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Click ‘Get Form’ to open it in the editor.
Begin with Section One by entering your Taxpayer Name and Trade Name in fields 1a and 1b. Ensure all information is printed clearly.
Fill out your mailing address in fields 2a, 2b, 2c, and 2d. This is where all correspondence regarding your claim will be sent.
Provide your Federal Identification Number or Social Security Number in field 3. If your address on the tax return differs from the mailing address, complete field 4.
Indicate the Type of Tax in field 5 and specify the Period Covered by Claim in field 6. Make sure to submit a separate claim for each tax type.
Enter the Date of Payment in field 7 if applicable, followed by the Amount of Claim in field 8, which must be completed for processing.
In Section Two, provide a detailed explanation of your claim along with any supporting documentation. If more space is needed, attach additional sheets.
Finally, complete Section Three by signing and dating the form. Include your title and contact phone number for verification purposes.
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