Vermont Department of Taxes     PO Box 547    Montpelier, VT  05601-0547
Phone:  (802) 828-2551
                                                                                                                    *166201100*
      VT Form                    Application for Refund of                                                          *166201100*
                                        VT Sales and Use Tax or                                                                                                              Page 2
 REF-620                                Meals and Rooms Tax

 Business Name                                                                                         Telephone Number

 Address                                                                                               Vermont Business Account Number 

 City                                                             State ZIP Code                       Period Covered by Claim (mm/dd/yyyy - mm/dd/yyyy)
                                                                                       -                                           -
 Foreign Country (if not United States)                           E-mail Address

 Name of Representative (if any)                                                                       Telephone Number

 Address                                                          City                                 State               ZIP Code
                                                                                                                                                           -
 E-mail Address

                                                                                 Refund Amount      . . . . . .  .$   __________________  .____

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

I, the claimant named above, or partner, officer, or other authorized representative of such claimant, make application for refund of Sales and Use tax or Meals and 
Rooms tax pursuant to 32 V.S.A. § 9781 (SU), and § 9245 (MR).  I certify all Vermont Sales and Use taxes or Meals and Rooms 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                                   Date                     Daytime telephone                May the Dept. of Taxes discuss this 
                                                                                                  number (optional)                return with the preparer shown?
                                                                                                  (               )                  Yes             No
      Printed name                                                       E-mail 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 e-mail address (optional)
                                        (                )

                                                                                                                                                            Form REF-620
                                                                                                                                                            (formerly SMWA-1)
5454                                                                                                                                                        Rev. 04/16

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