Form 853 "Customer Refund Request" - Alaska

What Is Form 853?

This is a legal form that was released by the Alaska Department of Administration - a government authority operating within Alaska. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 12, 2016;
  • The latest edition provided by the Alaska Department of Administration;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form 853 by clicking the link below or browse more documents and templates provided by the Alaska Department of Administration.

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Download Form 853 "Customer Refund Request" - Alaska

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CUSTOMER REFUND REQUEST
State of Alaska - Dept. of Administration
Division of Motor Vehicles
1300 W. Benson Blvd., Ste. #400
Anchorage, AK 99503-3692
Phone: (907) 269-5019 / Fax: (907) 333-8615
EMAIL: DOA.DMV.FISCAL@ALASKA.GOV
Customer Name:
Business Name:
Mailing Address:
City:
State:
Zip:
Phone:
EMAIL:
PLATE NUMBER: _________________________________
DRIVER LICENSE NUMBER: _________________________
Alaska Administrative Code 2AAC92.150 (h) requires we send your refund to the address on record. To update your
address please visit your local DMV or go online at: http:// DOA.Alaska.GOV/DMV
Refund Amount: $ ___________
PLEASE READ CAREFULLY REGARDING OUR REFUND POLICY
Please allow 12 weeks for processing of refund requests.
*
Fees collected for online driving records are non-refundable.
*
Road test fees are non-refundable UNLESS a DMV representative cancels the test.
*
Fees are not prorated: "unused " portions of the fee are not refunded.
*
Fees for personalized plate requests are non-refundable unless the plate selection is rejected by
*
DMV and the rejection letter is included with this request.
Original tabs must be received for consideration of registration refunds.
*
Authorization: The Facts Provided are True and Correct:
Date:
Signature:
Refund Requests should be faxed, mailed or emailed to the address listed above.
FOR OFFICIAL USE ONLY
Audited: ___________________ Approved: ______________________ Denied: _____________________
IRIS Coding: __________________ ID: ____________________________ Amount: $ __________________
______ $__________ / ______ $__________ /______ $__________
ALVIN Coding : ______ $__________ /
Form 853
Revised 4/12/2016
CUSTOMER REFUND REQUEST
State of Alaska - Dept. of Administration
Division of Motor Vehicles
1300 W. Benson Blvd., Ste. #400
Anchorage, AK 99503-3692
Phone: (907) 269-5019 / Fax: (907) 333-8615
EMAIL: DOA.DMV.FISCAL@ALASKA.GOV
Customer Name:
Business Name:
Mailing Address:
City:
State:
Zip:
Phone:
EMAIL:
PLATE NUMBER: _________________________________
DRIVER LICENSE NUMBER: _________________________
Alaska Administrative Code 2AAC92.150 (h) requires we send your refund to the address on record. To update your
address please visit your local DMV or go online at: http:// DOA.Alaska.GOV/DMV
Refund Amount: $ ___________
PLEASE READ CAREFULLY REGARDING OUR REFUND POLICY
Please allow 12 weeks for processing of refund requests.
*
Fees collected for online driving records are non-refundable.
*
Road test fees are non-refundable UNLESS a DMV representative cancels the test.
*
Fees are not prorated: "unused " portions of the fee are not refunded.
*
Fees for personalized plate requests are non-refundable unless the plate selection is rejected by
*
DMV and the rejection letter is included with this request.
Original tabs must be received for consideration of registration refunds.
*
Authorization: The Facts Provided are True and Correct:
Date:
Signature:
Refund Requests should be faxed, mailed or emailed to the address listed above.
FOR OFFICIAL USE ONLY
Audited: ___________________ Approved: ______________________ Denied: _____________________
IRIS Coding: __________________ ID: ____________________________ Amount: $ __________________
______ $__________ / ______ $__________ /______ $__________
ALVIN Coding : ______ $__________ /
Form 853
Revised 4/12/2016