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District of Columbia Department of Buildings

1100 4th Street, SW, Washington, DC 20024

Phone: (202) 671-3500


Fine and Special Assessment Refund Request


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).

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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 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.

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