"Refund Request Form" - Mississippi

Refund Request Form is a legal document that was released by the Mississippi Department of Employment Security - a government authority operating within Mississippi.

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State of Mississippi
Department of Employment Security
Jackson, MS
 
REQUEST FOR REFUND
 
Give exact name of business, address and account number as identified on your contribution report.
Mail to:
MDES Tax Department
PO Box 22781
Jackson, MS 39225-2781
Fax to:
(601) 321-6011
Email to:
tax@mdes.ms.gov
BUSINESS   N AME   A ND   A DDRESS:  
 
 
 
DATE:   _ __________________________  
_____________________________________________    
ACCOUNT   N O:   _ ___________________  
_____________________________________________  
_____________________________________________  
_____________________________________________  
_____________________________________________  
 
EMPLOYER’S   S IGNATURE/TITLE:   _ _________________________________________________________  
 
 
 
Employers   w ho   h ave   p aid   m ore   t ax   t han   i s   d ue   f or   t he   q uarter   m ay   b e   e ligible   f or   a   r efund,   u nless   t here   i s   a   d ebit   o n   t he   a ccount  
in   a nother   q uarter,   i n   w hich   c ase,   t he   a mount   w ill   b e   u sed   t o   s atisfy   t he   d ebit.     A ny   c redit   e xisting   a fterwards   m ay   b e   r efunded  
upon   w ritten   r equest   o f   t he   e mployer.   E ligibility   f or   r efunds   m ay   b e   d etermined   4 5   d ays   a fter   t he   d ate   o f   p ayment   a nd  
verification   t hat   t he   a ccount   i s   i n   g ood   s tanding.   C redits   r emain   a vailable   f or   r efund   f or   a   p eriod   o f   t hree   y ears   a fter   t he   e nd   o f  
the   c alendar   y ear   f or   w hich   t he   c redit   w as   c reated.   C redits   n ot   u sed   o r   r equested   a s   a   r efund   w ithin   t he   t hree-­‐year   p eriod   w ill  
result   i n   f orfeiture   o f   t he   c redit  
State of Mississippi
Department of Employment Security
Jackson, MS
 
REQUEST FOR REFUND
 
Give exact name of business, address and account number as identified on your contribution report.
Mail to:
MDES Tax Department
PO Box 22781
Jackson, MS 39225-2781
Fax to:
(601) 321-6011
Email to:
tax@mdes.ms.gov
BUSINESS   N AME   A ND   A DDRESS:  
 
 
 
DATE:   _ __________________________  
_____________________________________________    
ACCOUNT   N O:   _ ___________________  
_____________________________________________  
_____________________________________________  
_____________________________________________  
_____________________________________________  
 
EMPLOYER’S   S IGNATURE/TITLE:   _ _________________________________________________________  
 
 
 
Employers   w ho   h ave   p aid   m ore   t ax   t han   i s   d ue   f or   t he   q uarter   m ay   b e   e ligible   f or   a   r efund,   u nless   t here   i s   a   d ebit   o n   t he   a ccount  
in   a nother   q uarter,   i n   w hich   c ase,   t he   a mount   w ill   b e   u sed   t o   s atisfy   t he   d ebit.     A ny   c redit   e xisting   a fterwards   m ay   b e   r efunded  
upon   w ritten   r equest   o f   t he   e mployer.   E ligibility   f or   r efunds   m ay   b e   d etermined   4 5   d ays   a fter   t he   d ate   o f   p ayment   a nd  
verification   t hat   t he   a ccount   i s   i n   g ood   s tanding.   C redits   r emain   a vailable   f or   r efund   f or   a   p eriod   o f   t hree   y ears   a fter   t he   e nd   o f  
the   c alendar   y ear   f or   w hich   t he   c redit   w as   c reated.   C redits   n ot   u sed   o r   r equested   a s   a   r efund   w ithin   t he   t hree-­‐year   p eriod   w ill  
result   i n   f orfeiture   o f   t he   c redit