00-957                                                                                                                 PRINT FORM                             CLEAR FIELDS
   (Rev.6-19/9)

 Texas Claim for Refund
   IMPORTANT: If the purchaser did not have an active Sales Tax permit during the claim period, the purchaser is required to obtain a 
   completed and signed Texas Assignment of Right to Refund (Form 00-985) and submit it, along with this claim, to the Texas Comptroller’s 
   Office. However, if the purchaser is requesting a refund of local tax only, paid to a Remote Seller, the Texas Assignment of Right to Refund 
   form is not required. If someone other than the taxpayer/claimant submits the claim, a completed Power of Attorney (Form 01-137) must 
   be submitted. 
   For information on documentation required to file a Sales Tax refund claim, please visit our website at www.comptroller.texas.gov/taxes/
   sales/refunds/.

Taxpayer/Claimant name                                                                                         Claimant ID number (Texas taxpayer number if you have one)

Mailing address (Street)                                                                                       Total amount of refund requested:

City, state and ZIP code                                                                                       Check here if you entered an amended return online  
                                                                                                               for this same period.

                                             First date:                                                       Last date:
1. Period of claim  ..................................................(mm/dd/yy)                               (mm/dd/yy)
2.Please state fully, and in detail, each reason or ground on which this refund claim is founded. Please note, simply stating “Tax paid in error” does not
  provide a sufficient reason for a refund. Attach additional sheets, if necessary.

3. Type of tax or fee upon which this refund claim is based (Enter code from list below.) .......................................................................
   26 - Sales Tax              50 - Texas Emissions Reduction Surcharge          64 - Petroleum Product Delivery Fee      73 - Mixed Beverage Gross Receipt
   27 - Direct Pay             63 - Mixed Beverage Sales                         70 - Motor Vehicle Seller-Financed Sales 75 - Hotel Occupancy - State Only
   Other tax

4. For Accounting Errors - submit accounting records. For other claims: Submit invoices for each claim request. Attach a schedule (see example
  Form 01-911) to support claims with more than 10 sales invoices.

5.FOR SALES TAX ONLY, the name, authority ID, and amount of tax claimed for each local jurisdiction must be included on the schedule Form 01-911.
  (To find local codes go to https://mycpa.cpa.state.tx.us/atj/ or ask the seller.)

Name of contact (please print)                                                   Email address of contact:

     Signature of taxpayer/claimant/contact:                                                              Date                    Daytime phone (Area code and number)

                                 You have certain rights under Chapters 552 and 559, Government Code, to review, request and
                                 correct information we have on file about you. Contact us at the address or phone number listed below.

Please choose one method of submitting your request and supporting documentation:
Mail to: Comptroller of Public Accounts      Email to:                refund.request@cpa.texas.gov                        For assistance, call
     Revenue Accounting Division                                                                                         1-800-531-5441 ext. 34545
     Sales & Motor Vehicle Tax Refunds       Inquiries only:  refund.status@cpa.texas.gov                                 or 512-463-4545.
     111 E. 17th Street
     Austin, TX  78774-0100