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Request For Refund (Accounting) - California
| Request For Refund (Accounting) Form. This is a California form and can be used in General San Francisco Local County . |
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Superior Court of California County of San Francisco Request for Refund Name of Claimant (please print) _____________________________________________________________ Address of Claimant _____________________________________________________________________ Amount requested to refund __________________________________________________________________ Date(s) of Transaction _____________________________________________________________________ Transaction/Fee Tag Number(s) ______________________________________________________________ Case Number/Title _____________________________________________________________________ (This is required for consideration of merit, attach a separate sheet if additional space is needed.) Reason for request of refund: The amount claimed is justly due and this claim has been presented and filed with the department originally receiving said money within the time prescribed by law. I DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. EXECUTED ON ________________ AT ____________________, CALIFORNIA. SIGNATURE OF CLAIMANT DEPARTMENTAL USE ONLY Refund request approved/denied on the basis of: Amount to be refunded: _____________________ Date _________________________________________________________ Division Manager Authorization (DL) 415-551-5968 400 McAllister Street, Room 103 San Francisco, CA 94102-4514 Attention: Accounting FAX 415-551-3801 American LegalNet, Inc. www.USCourtForms.com
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