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Indiana Free Printable  for 2019 Indiana Business Tax Claim for Refund

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Business Tax Claim for Refund
Form GA-110L

Indiana Department of Revenue Form GA-110L Claim for Refund State Form 615 (R11 / 9-18) □ POA-1 form Included Name of Taxpayer Taxpayer Identification Number (include 3 digit location) Address Federal Identification Number City State Zip Social Security Number Indicate only one tax type from one of the following sections: Section A □ County Innkeepers □ Food & Beverage □ Motor Vehicle Rental □ Sales & Use (Not Fuel Related) □ Penalty □ Sales & Use (Utilities) □ Withholding □ Collection Fees □ HRT-103 □ Other _______________________ Section B □ Aviation Fuel Excise □ Gasoline Use □ Oil Inspection Fee □ Sales (Diesel) □ Surcharge (Special Fuel - see instructions) □ Other Fuel Related ___________________ Section C □ Aeronautics Section D □ BAS □ Cigarette Excise □ IFTA □ Alcohol Excise □ Other Tobacco Products Excise □ IRP/BPR □ Motor Carrier Fuel Tax □ Oversize/Overweight □ UCR Provide the explanation as to why a refund is due: Year or Period Ending Requested Refund (mm/dd/yyyy) Amount Date(s) of Tax Payment(s) Year or Period Ending (mm/dd/yyyy) Requested Refund Amount Date(s) of Tax Payment(s) I hereby certify that the foregoing account is just and correct; that the amount claimed is legally due, after allowing all just credits; and that no part of the same has been paid. I further understand that this refund may be applied to any liability which I currently have outstanding. Under penalties of perjury, I declare that I have examined this form, including the accompanying schedules and statements, and to the best of my knowledge and belief it is true, correct, and complete. Sign Form GA-110L and include evidence to support your claim. Failure to attach ALL documentation with your claim may result in your claim being rejected or denied. Signature:_______________________________ Printed Name:__________________________ Title:_______________________ Daytime Phone Number:____________________ Email:_________________________________ Date:______________________ For Department Use Only Tax Analyst/Auditor:________________________ Date:_____________ Supervisor:_____________________ Date:_____________ Claim Number:____________________ Year Interest Paid From Interest Paid To Total Interest Amount Total Refund Amount DLN Instructions for Completing Form GA-110L Complete a separate Form GA-110L for each tax type and location. Fill-in all blanks because any missing or incomplete information may delay the processing of your Claim for Refund or may cause the Claim for Refund to be rejected or denied. Make sure any and all returns have been filed. • Include the taxpayer’s name, address, and correct Taxpayer Identification Number with location number that was assigned by the state for your specific location. • Check only ONE Tax Type. ○○ Each tax type requires a separate GA-110L. ○○ Refunds of the Surcharge tax are available to non-motor carriers who purchased special fuel (diesel, biodiesel, compressed natural gas or liquified natural gas) in Indiana from July 1, 2017 through June 30, 2018. The vehicle make, model and Vehicle Identification Number (VIN) must be included, along with purchase receipts. • Include a complete explanation of why the refund is due. Attach ALL evidence to support your claim. Examples but not all inclusive: invoices showing tax paid; copy of exemption certificate if it is an exempt customer; purchase agreement and contract for items such as software and warranties; proof of payment (credit invoice or canceled checks); utility bills showing meter number; use tax journal and any additional documentation to support your claim. Failure to attach ALL documentation with your claim may result in your claim being rejected or denied. • For a refund claim to be valid, a refund amount must be a request for the amount legally due for a specific tax period. Refund claim amounts must be separately stated by period or tax year. Include each requested refund amount for the appropriate period(s). • Be sure to sign the GA-110L form and include a daytime phone number and email address.The form must be signed to be a valid refund claim. ○○ Including a correct email address could help expedite the refund process. • Complete and attach a Power of Attorney (POA-1) form authorizing the department to discuss your claim and specific tax type with someone other than the taxpayer. Please allow 60 days for processing before contacting the department regarding the status of your claim. For a refund to be valid, it must meet the statutory requirements of a claim for refund and at a minimum include: 1. the refund amount; 2. the tax period for which the refund is due; 3. the reason for the refund; and 4. the taxpayer’s signature. If your claim does not include these items, it will be rejected. Mailing/Contact Information Please use the information below based on the tax type selected. Section A Section B Section C Section D Indiana Dept. of Revenue P.O. Box 935 Indianapolis, IN 46206-0935 Indiana Dept. of Revenue P.O. Box 1971 Indianapolis, IN 46206-1971 Indiana Dept. of Revenue P.O. Box 901 Indianapolis, IN 46206-0901 Indiana Dept. of Revenue P.O. Box 6075 Indianapolis, IN 46206-6075 (317) 232-2339 [email protected] (317) 615-2552 [email protected] (317) 615-2710 [email protected] (317) 615-7345 [email protected]
Extracted from PDF file 2018-indiana-form-ga-110l.pdf, last modified June 2013

More about the Indiana Form GA-110L Other TY 2018

Complete a separate Form GA-110L for each tax type and location. Fill-in all blanks because any missing or incomplete information may delay the processing of your Claim for Refund or may cause the Claim for Refund to be rejected or denied. Make sure any and all returns have been filed.

We last updated the Business Tax Claim for Refund in January 2019, so this is the latest version of Form GA-110L , fully updated for tax year 2018. You can download or print current or past-year PDFs of Form GA-110L directly from TaxFormFinder. You can print other Indiana tax forms here.

Other Indiana Other Forms:

TaxFormFinder has an additional 69 Indiana income tax forms that you may need, plus all federal income tax forms.

Form Code Form Name
Form URT-1 Current Year Indiana Utility Receipts Tax Return
Form BC-100 Indiana Business Closure Request
Form POA-1 Indiana Department of Revenue Power of Attorney
Form 53227 Business Tax Clearance Form
Form BT-1 Business Tax Application

Download all IN tax forms View all 70 Indiana Income Tax Forms


Form Sources:

Indiana usually releases forms for the current tax year between January and April. We last updated Indiana Form GA-110L from the Department of Revenue in January 2019.

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