Allen Parish School Board 
                                    Sales andthUse Tax 
                                      1111 W 7  Avenue 
                                      P.O. Drawer 190 
                                      Oberlin, LA  70655 
                                                      
                               Claim for Refund of Taxes Paid 
 
Make separate claim for each parish & type of tax 
 
Name of taxpayer                                                                                         
Mailing Address:  
Address                                                                                                  
 
City                                                  State                    Zip                       
 
Parish Account Number                                                                                    
 
Check type of tax:     
            Sales Tax                               Occupational License Tax    
            Alcohol Beverage Permit                 Hotel/Motel Occupancy Tax 
            Insurance Premium Tax                                                                        
 
Period(s) of overpayment                                                                                  
Contact Person: 
Name                                                                                                      
 
Email Address                                                                                            
 
Telephone                                              Fax                                               
 
Total remitted for the period                         $                                                  
 
Amount claimed to be due as amended                   $                                                  
 
Difference (refund requested)                         $                                                  
 
This refund is claimed for the following reasons: 
                                                                                                         
Providing  appropriate  documentation  for  refund  requests  will  expedite  the  refund  claim.    For  example:  
original invoice, credit invoice, original tax return, and proof of payment.  
 
For bad debt write-offs, please supply the state’s approval letter. 
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FOR OFFICE USE ONLY:   
Total Approved for Payment                            $                                                  
 
Date                            Approved By                                                              

Rev 09/04                                                            Claim for Refund of Taxes Paid.doc