Financial Services 
                                                                                     Sales Tax Division 
                                                                                     215 North Mason Street, 2 ndFloor 
                                                                                     P.O. Box 580 
                                                                                     Fort Collins, CO 80522 
                                                                                     970.221.6780 
                                                                                     970.221.6782 - fax 
                                                                                     fcgov.com/salestax 

                      REFUND CLAIM FOR CITY TAXES PAID 

Please refer to the instructions on the back of this form. 

Name of Claimant:  

Residence or Business Address:    

Mailing Address: 

Phone:                                                     Email Address:   

Date of Payment:                                           Type of Tax Paid:  

Total Amount Paid $                                        Total Refund Requested $ 

Reasons for Claim:  

I/we declare, under penalties of perjury, that this claim (including any accompanying schedules and statements) has 
been examined by me/us, and to the best of my/our knowledge and belief is true, correct and made in good faith, for 
the purpose stated. 

A claim by an agent must be accompanied by power of attorney. 

_____________________________________________________________________________________________ 
Signature of person other than taxpayer preparing claim                              Date 

_____________________________________________________________________________________________ 
Signature of Taxpayer                                                                Date 

======================================================================================== 

Office Use Only:                  Audited by: _______________________ Approved by: __________________________  
                                                                                    Sales Tax Manager/Financial Officer 

                                  Amount of Refund: _________________ Date: ________________________________ 

INSTRUCTIONS 

Claim must be filed within three (3) years after the date of purchase, storage, use, or consumption of the good or 
service.  

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. Any false statement made by the 
applicant for sales/use tax refund is punishable on conviction by a maximum fine of $300 or a minimum sentence 
of ninety (90) days, or both.  Additional documentation or verification may be required after receipt of your 
claim and original documentation.  

Licensed Taxpayer Claims Require: 

1. Detailed explanation of how the error occurred.

2. Copy of invoice(s) ,credit memo(s), and other documentation you consider appropriate to the claim.    *

3. Sales journals that provide sufficient evidence as to how the sales for the period were summarized and 
   clearly show the total monthly sales totals (including the invoice(s) in question) and the amount of tax 
   reported and paid to the City of Fort Collins.

4. The claim should be signed by the taxpayer, if possible.  Whenever it is necessary to have the claim 
   executed by an attorney or agent, on behalf of the taxpayer, an authenticated copy of the document 
   specifically authorizing such an agent or attorney to sign the claim on behalf of the taxpayer should 
   accompany the claim.

5. Where the taxpayer is a corporation, the claim shall be signed with the corporate name, followed by the 
   signature and title of the officer having authority to sign for the corporation.  

3rd Party Claims from Individuals (Customers) Require: 

1. Copy of original invoice on which City of Fort Collins tax was charged. *

2. Proof of payment of invoice (receipt, or copy of front and back of canceled check).

3. Include other documentation you consider appropriate.

* If the claim is for tax paid on a vehicle, the following must be included:

   1. Copy of Colorado driver’s license showing current address.
   2. Copy of registration on the vehicle.
   3. Copy of the sales invoice.