Transcription of State of New Jersey Division of Taxation CLAIM …
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State of New Jersey Division of Taxation CLAIM …
State of New JerseyDivision of TaxationCLAIM FOR REFUND - BUSINESS TAXES ONLYA-3730(11-10)Please Print or Type / See Instructions On Reverse SideDO NOT USE THIS FORM FOR GROSS INCOME TAX (Individual)COMPLETE ALL APPLICABLE ITEMSSECTION ONECOMPUTATION OF CIGARETTE TAX REFUNDSL icense THREESECTION TWOI declare under the penalties of perjury that this CLAIM (including any accompanying schedules and statements) has been examined by me and to thebest of my knowledge and belief is true and Name of Taxpayer1b. Trade Name2d. Zip Code2c. State2b. City2a. Number and Street3. FID Number or Social Security Number4. Name and Address on Return (if different from above)5. Type of Tax6. Period Covered by Claim7. Date of Payment8. Amount of ClaimSignatureTitle of Signing OfficerPrinted Name of Signing OfficerContact Phone NumberDateNumber of PackagesBrandDenomination of StampsValue of StampsNet Refund AmountLess DiscountTotal$EXPLANATION OF CLAIMIn accordance with 18 , submit a detailed explanation as well as all supporting documentation to substantiate this CLAIM .
State of New Jersey Division of Taxation CLAIM FOR REFUND - BUSINESS TAXES ONLY A-3730 (11-10) Please Print or Type / See Instructions On Reverse Side
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