dob@dc.gov
1100 4th Street, SW, Washington, DC 20024
Phone: (202) 671-3500
The purpose of this form is to initiate a financial review of funds paid to the Department of Buildings to be considered for a refund from the Office of the Chief Financial Officer. Refund requests are considered in cases of excess payment and/or duplicate payment. The requested information, including proof of payment and Social Security Number or Tax ID Number are required.
Infraction Location Address
Payee Full Name / Payee Company Name
Payee Address
Upload Proof of Payment (i.e., front and back of cashed check, credit card statement, receipt from DOB or District Cashier's Office).
Upload any documents (excluding proof of payment) that support your refund request.
Full Name of Party Requesting Refund If Different from the Payee
Refund Mailing Address (P.O. Boxes not accepted)
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.
Sign Here
