TAX CLAIM FOR REFUND  
                                                                   
City Of Brighton, Colorado   
Sales Tax Division 
500 S 4 thAve 
Brighton, CO  80601 
Phone: 303-655-2041 
E-mail: SalesTax@Brightonco.gov 
 
  Submit separate claim for each type of tax (e.g. City Sales, City Use). 
  Periods can be combined if consecutive for each type of tax. 
  Retain copy for your records. 
 
 Refund to be made payable to, and mailed to:                                  (If this is different from the name and address on the City's Tax License records 
                                                                               for the account number(s) used, provide explanation and notarized power of 
                                                                               attorney specific to this refund to initiate the action.) 

 Taxpayer Name: 

 Taxpayer DBA (if applicable): 

 Mailing Address: 

 City:                                           State:                                                          Zip: 

 City License Number:                            Type of Tax:                                                    Period (mo/yr-mo/yr): 

 Original Amount Paid:                           Correct Amount:                                                 Refund Requested: 

 Reason for Refund Request: (Explain below or on a separate sheet of paper if needed).  All supporting documentation must be attached, including copies of receipts. 
  
 I declare under penalty of perjury in the second degree that this claim including all attachments is to the best of my knowledge true and 
 correct.  I further understand that the claim and documentation may be subject to the same verification process used by the Brighton Sales 
 Tax Division in auditing other taxes for three years from the date of payment of the claim. 
 Taxpayer Signature (this line must be signed by an officer, partner, or owner of the firm claiming the refund): 
  
 Title:                                                            Telephone:                                                          Date: 

 Contact E-mail:  

 Signature of Preparer (if other than taxpayer): 

 Name of Firm:                                                     Telephone:                                                          Date: 

                               FOR CITY OF BRIGHTON USE ONLY.  Do not write in this section. 
 Amount to be refunded: ___________________________________ 
 Comments:  
  
 I certify that I have made an examination of the documents and facts related to this claim. 

 Initiator:                                        Date:                   GL Account(s): 

 1 ndApprover:                                     Date:                   2 ndApprover                                                Date: