GRAND LIST YEAR OFFICE OF THE TAX COLLECTOR
_______________ Town of Goshen
42 North Street
BILL NO. Goshen, CT 06756
_______________
PLEASE READ, SIGN AND DATE BELOW:
I, ____________________________, hereby apply for a refund of motor vehicle, real estate, or personal property taxes (circle one) on the grand list of _____________ in the amount of $_______________________.
I am entitled to this refund because I have made the payments from funds under my control and no other party will be requesting this refund.
I understand that false or deliberately misleading statements subject me to penalties for perjury and/or obtaining money under false pretense.
See Conn. Gen. Stat. 12-129: Refund of Excess Payments.
Your signature below will indicate that you did make the overpayment and are in fact due the refund. Therefore, if you sign, indicate the method of disbursement you prefer and return this form to the Tax Collector, PO Box 187, Goshen, CT 06756, a refund check will be forthcoming.
Signed ________________________________ Date ______________________________
******************************************************************************
For Town Use Only
To the Board of Selectmen Date _________________________
It is recommended that a refund of property taxes in the amount of $_______________ be made to the above named Taxpayer/ the Tax Collector in accordance with the provisions of Section 12-129.
__________________________________________
Launa M. Goslee, Tax Collector, Town of Goshen
*** *** *** *** *** *** *** *** *** ***
Date of approval on the warrant by Board of Selectmen __________________
*** *** *** *** *** *** *** *** *** ***
Check # __________________
Processed in Tax Computer on _________________________
| 
