date(s) of payment
Dollars ($ ) which is the amount of said
$ was paid by the applicant to the Alabama Department of Revenue as above stated As
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ALABAMA DEPARTMENT OF REVENUE
APPLICANT
Application for Refund of Estate Tax
APPROVED FOR PAYMENT:
ASSISTANT COMMISSIONER OF REVENUE
authorized by Section 40 15 21 Code of Alabama 1975 it is requested that you draw your warrant on Estate Tax Fund in
DIRECTOR INDIVIDUAL AND CORPORATE TAX DIVISION
ESTATE (TYPE OR PRINT)
estate tax erroneously paid to the Alabama Department of Revenue plus interest at the legal rate as provided by law from
ESTATE TAX SECTION
favor of the above named applicant for the sum of
I Assistant Commissioner of the Alabama Department of
IT: EST 123
MAILING ADDRESS
MONTGOMERY ALABAMA
NOTARY PUBLIC
on the date or dates as follows:
P O Box 327440 Montgomery AL 36132 7440
Paid Through Mistake or Error to the Alabama Department of Revenue
Prepare This Form In Triplicate Send Two Copies To The Alabama Department of Revenue At The Address Above Retain One Copy For Your Records
Received of State Comptroller his Warrant No for in full payment of the above
Revenue do hereby certify that the above application for refund has been examined and that estate tax in the amount of
Revenue paid by the said applicant through mistake or error to the Department of Revenue said amount having been paid
SIGNATURE
STATE COMPTROLLER
STATE ZIP
Sworn to and subscribed before me this the day of 20
the amount of $ and such additional amount as may be determined by the Alabama Department of
The facts in support of this application and the cause for alleged overpayment are briefly stated as follows:
This day of 20
Under the provisions of Section 40 15 21 Code of Alabama 1975 application is hereby made for a refund of estate tax in
