ASSIGNMENT OF RIGHT TO REFUND

To the Comptroller of Public Accounts for the State of Texas (hereinafter “Comptroller”):

(1) My name is  _____________________________________ , and I am a duly authorized  representative  of
    __________________________________________  (the “Assignor”). By executing this Assignment of Right
   to a Refund (“Assignment”), the Assignor assigns all rights and interest to the tax refund herein described that
   the Assignor may have to  _____________________________ (the “Assignee”), subject to the limitation noted
   herein. The Assignee’s Taxpayer Number is  ____________________ (if permitted in Texas).

(2) Assignor hereby assigns the Assignee (check whichever is applicable):
    ____ a. The right to file a request for a refund and to receive the refund.
    ____ b. The right to receive the refund only.

(3) The tax refund that is the subject of this Assignment is described as follows:
   Tax Type:  ________________________________________
   Period:  __________________________________________
   Transactions:  __________________________________________________________________________
    ________________________________________________________________                  (Attach  schedule, if  necessary.)
   Other specific limitations:   ________________________________________________________________

(4) The Assignor understands that the Comptroller may require both parties to provide documents for information 
   necessary for the Comptroller to verify the validity of the refund claim and/or to transfer any verified amount to 
   the Assignee.

(5) By executing this Assignment, the Assignor affirms that the Assignor has neither previously claimed a refund 
   nor taken a credit on a return for taxes that are subject of this Assignment, and further affirms that the Assignor 
   will not claim a refund or a credit for those taxes in the future.

                                ______________________________________  ________________
                               Assignor Entity Name                                                                                 Assignor Taxpayer Number

                                _______________________________________________________
                               Print or type the name of person authorizing assignment

                                _______________________________________________________
                               Relationship to entity (i.e., President, Treasurer)

                                ______________________________________  ________________
                               Signature of person authorizing assignment                                                           Date

                                _______________________________________________________
                               Area code/daytime phone number

Under Ch. 559, Government Code, you are entitled to review, request, and correct information we have on file about you, with limited exceptions in accordance with Ch. 
552, Government Code. To request information for review or to request error correction, contact us at the Texas Comptroller’s office

Form 00-985 (Rev.8-23/3)