Finance Department 
                                                                                           Sales Tax Division 
                                                                                           500 E Third Street Suite 110 
                                                                                           Loveland, CO 80537 
                                                                                           970.962.2708 
                                                                                           970.962.2927 - fax 
                                                                                             lovelandgovernment.org/salestax 
                                                                                          salestax@cityofloveland.org 
 
                         REFUND CLAIM FOR CITY TAXES PAID 

  Please refer to the instructions on the back of this form. 
 
  Name of Claimant:                                                                                                      
 
  Residence or Business Address:                                                                                         
 
  Mailing Address:                                                                                                       
 
  Phone:                                                     Email Address:                                              
 
  Date of Payment:                                           Type of Tax Paid:                                           
 
  Total Amount Paid $                                        Total Refund Requested $                                    
   
  City of Loveland Sales Tax License #:                     
 
  Reasons for Claim:                                                                                                     
 
  I/we declare, under penalties of perjury, that this claim (including any accompanying schedules and statements) has 
  been examined by me/us, and to the best of my/our knowledge and belief is true, correct and made in good faith, for 
  the purpose stated. 
 
  A claim by an agent must be accompanied by power of attorney. 
 
  Signature of person other than taxpayer preparing claim                                 Date 
 
  Signature of Taxpayer                                                                   Date 
 
  ======================================================================================== 
 
  Office Use Only:                       Audited by:              Approved by:                                            
                                         Amount of Refund:        Date:                                                  

 INSTRUCTIONS 
 
 Claim must be filed within three (3) years after the date of purchase, storage, use, or consumption of the good or 
 service. 
 
 Submitting your claim with all required documentation detailed below will verify the validity of your claim. Failure 
 to provide all required documentation will delay the processing of the claim. 
 
 Licensed Taxpayer Claims Require: 
 
 1. Detailed explanation of how the error occurred. 
 
 2. Copy of invoice(s), credit memo(s), and other documentation you consider appropriate to the claim. * 
 
 3. Sales journals that provide sufficient evidence as to how the sales for the period were summarized and 
    clearly show the total monthly sales totals (including the invoice(s) in question) and the amount of tax 
    reported and paid to the City of Loveland. 
 
 4. The claim should be signed by the taxpayer, if possible. Whenever it is necessary to have the claim 
    executed by an attorney or agent, on behalf of the taxpayer, an authenticated copy of the document 
    specifically authorizing such an agent or attorney to sign the claim on behalf of the taxpayer should 
    accompany the claim. 
 
 5. Where the taxpayer is a corporation, the claim shall be signed with the corporate name, followed by the 
    signature and title of the officer having authority to sign for the corporation. 
 
 3rd Party Claims from Individuals (Customers) Require: 

 1. Copy of original invoice on which City of Loveland tax was charged. * 
 
 2. Proof of payment of invoice (receipt, or copy of front and back of canceled check). 
 
 3. Include other documentation you consider appropriate. 
 
 * If the claim is for tax paid on a vehicle, the following must be included: 
 
    1. Copy of Colorado driver’s license showing current address. 
    2. Copy of registration on the vehicle. 
    3. Copy of the sales invoice.