Form 472f - Application For Food Tax Refund - Missouri Department Of Revenue
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1MISSOURI DEPARTMENT OF REVENUE
CLAIM NUMBER
FORM
TAX ADMINISTRATION BUREAU
472F
P.O. BOX 3350, JEFFERSON CITY, MISSOURI 65105-3350
APPLICATION FOR FOOD TAX REFUND
(REV. 10-97)
TO APPLY FOR A 3% REFUND OF SALES/USE TAX COLLECTED ON RETAIL SALES OF QUALIFYING FOOD ITEMS, PLEASE COMPLETE THIS
FORM. THE 3% REFUND IS ALLOWED ONLY FOR TAX COLLECTED (AND TIMELY REMITTED) FOR FILING PERIODS BEGINNING OCTOBER 1,
1997 AND ENDING SEPTEMBER 30, 1998. THIS APPLICATION FOR REFUND MUST BE POSTMARKED NO LATER THAN SEPTEMBER 30, 1999.
BUSINESS NAME
TAX IDENTIFICATION NUMBER
NAME TO BE TYPED ON CHECK
PHONE NUMBER
MAILING ADDRESS
CITY, STATE, ZIP CODE
TAX COLLECTED ON FOOD
RETURN
3% REFUND
ENTER TOTAL “AMOUNT OF TAX”
FILE
MULTIPLY PREVIOUS COLUMN BY .03
DEPARTMENT USE ONLY
FROM ALL “FOOD” LINES AS
PERIOD
AND ENTER RESULT
REPORTED ON ORIGINAL RETURN(S)
OCT 97
NOV 97
DEC 97
JAN 98
FEB 98
MAR 98
APR 98
MAY 98
JUN 98
JUL 98
AUG 98
SEP 98
$
$
TOTAL (AMOUNT REFUND
REQUESTED)
DEPARTMENT USE ONLY
YOUR REFUND REQUEST HAS BEEN PROCESSED AS FOLLOWS:
AMOUNT REQUESTED
$
PROCESSING TECHNICIAN
DATE
AMOUNT APPROVED
$
DIFFERENCE* (AMOUNT DENIED)
$
SUPERVISOR APPROVAL
DATE
*YOU HAVE THE RIGHT TO APPEAL ANY AMOUNT DENIED.
SEE REVERSE SIDE FOR APPEAL PROCEDURES AND INSTRUCTIONS FOR COMPLETING REFUND APPLICATION.
DISTRIBUTION: WHITE & CANARY — TAX ADMINISTRATION BUREAU
PINK — TAXPAYER
MO 860-2772 (10-97)
This publication is available upon request in alternative accessible format(s).
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