Looking for a New York State Tax Forms And Templates? Download it for free!

Form Tp-550-R - Claim For Refund Of Special Assessments On Hazardous Waste In New York State

TP-550-R

New York State Department of Taxation and Finance

Claim for Refund of Special Assessments

(11/11)

on Hazardous Waste in New York State

Environmental protection agency (EPA) number

Employer identification number (EIN) or social security number (SSN)

Legal name

Street address

City

State

ZIP code

Change of business information? See Business information on back.

Computation of refund

(Give all facts. List the quarterly period(s) for which you are claiming a refund and attach copies of returns

and canceled checks. Attach additional sheets if necessary.)

I hereby certify that this claim and any attachments are to the best of my knowledge and belief, true, correct, and complete.

Authorized

Signature of authorized person

Official title

Date

person

Firm’s name

Firm’s EIN

Preparer’s PTIN or SSN

Paid

(or yours if self-employed)

preparer

Signature of individual preparing this claim

Address

City

State

ZIP code

use

only

E-mail address of individual preparing this claim

Preparer’s NYTPRIN

Date

(see instr.)

Form Tp-550-R - Claim For Refund Of Special Assessments On Hazardous Waste In New York State