CITY AND BOROUGH OF SITKA 
                                    REQUEST   FOR           Department of Finance, Sales Tax Division 
                                                            100 Lincoln Street, Sitka AK 99835 
                               SALES   TAX   REFUND         Ph (907)747-1840   Fax (907)747-0536 
                                     
Sales Tax in the amount of      $_____________________     has been received by 
 
______________________________________   and  remitted to the City of Sitka 
  (Business Name) 
with returns for _________year__________________qtr(s).  This tax was paid by 
 
___________________________________________ and is now being requested  
  (Customer) 
 to be refunded because the person(s) or company: 
 
(   )     Is senior tax exempt.      Card#____________  
(   )    The product was resold . Card#____________ 
(   )    Other exemption. - Please explain and attach applicable back up._________ 
          ____________________________________________________________ 
 
Please attach copies of all sales tax payments for which you are requesting a refund. 
 
I hereby certify that the above statement of facts is true. 
 
Claimant ________________________________      Date ____________ 
  (Signature) 
 
 ____________________________________________________________________________      
  Printed name 
 
 ____________________________________________________________________________              
  Street address, City, State & Zip 
 
Business Owner/Agent_________________________________________      
                                   (Signature certifying Sales Tax was paid to the City and Borough of Sitka) 
 
 _________________________________________________     Date ____________ 
  Printed name 

Revised by Ordinance 03-1758: 2004  
Effective date: July 1, 2004  
Updated on website: 7/08/10