Form Dr-26i - Application For Refund - Intangible Personal Property Tax

Form Dr-26i - Application For Refund - Intangible Personal Property Tax - 2003

DR-26I

Application for Refund - Intangible Personal Property Tax

N. 06/03

Use this form to apply for a refund of annual intangible personal property tax.

Complete Parts 1 through 6 and attach appropriate documentation.

Type or print clearly.

Mail original application to:

Refund Subprocess

Florida Department of Revenue

PO Box 6490

Tallahassee FL 32314-6490

Fax number: 850-410-2526

Name of applicant/payee:

Part 1

Fill in name, address,

and contact numbers.

Mailing address:

City, State, ZIP:

Location address (other than above):

City, State, ZIP:

Business telephone number (include area code): Home telephone number (include area code):

(

)

(

)

Fax number including area code (optional):

E-mail address (optional):

(

)

Signature of applicant/representative:

Date:

Part 2

If signed by a taxpayer’s

representative, see

Print name:

Title:

instructions on Page 3.

Part 3

Enter amount of refund

requested.

Identification number of applicant/payee:

Part 4

Provide the identification

Social security number:

For joint filers, spouse’s social security number:

number under which the

tax was paid.

Federal employer identification number:

Part 5

FOR DOR

DOC TYPE 76

USE ONLY

Enter the year shown on

Tax Year(s): ________________________________________

the tax return(s) and/or

Refund

Approval Amount $ ________________________

the date(s) tax was paid.

Date(s) Paid: _______________________________________

Date ____________________________________

Authorized By ____________________________

Part 6

Reason for this refund (additional sheets may be added):

Review

Refund Amount $ __________________________

Clarify and speed up

_________________________________________________

your refund claim by

Date ____________________________________

providing a brief

Approved By _____________________________

_________________________________________________

explanation.

Form Dr-26i - Application For Refund - Intangible Personal Property Tax - 2003

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