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Get Au-738a, Motor Vehicle Fuels Tax Nutrition Program ... - Ct.gov - Ct

UND 1. See reverse side for general instructions and information. 2. Mail original to the Department of Revenue Services at the above address. 3. REFUND CLAIMS MUST BE FILED BY MAY 31, 1999 for purchases made during calendar year 1998. CT Tax Registration Number / Social Security Number FOR DEPARTMENT USE ONLY Telephone Number ( Audit Number ) Name of Claimant (Please type or print) Claim Number Number and Street Refund Gallons City or Town State Type of Business Location of Record.

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