Free Claim for Refund of Tax and License Fees Erroneously Paid to the State of Maryland Through the Clerk of Court (OC Form X-4) - Maryland


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State: Maryland
Category: Court Forms - State
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http://www.courts.state.md.us/courtforms/circuit/oc_aocx4.pdf

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Preview Claim for Refund of Tax and License Fees Erroneously Paid to the State of Maryland Through the Clerk of Court (OC Form X-4)
MARYLAND JUDICIARY
CIRCUIT COURTS
CLAIM FOR REFUND OF TAX AND LICENSE FEES ERRONEOUSLY PAID TO STATE OF MARYLAND THROUGH THE CLERKS OF COURT NOTE: To be eligible for a refund, a Claim for Refund must be submitted on or before 3 years from the date the tax or license fee was paid (Tax-Property Article ß14-915).

SECTION 1 To:
(Circuit Court to which erroneous payment was made)

Date:

In accordance with provisions of the Annotated Code of Maryland, application is hereby made by: Name: Address: City, State, Zip:

For refund of payment in the amount of Dollars ($ ) erroneously paid to your office.

(Give below date of payment and nature of tax for which refund is requested, reason for requesting refund and other information pertinent to claim. Receipt issued by the Circuit Court on tax claimed to be erroneously paid should be attached hereto.)

NOTE: Mail form to the appropriate circuit court. See Instructions on page 2. (Signature of Claimant) SECTION 2 , Maryland (City or County) The facts set forth in the above claim have been verified by me and I hereby certify that the claimant is entitled to refund in the amount of Dollars ($ ) APPROVAL OF CLAIM Date

(Clerk of the Circuit Court) Page 1 of 2
AOC Form X-4 Revised 02/2009

(Signature of Clerk) (See Instructions on page 2)

CLAIM FOR REFUND OF TAX AND LICENSE FEES ERRONEOUSLY PAID TO STATE OF MARYLAND THROUGH THE CLERKS OF COURT

INSTRUCTIONS This form to be used when a taxpayer requests a refund of special taxes erroneously paid to the State of Maryland through the Clerk of the Circuit Court. A - Section 1 - Will be filled out by the claimant in duplicate and mailed to the Clerk of the Circuit Court to which the erroneous payment was made. (See Circuit Court directory at http://mdcourts.gov/circuit/directory.html) B - Section 2 - Will be filled out by the Circuit Court Clerk who verifies all facts in the claim, fills out the disbursement transmittal, and sends it with the X-4 Form to the Judiciary's Department of Budget and Finance, Revenue Unit.

Page 2 of 2
AOC Form X-4 Revised 02/2009