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Get CT DRS AU-524 1999

SIGNATURE OF AUTHORIZED REPRESENTATIVE NAME OF AUTHORIZED REPRESENTATIVE PLEASE PRINT TITLE PLEASE PRINT THIS SCHEDULE SHALL BE ATTACHED AND MADE A PART OF SALES TAX CLAIM OF CLAIMANT AU-524 Rev. 2/99. DEPARTMENT OF REVENUE SERVICES AUDIT DIVISION 25 SIGOURNEY STREET HARTFORD CONNECTICUT 06106 ASSIGNMENT OF RETAILER S RIGHTS FOR REFUND SCHEDULE NO. NAME OF CLAIMANT SALES TAX PERMIT NO. NAME OF RETAILER STREET ADDRESS CITY OR TOWN DATE GROSS AMOUNT OF PORTION OF SALE INVOICE NUMBER SALES EXCLUDIN.

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