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:                $                                                            Refunds under $10.00 will 
                                                                                                be issued a   Credit Memo 
 2. Taxes due, as amended:         $                                                            to  be  used  on  future 
                                                                                                returns  unless  account  is 
 3. Refund requested:              $                                                            closed. 
 This refund is claimed for the following reasons (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 on 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 or was due to the overpayment of 
    occupational license tax.
    Other (describe): 
 
 Include the following documents: 
    •     An amended return for the applicable period(s), 
    •     If this application for refund is for multiple months, please attach a monthly detail of taxes remitted, taxes
          due and refund amounts
    •     All documentation needed to adequately determine that a refund is due. This may include, but is not 
          limited to original invoices, credit invoices, original tax return, proof of payment, and monthly sales 
          summary.
    •     For bad debt write offs, please supply the State ’s approval letter and the corresponding federal incometax 
          return.

 If all documentation is not received, including this completed and signed Application form, the Refund Request will 
 not be considered received and ready for review. 
 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 

                                                                       Date: 
                   Title 

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