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Currently electronic submissions of this form cannot be processed. Completed forms need to be printed, signed, and submitted to the applicable county treasurer's office.

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Please select a check box and sign the form for the applicable refund request:
Please select a check box and sign the form for the applicable refund request:
Please select a check box and sign the form for the applicable refund request:
4% Excise Tax Refund
4% Excise Tax Refund
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