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                                                                                                                      City of Westminster
                                                            Claim for Refund                                      Department of Finance
                                                                                                                      Sales Tax Division
                                                            Please Type or Print Clearly
                               1) Legal Name of Business or Individual Name (Last, First):

                               2) Trade Name of Business (if any):

                               3) Mailing Address:                                                                7) Contact Person (if Business):

                               4) City:                                                 5) State:      6) Zip:    8) Phone Number:

                               E-mail Address:                                                                    9) City Account Number:

10) Amount of Claim:           $                                                       11) Date(s) of Overpayment:

12) Tax Type(s):               Sales       Use              Admissions                    Accommodations          Other:____________________

13) Give a brief explanation of your claim. Attach supporting documentation such as invoices, tax returns, supporting schedules, permits, etc. If the refund is to be
mailed to an address other than the address on file with the Sales Tax Division, include an explanation of why the alternate address should be used. Attach
additional sheets if necessary.

                          Under penalty of perjury, I declare that I have examined this Claim for Refund and that it is true and correct to the best of my knowledge and belief.

Claimant
Signature                 Signature                                                                               Date

                          Printed Name                                           Title                            Phone No.
Return completed form to:      Westminster Department of Finance   Sales Tax Division   4800 W 92nd Avenue   Westminster,CO 80031
                               (303) 658-2065   Fax: (303) 706-3923  https://www.cityofwestminster.us
                                                            CITY USE ONLY

                                                                                                  CLAIM NO.       R-
Reviewed By:                                                                                                   CASHIER VALIDATION
                          Signature                                              Date                             (If Petty Cash)

Disposition:     Denied        Approved    Approved in Part: 

Approved By:
                          Signature                                              Date

Finance Director
or City Manager:          Signature (As Required Per City Purchasing Procedures) Date

                 5300.____________.0000 Amount:

ACCOUNTS         5400.____________.0000 Amount:

                 5300.____________.0911 Amount:                                                        Petty Cash Rcvd By:_________ Date:______

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Instructions for Claim for Refund

General Instructions Claims may be made only for overpayment of
City of Westminster tax. The City will not
refund taxes overpaid to the State of Colorado
Purpose of Form or any other county, municipality, district, or
taxing jurisdiction. For example, a taxpayer
This form is used for taxpayers to request a refund of tax who pays sales tax to another municipality due to failure to
overpayments remitted to the City of Westminster (“City”) or present a Westminster building permit must seek a refund
to a retailer licensed and authorized to collect the same. from that municipality.
Pursuant to § 4-1-17 of the Westminster Municipal Code
(the “Code”), no tax overpayment shall be refunded unless Line 11 – Date(s) of Overpayment. List the dates the tax
a signed Claim for Refund form is submitted along with was purportedly overpaid. Taxpayers seeking a refund of
adequate documentation of the claim. disputed tax paid to a licensed Westminster retailer should
list the date of the purchase in dispute. Taxpayers seeking
Reminders a refund of taxes overpaid on a return should list the return
periods covered. All other claimants should list the date
Include supporting documentation. Documentation such overpayment was paid to the City.
supporting (1) that Westminster tax was, in fact, paid to the
City or to a licensed retailer; (2) the date(s) that Line 12 – Tax Types. Check the appropriate boxes
overpayment occurred; and (3) that Westminster tax was indicating the tax types for which a refund is being claimed.
not due must be submitted along with the Claim form. If a refund of multiple tax types is being claimed, the
Claims that are not adequately documented will be denied. specific amounts attributable to each tax type should be
detailed on line 13.
Claims may be barred by the Statute of Limitations.
 A purchaser who claims that Westminster tax was Line 13 – Explanation of Claim. Give a brief account of
erroneously paid on a purchase from a licensed the reasons for the claim. Details should include whom the
retailer must submit all claims on or before sixty (60) tax was paid to, if applicable, and why the tax is not due. If
days from the date of such purchase. the overpayment was the result of a calculation error,
 Any claim for refund resulting from a Notice of describe how the error occurred. If the taxpayer is claiming
Overpayment must be submitted on or before thirty transactions or items should be exempt under the Code,
(30) days from the date of such Notice of cite the applicable sections. All relevant factual and legal
Overpayment. claims should be included. Also include other required
 All other claims must be submitted on or before three explanations such as the reason for an alternate mailing
years after the date of such overpayment was paid to address or the amounts attributable to multiple tax types.
the City. Attach additional sheets if necessary.

Refunds are not assignable. The right of any person to Documentation – Attach the various documents
obtain a refund shall not be assignable. supporting the claim. Additional documentation may be
requested if it is needed to complete the review.
Signature required. The person completing the claim on
behalf of the taxpayer must sign and date the form at the Signature – After reviewing the form for accuracy, sign and
bottom. A printed name is also required. If the taxpayer is date the form. Print your name and title below your
not a natural person, the title of the officer or agent signature. Return the form to the Westminster Dep artment
completing the form on behalf of the taxpayer must also be of Finance along with the required documentation.
printed on the form. Forms without a signature will be
returned and may not be considered timely filed. Review & Determination – The review time required will
vary depending on the nature and scope of the claim. If
necessary, the claim will be assigned to an auditor who
Specific Instructions may contact you regarding the review. If the claim is
approved, a refund check will be sent approximately two
Lines 1 thru 8 – Claimant Information. Print the legal weeks after approval. Claims under $200 may be disbursed
name, the trade or other name the taxpayer is known as, immediately by the Cashier at City Hall. If the claim is
and the mailing address of the organization. For claims by denied, in full or in part, written notice of the determination
natural persons, print the last name followed by the first will be sent along with the payment, if any. Such
name on line 1 and do not complete line 2. Licensed determination may be protested within twenty (20) days of
taxpayers requesting that the refund be mailed to an issuance.

address other than the address on file with the Sales Tax
Division must include an explanation of why the refund
should be mailed to the alternate address on line 13.

Line 9 – City Account Number. If the taxpayer is licensed
with the City, list the 7 digit City account number. Department of Finance
Sales Tax Division
nd
Line 10 – Amount of Claim. List the claimed amount of 4800 W 92 Avenue
Westminster tax overpaid in dollars and cents. Do not Westminster, CO 80031
round. (303) 658-2065

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