Corporations Refund Request Application

The purpose of this form is to initiate a financial review of funds paid to the Corporations 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 overpayment and/or duplicate payment ONLY. The request for refund shall be made within sixty (60) calendar days from the date of payment; or from the date of DLCP's rejection notification.In order to initiate a refund request, the following documentation is required:Refund Request ApplicationRejection Letter (if applicable)Recipient’s Name, FEIN and Mailing AddressProof of All Associated Payment(s):Check: Front and back of cashed checkCredit Card: Receipt and first six and last four digits of credit card numberCash: Receipt of payment from Cashier's OfficeMoney Order: Money Order Receipt*Please attach all required supporting documentation to this request to avoid any delays in receiving your refund. Legal AuthorityD.C. Municipal Regulations Title 17 Chapter 708.1 states the following: The request for refund shall be made within sixty (60) calendar days from the date of payment; or from the date of DLCP's rejection notification.Pursuant to D.C. Code § 29–102.13. (d) Overpayments and duplicate and erroneous payments shall be refunded. The term “erroneous” is defined as when payment was sent to Corporations division but intended for another recipient (ex. tax or license payments erroneously sent to Corporations division). “Erroneous” payment does not include the case where customers change his/her mind and wants to rescind the filing (remove the filing in order to get refund).Pursuant to D.C. Code § 29–102.13. (d) A mere change of purpose after the payment of money, as when a party desires to withdraw a filing, shall not entitle a party to a refund.

Corporate File Number

Name of Organization

Reason for Refund Request

Amount Requested

What method of payment was used for this transaction?

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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9-Digit Tax Number (No spaces or dashes)

Please enter the first (6) six and last four (4) digits of credit card number used for transaction. (i.e., 1234-56xx-xxxx-7890)

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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If any additional payments are associated with this request, please select the additional method of payment.

Please enter the first (6) six and last four (4) digits of credit card number used for transaction. (i.e., 1234-56xx-xxxx-7890)

Upload Proof of Credit Card Payment (Receipt)

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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 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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Did you receive a Rejection Letter from the Corporations Division?

Yes

Upload Rejection Letter

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Title of Requestor

Requestor's Phone Number

Requestor's Email Address

To Whom Should the Refund be Made? (i.e., Business, Inc. c/o Jane Doe)

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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First Name

Last Name

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

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