State of Maryland
Comptroller of Maryland
Compliance Division
301 West Preston Street, Room 303
Baltimore, Maryland 21201-2383
Refund Application: Admissions and Amusement Tax
Trade Name:
Admissions Tax
Account Number:
Owner Name:
Mailing Address:
FEIN or Social
Security Number:
City or Town, State and Zip: Telephone Number:
The undersigned, hereby requests the Comptroller to refund the sum of $ . This sum is the amount of
admissions and amusement tax that has been improperly paid by the undersigned for the reasons described below:
1.
2.
3.
Type of Activity
Subdivision
Imposing Tax
Tax
Rate
Period Covered
Gross Receipts
Before
Deducting Tax
Tax Paid Tax Refund
(Attach extra sheets if needed. Use same format.)
NOTE:
I HEREBY CERTIFY that I have examined the information set forth in this claim,
including any accompanying schedules or statements, and that said information
is true, accurate and complete to the best of my knowledge and belief.
Signature
Refund Supervisor: 410-767-1538 in Baltimore or toll-free 1-800-492-1751 from elsewhere in Maryland
For the hearing impaired: MRS 1-800-735-2258 * TDD 410-767-1967 * EOE
Print Name and Title
Date
COT/ST 601
Rev. 6/2007
Claim Number _______________ Claim Code _____________
Amount Approved ___________________________________
Liabilities __________________________________________
Amount Forwarded to Claimant _________________________
Approved By _______________________________________
Manager's Signature _________________________________
(Blue or Black Ink)
In order to expedite this application, non-returnable copies of records supporting the refund request should accompany this
form. These records should include, when appropriate, collection tickets, sales journals, cash receipts journals, and admissions
and amusement tax returns corresponding to entries in this application. If it is impractical to forward copies of all supporting
documents, the records must be made readily available for review by an employee of the Compliance Division, if requested.
