Free Utah Claim for Refund of Fees or Sales Tax for Motor Vehicles, TC-55A - Utah

Utah State Tax Commission (Instructions on reverse side)
Name Address City State

Clear form
TC-55A Rev. 5/05

Claim for Refund of Fees or Sales Tax for Motor Vehicles
License plate, permit or assigned number VIN/HIN Zip code

Daytime Telephone no.

1. Amount of sales tax or license fees paid 2. Correct amount of sales tax or license fee as computed by taxpayer 3. Amount claimed as a refund (subtract amount on line 1 from line 2) I believe that this claim should be allowed for the following reasons: (use reverse side if needed)

$ $ $

Under penalties of perjury, I declare that I have examined this claim and to the best of my knowledge and belief it is true, correct and complete. Signature Date

For Motor Vehicle Use Only
Returned plate #: _________________ Decal #: _________________ Registration month/year: ______________ TXID: ______________

For Tax Commission Use Only
Checked by Approved by DMV accounting approval Date Date Date

Transaction #: ___________________________________________________________ Sales tax $ Total amount of refund as computed by the Utah $ State Tax Commission Watercraft/Off-highway

Motor vehicle fees $

Breakdown of refund by account

Motor Vehicle

Indicate for each account listed below the amount of the refund approved by the examining agent.
Account type Registration fees
Title

Amount of refund

Account type IRP DUI Sales Tax Impound Insurance Revocation

Amount of refund

Registration canceled? Yes No

$ $ $ $

$ $ $ $ $

Date canceled: ____________________ TXID: ______________

Driver's Ed. Insurance Data

Personalized Plate Fee $ Plate Fee Postage

$ $

RPS/Internet Fall Outs $ Other: ____________

$

Instructions
1. You must apply to your local county assessor for refunds for property tax or age-based fees. 2. You must return all registration materials that pertain to refund request (i.e. decals, registration, plates, etc.). 3. Attach a copy of all receipts or a copy of your canceled checks (both the front and back). 4. If you paid through the internet, you must provide a copy of your statement which shows the date and amount of the payment. 5. Please provide copies of all documents which support your reason for requesting a refund.


If the vehicle has been sold or traded in, please include documentation which includes the VIN/HIN signed by both the seller and the purchaser and the date of the transaction. LEASE BUY OUTS: Please include a copy of your lease buy out agreement which includes the VIN/HIN and the date the leased vehicle was purchased. FOR SALES TAX ONLY: If the vehicle purchased was returned to the seller and the sale canceled, attach a copy of the canceled sale documentation, which includes the VIN/HIN, signed by both seller and purchaser.





6. Mail refund claim and all supporting documentation directly to DMV Accounting - 4th floor at the Utah State Tax Commission, 210 N 1950 W, SLC, UT 84134. Please keep a copy of the refund claim and all documentation for your records.
Statement Continuation