RETURN TO: 
                                                                                                                                Refund@denvergov.org 
                                   CITY AND COUNTY                                  OF DENVER                                                                  OR 
                                                                                                                             Department of  Finance  – Refunds 
                                           CLAIM FOR REFUND 
                                                                                                                                201 W. Colfax Ave. 
                                                                                                                                MC 1001  Dept 1009 
         Sales Tax          Use Tax              Lodger’s Tax                       Occupational Privlegei       Tax            Denver, Colorado 80202 

         TBT                FDA                  License Fee                                                                    Phone: (720) 913-9955 

Licensed Taxpayer Claims  – (Claims filed by taxpayers licensed  with the  City and County of Denver) 

    Name of  Claimant __________________________________________________ Ph. #___________________________ 
    Refund Mailing Address_____________________________________________________________________________ 
                                   Street                     City                                               State                                     Zip 

       Contact Person ____________________________________         mE- ail:________________________________ 

       Amount  of Claim for  Refund $  _______________________                                            Denver Account  # _______________________ 

       Period(s) Being Claimed: _______________________ 
rd 
3  Party Claims  –  (Claims filed by  purchasers/employees  not licensed  with the City and County of Denver)  
         Must be filed within 60 days  of  transaction resulting in overpayment of tax  –  see instructions  

         Name of  Claimant _________________________________________________ Ph. #____________________________ 
         Refund Mailing Address  ____________________________________________________________________________ 
                                   Street                     City                                               State                                     Zip 

         Contact Person ___________________________________                          E-mail: _____________              __________________________ 

         Amount  of Claim for  Refund $  ______________________  

         Tax Paid to: ______________________________________                         Date(s) Tax  Paid: _______________________________ 
Statement of REASON FOR REFUND CLAIM                   

   I hereby certify,  under  penalty of perjury,  that the statements  made herein   are true and  correct to the best  of my knowledge.   I understand 
   that  making false  statements in connection  with an application for refund is a  violation of the           Denver Revised Municipal Code                   and may 
   be  punishable by fines  not to exceed $999.00 and/or imprisonment  of  up to  one (1) year. 
   Unsigned forms will be considered incomplete and      not logged or processed     .   

    _______________________________________________________                                                      ___________________________ 
    Signature of Claimant                                                                                        Date 

   _______________________________________________________  
   Print Name 

                                                  OFFICIAL USE ONLY 
Adjustments Total  $_________________             Denied Total  $_________________                               Interest Total__________________ 

   REFUND AMOUNT APPROVED $ ____________________________ 

   REVIEWER__________________________________________________                                                    Date___________________ _ _  
   SUPERVISOR________________________________________________                                                    Date____________________ _ 
   MANAGER__________________________________________________                                                     Date____________________ _ 
   DIRECTOR __________________________________________________                                                   Date____________________ _ 

                                                                                                                                                                  Rev 12/201 8 

                   GENERAL INSTRUCTIONS                       AND INFORMATION 
This form should be completed for   all claims for refund  of   Denver sales, use, lodger’s occupational, privilege  
(OPT), telecommunications business (TBT) and facilities development admissions (FDA)  taxes. 
Submission of request for refund on any other form (exclusive of those filed via Denver's eBiz Tax Center) 
will  be  considered  invalid,  not  logged  or  processed.  Submitting  your  claim  with  all  required 
documentation detailed below will verify the validity of your claim.            Failure to provide all required 
documentation will delay the processing of       the claim.  Additional documentation or verification may be 
required after receipt of your claim and original documentation. 
SALES, USE  AND LODGER’S TAX  
Licensed Taxpayer Claims Require: 
   1)  Detailed explanation of how error occurred. 
   2)  Copy of invoice(s) and credit memo(s) involved in claim. 
   3)  Sales  journals that provide sufficient evidence as to how  the sales for  the period were summarized   and 
       that clearly show  the total monthly sales total (including  the  invoice(s) in question) and  the amount of 
       tax reported and paid to the City and County of Denver. 
   4)  Include any other documentation you consider appropriate. 

   5)  Must be filed within three (3) years after the return is filed. 

rd 
3  Party Claims From Individuals (Customers) Require:   
   1)  Copy of original invoice on which Denver tax was charged. 
   2)  Proof of payment of the invoice (receipt, or copy of front and back of canceled check). 
   3)  Claims for tax charged on automotive vehicle purchases require return of the Denver motor vehicle 
       receipt (form TD 206) issued by the dealer, if the vehicle was not titled nor registered in Denver. 
   4)  Include any other documentation you consider appropriate. 

   5)  Must be filed within 60 days of the transaction resulting in the overpayment of tax. 

OCCUPATIONAL  PRIVILEGE TAX  

Licensed Taxpayer Claims Require: 
   1)  Detailed explanation of how error occurred. 
   2)  Proof of having refunded the employee(s) for any employee portion claimed (copy of front and back of 
       canceled check, or copy of payroll journal showing the refund). 
   3)  Copy of payroll journal that provides a detail listing of all employees during the period, in question, city 
       or location worked if not Denver, how much each employee was paid for the period, whether paid 
       hourly or by salary, and evidence the tax due was reported and paid to the City of Denver. 
   4)  Must be filed within three (3) years after the return is filed. 
rd 
3  Party Claims From Individual Employees Require:   
   1)  Proof of collection by employer (copies of check stubs or payroll journals). 
   2)  Signed statement  from employer on business letterhead acknowledging that work was not performed in 
       Denver during the period in question, if applicable. 

   3)  Must be filed within 60  days of the transaction resulting in the overpayment of tax. 

TBT  AND FDA TAX  
   1)  Submit all appropriate documentation to support the claim filed. 
   2)  Must be filed within three (3) years after the return is filed. 
                                                                                                                    Rev 12/2017