1. Clear form
Utah State Tax Commission
TC-55A
Claim for Refund of Fees or Sales Tax for Motor Vehicles Rev. 5/05
(Instructions on reverse side)
Name License plate, permit or assigned number
Address VIN/HIN
City State Zip code Daytime Telephone no.
1. Amount of sales tax or license fees paid $
$
2. Correct amount of sales tax or license fee as computed by taxpayer
3. Amount claimed as a refund (subtract amount on line 1 from line 2) $
I believe that this claim should be allowed for the following reasons: (use reverse side if needed)
Under penalties of perjury, I declare that I have examined this claim and to the best of my knowledge and belief it is true, correct and complete.
Signature Date
For Motor Vehicle Use Only
Decal #: _________________ Registration month/year: ______________
Returned plate #: _________________ TXID: ______________
For Tax Commission Use Only
Date
Checked by
Date
Approved by
DMV accounting approval Date
Transaction #: ___________________________________________________________
Total amount of refund
Sales tax $ as computed by the Utah $
Motor vehicle fees $
State Tax Commission
Breakdown of refund by account Motor Vehicle Watercraft/Off-highway
Indicate for each account listed below the amount of the refund approved by the examining agent.
Account type Amount of refund Registration canceled?
Account type Amount of refund
$
$ IRP
Registration fees Yes No
$
$ DUI
Title
Date canceled: ____________________
$
$ Sales Tax
Driver's Ed.
TXID: ______________
Impound $
$
Insurance Data
Insurance Revocation $
Personalized Plate Fee $
Plate Fee RPS/Internet Fall Outs $
$
Other: ____________
Postage $
$

2. Instructions
1. You must apply to your local county assessor for refunds for property tax or age-based fees.
2. You must return all registration materials that pertain to refund request (i.e. decals, registration, plates, etc.).
3. Attach a copy of all receipts or a copy of your canceled checks (both the front and back).
4. If you paid through the internet, you must provide a copy of your statement which shows the date and amount of the
payment.
5. Please provide copies of all documents which support your reason for requesting a refund.
If the vehicle has been sold or traded in, please include documentation which includes the VIN/HIN signed by both
●
the seller and the purchaser and the date of the transaction.
LEASE BUY OUTS: Please include a copy of your lease buy out agreement which includes the VIN/HIN and the
●
date the leased vehicle was purchased.
FOR SALES TAX ONLY: If the vehicle purchased was returned to the seller and the sale canceled, attach a copy
●
of the canceled sale documentation, which includes the VIN/HIN, signed by both seller and purchaser.
6. Mail refund claim and all supporting documentation directly to DMV Accounting - 4th floor at the Utah State Tax
Commission, 210 N 1950 W, SLC, UT 84134.
Please keep a copy of the refund claim and all documentation for your records.
Statement Continuation