Form Local Governments Revenue Direct Petition For Refund - Alabama Department Of Revenue
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1______________
Pay $
The facts set out in this petition
and the records of this office
justify a refund in the amount
shown above.
L
G
R
L
G
R
________/________
L
G
R
ocal
overnments
evenue
L
G
R
The Tax Company
Direct Petition for Refund
NOTE: Separate Petitions Are Required For Each Type of Tax
The undersigned hereby make application for refund of ___________________________________
_____________________________________________Dollars, ($__________________________________)
________________________________________ tax paid by said undersigned to the Alabama
Department of Revenue for the period(s) __________________________________________________
_________________________________________________________________________, which amount
was erroneously paid, or paid in excess of the amount due, or was paid through mistake of
fact or law.
Explain in detail the reasons for refund claim (attach additional pages if necessary):
Petition
_______________
Adjustment _______________
Discount
_______________
Interest
_______________
Transfer
_______________
Total Amt. To
be refunded _______________
Signatures: A petition must bear the signature the party involved. If a petitioner is an individual, the individual must
sign. If a petitioner is a partnership, a partner must sign. If a petitioner is a corporation, an officer of the corporation
must sign.
____________________________________________________
__________________________________________________________
Petitioner’s Name
Account No.
____________________________________________________
__________________________________________________________
D/B/A
Telephone No.
____________________________________________________
__________________________________________________________
Petitioner’s Signature
Title
__________________________________________________________________________________________________________________
Mailing Address
__________________________________________________________________________________________________________________
City
State
Zip Code
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