DNR Form 158-A "Application for Refund" - Maryland

What Is DNR Form 158-A?

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

Form Details:

  • Released on December 1, 2017;
  • The latest edition provided by the Maryland Department of Natural Resources;
  • 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 printable version of DNR Form 158-A by clicking the link below or browse more documents and templates provided by the Maryland Department of Natural Resources.

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Download DNR Form 158-A "Application for Refund" - Maryland

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MARYLAND DEPARTMENT OF NATURAL RESOURCES
LICENSING AND REGISTRATION SERVICE
APPLICATION FOR REFUND
PLEASE PRINT IN INK AND PRESS FIRMLY– FOR COMPLETE INSTRUCTIONS SEE REVERSE
_______________________
DNR ID#
First Name
Middle Name
Last Name
Social Security or Federal
Identification Number
(Required)
Mailing Address
Daytime Telephone No.
$
________________________________________________________________________________________
Total Refund Requested
City
State
Zip Code
PCA Code _________ Source Code _________ Amt. __________
PCA Code _________ Source Code _________ Amt. _________
PCA Code _________ Source Code _________ Amt. __________
PCA Code _________ Source Code _________ Amt. _________
Refund is hereby requested for: (check one)
Refund Amount
I. BOATING
Indicate vessel number
_________________
.
A
The cost of an unused set of decals (decals and registration card returned with this
th
application) by June 30
in the first calendar year of registration.
______________
B. The cost of a single set of decals (decals and registration card returned with this
application) in the first calendar year of the vessel’s 2-year registration.
NOTE: Only the second year’s registration fee will be refunded.
______________
C. Waiver of penalty $___________________ and/or interest $____________________
______________
D
____________________________________________
. Other: Explanation
___________________
II. COMMERCIAL FISHING
Waterman ID #
______________
____________________________________________________
Explanation
_____________________
III. SPORT HUNTING/FISHING
Transaction #
______________
____________________________________________________
Explanation
IV. OTHER
______________
Explanation ___________________________________________________________
I/We certify, under penalty of perjury, that the statements made herein are true and correct to the best of my/our
knowledge, information and belief.
______________________________________________________________________________________
Applicant’s Signature
Date
Approved By: ________________________________________
_________________________________________________
Supervisor
Date
Fiscal Officer
Date
DNR 158-A (12/17)
MARYLAND DEPARTMENT OF NATURAL RESOURCES
LICENSING AND REGISTRATION SERVICE
APPLICATION FOR REFUND
PLEASE PRINT IN INK AND PRESS FIRMLY– FOR COMPLETE INSTRUCTIONS SEE REVERSE
_______________________
DNR ID#
First Name
Middle Name
Last Name
Social Security or Federal
Identification Number
(Required)
Mailing Address
Daytime Telephone No.
$
________________________________________________________________________________________
Total Refund Requested
City
State
Zip Code
PCA Code _________ Source Code _________ Amt. __________
PCA Code _________ Source Code _________ Amt. _________
PCA Code _________ Source Code _________ Amt. __________
PCA Code _________ Source Code _________ Amt. _________
Refund is hereby requested for: (check one)
Refund Amount
I. BOATING
Indicate vessel number
_________________
.
A
The cost of an unused set of decals (decals and registration card returned with this
th
application) by June 30
in the first calendar year of registration.
______________
B. The cost of a single set of decals (decals and registration card returned with this
application) in the first calendar year of the vessel’s 2-year registration.
NOTE: Only the second year’s registration fee will be refunded.
______________
C. Waiver of penalty $___________________ and/or interest $____________________
______________
D
____________________________________________
. Other: Explanation
___________________
II. COMMERCIAL FISHING
Waterman ID #
______________
____________________________________________________
Explanation
_____________________
III. SPORT HUNTING/FISHING
Transaction #
______________
____________________________________________________
Explanation
IV. OTHER
______________
Explanation ___________________________________________________________
I/We certify, under penalty of perjury, that the statements made herein are true and correct to the best of my/our
knowledge, information and belief.
______________________________________________________________________________________
Applicant’s Signature
Date
Approved By: ________________________________________
_________________________________________________
Supervisor
Date
Fiscal Officer
Date
DNR 158-A (12/17)
INSTRUCTIONS FOR COMPLETING APPLICATION
The refund application must be completed in full. Please follow the steps outlined below.
Step 1: Please print DNR ID#, name and address clearly. Your refund will be mailed to the address indicated on
this application
.
Step 2: Your Social Security or Federal Identification Number is required by the Comptroller of the Treasury to
obtain a refund.
Step 3: Check the appropriate box indicating the type of refund requested and submit the required information.
I. BOATING – Indicate vessel number for which you are requesting a refund.
th
A. For a refund of the cost of an unused set of decals, surrender to the Department by June 30
in the first
calendar year of the registration period:
1. Set of unused decals and registration card.
2. Completed refund application.
B. For a refund of the cost of the second year’s registration fee, surrender to the Department between July and
December in the first calendar year of the vessel’s 2-year registration:
1. Set of decals (removed from the vessel) and registration card.
2. Completed refund application.
C. Waiver of penalty and/or interest.
D. Boating transactions other than registration and penalty and interest waivers. Provide an explanation for
the refund request.
II. COMMERCIAL FISHING, SPORT HUNTING/FISHING or OTHER
A. Complete refund application.
B. Provide an explanation for the refund request.
YOUR APPLICATION MAY BE FORWARDED TO ANY OF THE FOLLOWING
DNR LICENSING & REGISTRATION SERVICE CENTERS
Business Hours: 8:30 am to 4:30 pm Monday – Friday (except state holidays)
Essex Service Center
Annapolis Service Center
Central Service Center
East Central Service Center
1338 Eastern Blvd. A
501 W. MacPhail Rd. #2
P.O. Box 1869
120 Broadway Ave #5
Essex, MD 21221
Centreville, MD 21617
Annapolis, MD 21404
Bel Air, MD 21014
667-401-0760
410-260-3220
410-836-4550
410-819-4100
1-866-344-8889 (Toll Free in MD)
1-886-535-8319 (Toll Free in MD)
1-866-623-3187 (Toll Free in MD)
1-866-439-1708 (Toll Free in MD)
410-260-3281 (Fax)
410-284-3505 (Fax)
410-836-4562 (Fax)
410-819-4110 (Fax)
(WALK-In Only: M/W/F)
Cumberland Service Center
Western Service Center
Eastern Service Center
Southern Service Center
13300 Winchester Road
1601-A Bowmans Farm Rd.
251 Tilghman Road #2 Salisbury,
11 Industrial Park Drive
Cumberland, MD 21502
Frederick, MD 21701
Waldorf, MD 20602
MD 21801
240-236-9950
301-777-2134
410-713-3840
410-535-3382
301-777-5865(Fax)
1-866-679-0906 (Toll Free in MD)
1-866-812-1678 (Toll Free in MD)
1-866-688-3823 (Toll Free in MD)
240-236-9953 (Fax)
(WALK-In Only: Tues/Thurs)
410-713-3849 (Fax)
410-535-4737 (Fax)
DNR 158A back (01/19)
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