C.
D.
E.
F.
G.
H.
Period Bill Covers
x Manufacturing
Manufacturing Portion
Multiplier
Meter #
(copies of bills must be attached)
Date Tax Paid
State Tax Amount
Use % =
- State Tax
Refund Amount
through
x
% =
$ 0.00
0
$ 0.00
through
x
% =
$ 0.00
0
$ 0.00
through
x
% =
$ 0.00
0
$ 0.00
through
x
% =
$ 0.00
0
$ 0.00
through
x
% =
$ 0.00
0
$ 0.00
through
x
% =
$ 0.00
0
$ 0.00
through
x
% =
$ 0.00
0
$ 0.00
through
x
% =
$ 0.00
0
$ 0.00
through
x
% =
$ 0.00
0
$ 0.00
through
x
% =
$ 0.00
0
$ 0.00
through
x
% =
$ 0.00
0
$ 0.00
through
x
% =
$ 0.00
0
$ 0.00
9. Total Amount of Refund Request
$ 0.00
The undersigned purchaser agrees and certifies that this application is true, correct, and complete. This refund request is subject to audit verification.
Mail this request with attachments to:
Authorized Signature (Owner, Partner, or Officer)
Date
Arkansas Sales and Use Tax Section
P.O. Box 3566
Little Rock, AR 72203-3566
ET185R_4.5-4
07/2008
Clear Form

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