Claimant's Name*

City Account Number (if applicable)

Mailing Address Street*

Unit

Mailing Address City*

State*

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ZIP Code*

Contact Name*

Contact Phone

Contact Email*

Type of Refund *

Choose One Sales Tax Consumer Use Tax Building Use Tax Lodging Tax

Amount of Refund Requested*

Explanation of Claim*

1. For your refund to be processed, supporting documents must be attached as picture (.tif or .jpg) or portable document format (.pdf) files.
2. Helpful items tell the story and may include receipts, invoices, returns, exemption licenses, permits or other helpful documents.
3. Contact us to find out what you need to send if you're not sure (303) 235-2820

Attach Supporting Documents

By imprinting my name below I declare under penalty of perjury that the statements made herein are true and correct to the best of my knowledge and reasonable belief.

Individual's Name*

Individual's title or relationship to claimant