Form ID1197 (EMS5227) "Refund Request Application" - Washington

What Is Form ID1197 (EMS5227)?

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

Form Details:

  • Released on August 22, 2013;
  • The latest edition provided by the Washington State Employment Security Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form ID1197 (EMS5227) by clicking the link below or browse more documents and templates provided by the Washington State Employment Security Department.

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Download Form ID1197 (EMS5227) "Refund Request Application" - Washington

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P.O. Box 9046  Olympia, WA 98507-9046
Refund Request Application
Instructions Please see detailed instructions on the next page.
Mail this completed form to:
Employment Security Department
UI Tax & Wage Administration
P.O. Box 9046
Olympia WA 98507-9046
Date requested:
Employer Name and address that you use on tax reports:
1
3
ES reference number:
4
UBI number:
5
Shut-down date:
Phone
Phone number and any extension:
2
6
Refund
Amount of refund requested, including penalties and interest:
7
Reason
Please explain in detail why you should receive a refund:
8
Employer’s signature
Employer’s title
9
10
This claim for refund is provided under RCW 50.24.150 of the Washington Employment Security Act.
ID 1197 (8/22/13) EMS 5227 Refund request - application (to download)
P.O. Box 9046  Olympia, WA 98507-9046
Refund Request Application
Instructions Please see detailed instructions on the next page.
Mail this completed form to:
Employment Security Department
UI Tax & Wage Administration
P.O. Box 9046
Olympia WA 98507-9046
Date requested:
Employer Name and address that you use on tax reports:
1
3
ES reference number:
4
UBI number:
5
Shut-down date:
Phone
Phone number and any extension:
2
6
Refund
Amount of refund requested, including penalties and interest:
7
Reason
Please explain in detail why you should receive a refund:
8
Employer’s signature
Employer’s title
9
10
This claim for refund is provided under RCW 50.24.150 of the Washington Employment Security Act.
ID 1197 (8/22/13) EMS 5227 Refund request - application (to download)
General Information
An employer may request a refund of contributions, interest or penalties. The request must be in
writing, and it must be filed within three years of the payment date.
To read the relevant law, please visit
http://apps.leg.wa.gov/rcw/
and enter 50.24.150 in the search
box.
Instructions
Please type or print legibly with a ballpoint pen, and sign item 9.
Item
Description
Employer’s name and address
1
Enter the business name and mailing address that you use on quarterly tax reports.
2
Phone
Enter the phone number and any extension that we can call if we have questions.
3
Date
Enter the date you completed the form.
4
ES reference number
Enter the account number assigned to you by the Employment Security Department.
5
UBI number
Enter the Unified Business Identifier number assigned to you by the state of Washington.
6
Shut-down date
Enter the date you stopped having employees, if applicable.
7
Refund
Enter the total amount of the refund you are requesting, including any interest and penalties.
8
Reason
Explain in detail the reason you should receive a refund. (For example: Taxes were paid on
excess wages, exempt corporate officers were reported, taxes due were miscalculated, etc.)
Employer’s signature
9
Provide the signature of the employer or an authorized representative.
Employer’s title
10
Enter the employer’s title.
Questions?
If you have questions, please contact either:
Your Account Management Center, which you can locate at esd.wa.gov/tax-offices, or
The Employer Accounts Unit at
employeraccountstaxesd@esd.wa.gov
or 360-902-9650.
ID 1197 (8/22/13) EMS 5227 Refund request - application (to download)
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