1100 4th Street S.W., Washington, DC, 20024, US
The purpose of this form is to initiate a financial review of funds paid to the Weights and Measures Division at the Department of Licensing and Consumer Protection to be considered for a refund from the Office of the Chief Financial Officer. Refund requests are considered in cases of excess payment, duplicate payment and/or erroneous filing.
In order to initiate a refund request, the following documentation is required:
*Please attach all required supporting documentation to this request to avoid any delays in receiving your refund.
Are you a Farmer?
Please select the type(s) of device(s) for which you are requesting a refund.
Premise Address (Location of Business Operation)
Upload Proof of Cash Payment (i.e., receipt from DLCP Cashier's Office).
Upload Proof of Check Payment (i.e., front and back of cashed check)
Upload Proof of Credit Card Payment (Receipt)
Upload Proof of Money Order Payment (i.e., money order receipt and receipt from DLCP Cashier's Office)
Upload Proof of Cash Payment (i.e., receipt from DLCP Cashier's Office)
Upload Additional Proof of Check Payment (i.e., front and back of check)
Upload any documents (excluding proof of payment) that support your refund request.
Full Name of Party Requesting Refund
Refund Mailing Address (Check refunds will be mailed here)
I certify that the above statements on this application are true and complete to the best knowledge and belief. I agree to comply with all applicable laws and regulations of the District of Columbia. I/We understand that, anyone who makes a false statement on this form can be criminally prosecuted; and, if convicted, fined up to $1000, imprisoned up to 180 days, or both, under D.C. Official Code § 22-2405.
DC INSPECTOR GENERAL HOTLINE: If you are aware of corruption, fraud, waste, abuse, or mismanagement involving any DC Government agency, official or program, contact the Office of the Inspector General (OIG) at 202-727-0267 or 1-800 521-1639 (toll free). All reports are confidential and you may remain anonymous by law. Government employees are protected from reprisals or retaliation by their employers for reporting to the OIG. The information you provide may result in an investigation leading to administrative action, civil penalties, or criminal prosecution in appropriate cases.