Vermont Department of Taxes     PO Box 547    Montpelier, VT  05601-0547
Phone:  (802) 828-2551
                                                                                                                               *236201100*
  Vermont Form                          Application for Refund of                                                              *236201100*
                                        Vermont Sales and Use Tax,                                                                                                                  Page 2
 REF-620              Meals and Rooms Tax, or Local Option Tax

      Business Name                                                                                                            Federal ID Number

 OR   Individual Last Name                                             First Name                         MI OR                Social Security Number

 Address                                                                                                          Telephone Number

 City                                                                  State     ZIP Code                         Period Covered by Claim (MM/DD/YYYY - MM/DD/YYYY)
 Foreign Country (if not United States)                                Email Address                                                                                                FORM  (Place at FIRST page)
                                                                                                                                                                                    Form pages 
 Name of Representative (if any)                                                                                  Telephone Number

 Address                                                               City                                       State          ZIP Code

 Email Address                                                                                                                                                                      2 - 2

                                                                                          Refund Amount        . . . . . .  .$   __________________  .____
 Give a full explanation below (see instructions).  Use additional sheets if necessary and submit all documents needed to properly substantiate your claim.

                                                                                                                                                                                    FORM  (Place at LAST page)
                                                                                                                                                                                    Form pages 

I, the claimant named above, or partner, officer, or other authorized representative of such claimant, make application for refund of Sales and Use tax, Meals and Rooms 
tax, or Local Option tax pursuant to 32 V.S.A. § 9781 (SU), § 9245 (MR), and 24 V.S.A. § 138 (LO).  I certify all Vermont Sales and Use taxes, Meals and Rooms taxes, 
or Local Option taxes for which this claim is filed, have been paid, and no portion of the tax has been refunded or credited to me by any vendor.
      Signature of Responsible Officer or Individual                              Date                       Daytime Telephone                  May the Dept. of Taxes discuss this 2 - 2
                                                                                                             Number (optional)                  return with the preparer shown?
                                                                                                             (               )                    Yes             No
      Printed Name                                                                Email Address (optional)

                 Preparer’s                                                                                  Date                               Check if self-employed   
                 Signature
Paid             Preparer’s                                                                                  Preparer’s Social 
                 Printed Name                                                                                Security No. or PTIN
Preparer’s       Firm’s Name (or yours if self-employed) and Address
Use Only
                 EIN                                 Preparer’s Telephone Number          Preparer’s Email Address (optional)
                                                     (                )

                                                                                                                                                           Form REF-620
                                                                                                                                                                 Page 1 of 1
5454                                                                                                                                                             Rev. 02/23