Application for Refund of Taxes Paid                  
                                       Jefferson Parish 

Taxpayer Name:                                               JPSO Acct. No.:   
Contact Person: _______________________________________ Telephone: ______________________________    
Type of Tax:  __________________________________________ Email Address:       
Period(s):   
1. Taxes remitted:              $ 
2. Taxes due, as amended:       $ 
3. Refund requested:            $ 

This refund is claimed for the general reason (check all that apply): 

□    The  tax  was  overpaid  because  of  an error on the part of the taxpayer in mathematical computation on
     the return or any of the supporting documents.

□    The  tax  was  overpaid  because  of  a  construction  of  the  law  on  the  part  of  the  taxpayer  contrary to
     the collector's construction of the law at the time of payment. 

□    The  overpayment  was  the  result  of  an  error,  omission,  or  a  mistake  of  fact  of  consequence  to  the
     determination of the tax liability, whether on the part of the taxpayer or the collector.

□    The  overpayment  resulted  from  a  change  made  by  the  collector  in  an  assessment,  notice,  or  billing
     issued under the provisions of this Chapter. 
□    The overpayment resulted from a subsequent determination that the taxpayer was entitled to pay a tax
     at a reduced tax rate. 

□    The  overpayment  was the  result  of a payment  that  exceeded  either  the  amount shown  on  the  face of
     the return  or  voucher,  or  which  would  have  been  shown  on  the  face  of  the  return  or  voucher  if  a 
     return  or voucher were required. 
□    The overpayment resulted from a subsequent adjustment for bad debt.

□    Other:

Detailed reason for overpayment: _________________________________________________________________ 
______________________________________________________________________________________________ 
______________________________________________________________________________________________ 
______________________________________________________________________________________________ 

This application must comply with and include the following: 
    A complete application signed and dated by the taxpayer or authorized representative.
    A detailed reason for overpayment.
    All supporting schedules itemizing the overpayment of tax amounts by filing period.
    For  bad  debt  write  offs,  a  photocopy  of  the  State’s  approval  letter  and  the  corresponding  federal
     income tax return. 
Incomplete applications will not be accepted and returned to the applicant. 
Under the penalty of perjury, I declare all of the facts alleged above as a basis for reasonable cause; to the best     
of my knowledge and belief, including all accompanying documentation, are true, correct and complete. 

     Printed Name of Applicant                                           Signature of Applicant 

                Title                                                            Date 
                            Bureau of Revenue and Taxation P.O. Box 248, Gretna, LA  70054-0248