Form 8849 (Rev. January 2003) Claim for Refund of Excise Taxes. Summary: This is an example of Form 8849 (2003) with the following line items completed:
|
“Name of claimant” field contains STEVEN S SANDS
|
|
“Employer identification number” field contains 109876543
|
|
“Address (number, street, room or suite number)” field contains 987 WEST STREET
|
|
“City and state or province. If you have a foreign address, see page 2” field contains ANYTOWN USA
|
|
“ZIP code” field contains 12345
|
|
“Daytime telephone number (optional)” field contains 9875550000
|
|
“Month claimant's income tax year ends” field contains 12
|
| Under
“Schedules Attached”:
|
|
“Schedule 1--Nontaxable Use of Fuels” checkbox checked
|
|
Under
“Sign Here”:
|
“Signature and title (if applicable)” field contains Steven S. Sands
|
|
“Date” field contains 9/29/2003
|
|
“Type or print your name below signature” field contains Steven S. Sands
|
