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Monument Town Hall 645 Beacon Lite Road Monument, CO 80132 [PHONE REDACTED] Fax – [PHONE REDACTED] www.townofmonument.org Approved Permit # with Use tax charged and requesting refund Property address: TOWN OF MONUMENT Request for Use Tax Refund as per Town of Monument Municipal Code If you have purchased all of the materials needed for your project and can supply the Town of Monument copies of receipts or invoices containing proof of Town of Monument sales tax paid, you may be able to obtain a refund of the use tax paid; however, you will still need to get a LUP number for Regional Building. Please fill out the information below and present receipt for Use Tax payment and your receipt(s). If your request has been approved, we will send your refund check to you or a letter stating the reasons why you have been denied the Use Tax refund. Name: Address: Phone: Signature: Date: Approval: Date: Front Desk received Tax Payment Receipts ❑ ---PAGE BREAK--- 2 Town of Monument Use Tax Summary Sheet You must attach your retail receipts to this form Purchased From Materials Description Cost $ $ $ $ $ $ $ $ $ $ $ TOTAL $ By signing below, I certify all materials listed above were purchased locally, within the Town of Monument Boundaries. Date