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EXAMPLE: Customer purchases furniture from ABC Furniture Store, located in Bismarck, ND The selling price for the furniture as
follows: $3,000 for living room furniture, $3,000 for bedroom set, and $100 delivery charge. Total taxable purchase price - $6,100.
Point of Sale: Bismarck Taxable Sales Amount: $ 6,100
Invoice Date: 10/1/2014 State sales tax (5%) 305
Invoice Number: ZZ12345 Bismarck city sales tax (1%) 61
Seller: ABC Furniture Store Burleigh county sales tax (½%) 30.50
Total Tax Paid $ 396.50
Calculation of Local Tax Refund:
Total City Tax Paid ($6,100 x 1%) $ 61.00
Less: Bismarck City Maximum Tax - 25.00
Local City Tax Refund $ 36.00
Total County Tax Paid ($6,100 x ½%) $ 30.50
Less: Burleigh County Maximum Tax - 25.00
Local County Tax Refund 5.50
Total Local Tax Refund ($36.00 + $5.50) $ 41.50
WHEN TO FILE: A claim for refund must be postmarked no later than three years from the date of the invoice.
WHERE TO FILE: A claim for refund must be fi led with the North Dakota Offi ce of State Tax Commissioner, Sales and Special
Taxes, 600 E. Boulevard Ave. Dept. 127, Bismarck, ND 58505-0599.
DOCUMENTATION REQUIRED: The claim for refund must include copies of all invoices to support the claim. The invoice
should provide an invoice date, invoice number, seller name and address, items or materials purchased, purchase price of items or
materials purchased, and amount of city and/or county sales and use tax paid. Failure to submit copies of all invoices will result
in returning the claim with a request for additional information, which will delay the refund process. The Offi ce of State Tax
Commissioner reserves the right to request additional supporting documentation as it deems necessary.
PRIVACY ACT NOTIFICATION
In compliance with the Privacy Act of 1974, disclosure of a social security number or Federal Employer Identifi cation Number (FEIN) on this form
is required under N.D.C.C. §§ 57-01-15, 57-39.2-14, and 57-40.2-07, and will be used for tax reporting, identifi cation, and administration of North
Dakota tax laws. Disclosure is mandatory. Failure to provide the social security number or FEIN may delay or prevent the processing of this form.
(Instructions revised 4/16)
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