Webster Parish                                                                           

Sales & Use Tax Commission
1128 Homer Road ˜˜˜˜P.O. Box 357 ˜˜˜˜ Minden, LA 71058 ˜˜˜˜ Phone: (318) 377-8948 ˜˜˜˜Fax: (318) 377-4089

                                     Claim for Refund of Taxes Paid

Account #                                                  Period(s)                                                           

Taxpayer                                                                                                                                            

Address                                                                                                                                             

City, State, ZIP                                                                                                                                     

Telephone       (         )                                                 

Total amount paid for period                      $                                     

Amount claimed to be due                          $                                     

Amount now requested to be refunded               $                                     

This refund is claimed for the following reasons:
                                                                                                                                                        
Please attach any prior returns or documents explaining the refund (invoices, exemption certificates, etc.).

Taxpayer signature                                                                      Date