Form Dr 0137b - Claim For Refund Of Tax Paid To Vendors Page 3

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DR 0137B Claim for Refund of Sales or Use Tax
DR 0137B (11/28/16)
COLORADO DEPARTMENT OF REVENUE
Overpayment Spreadsheet
Business Tax Accounting Room 208
P.O. Box 17087
Denver, CO 80217-0087
(303) 238-SERV (7378)
Taxpayer’s Name
Account Number/FEIN/SSN
Store Name (Only one vendor per sheet)
Store's Address
City
State
ZIP
Store Number (if available) Where Product Was Purchased
Vendor's Sales Tax License or Account Number
Vendor’s FEIN (if known)
Type of Tax
Type of Exemption
Special
State
County
City
Amount
District
Date of
Invoice
Sales/
Sales/
Sales/
Explanation how item or
How item or service qualifies
of Sale
Sales/
Description of item or service
Number
Use
Use
Use
service is used
for the exemption claimed.
Purchase
Pretax
Use
Tax
Tax
Tax
Tax
Total
Tax
$
$
$
$
$

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