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Department of Licensing and Consumer Protection

dlcp@dc.gov

1100 4th Street, SW, Washington, DC 20024

(202) 671-4500

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Weights & Measures Refund Request Application

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:

  • Refund Request Application
  • Recipient’s Name, FEIN and Mailing Address
  • Proof of All Associated Payment(s):
    • Check: Front and back of cashed check
    • Credit Card: Receipt and first six and last four digits of credit card number
    • Cash: Receipt of payment from Cashier's Office
    • Money Order: Money Order Receipt

*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)

Amount Requested

Upload Proof of Cash Payment (i.e., receipt from DLCP Cashier's Office).

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Upload Proof of Check Payment (i.e., front and back of cashed check)

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Upload Proof of Credit Card Payment (Receipt)

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Upload Proof of Money Order Payment (i.e., money order receipt and receipt from DLCP Cashier's Office)

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Upload Proof of Cash Payment (i.e., receipt from DLCP Cashier's Office)

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Upload Additional Proof of Check Payment (i.e., front and back of check)

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Upload Proof of Credit Card Payment (Receipt)

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Upload Proof of Money Order Payment (i.e., money order receipt and receipt from DLCP Cashier's Office)

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Upload any documents (excluding proof of payment) that support your refund request.

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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.

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