Fillable Form 06: nn ecticut Office of the Se (State of Connecticut/Department of Administrative Services)

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Form 06: nn ecticut Office of the Se (State of Connecticut/Department of Administrative Services)

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BROWSE STATE OF CONNECTICUT/DEPARTMENT OF ADMINISTRATIVE SERVICES (CT) FORMS

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Office of the Se
cre
tary of
th
e State
State of
Co
nn
ecticut
30 Trinity Street
P.
O.
Box 15
04
70, Hartford,
CT
06
115
-04
70
DENISE
W.
MERRILL
Secre
tar
y of
th
e St
at
e
SCOTT
D.
BATES
D
ep
uty Secret
ar
y of the State
Following find the Refund Claim Form you will need to complete
in
order to obtain a
refund of your overpaid fees. It
is
acceptable to complete the form on-line, however, you
will need to print it then sign and date it and MAIL to the address above. You will also
need a copy
of
your canceled check, cash receipt, credit card receipt and any
supporting documentation to substantiate your claim.
Please remember that you have the option
of
using these funds toward another filing
with this office. If you choose to use the funds
in
this fashion, please return a copy of the
letter indicating that you have money
on
account with your next submission.
Procedures outlined in the Connecticut General Statues, sec. 4-37 and by the office
of
the comptroller involve a lengthy refund process. Assuming your claim is valid; you can
expect to receive a refund within two months from the date received by this office.
Please contact the Financial Unit at (860) 509-6154 if we can be
of
further assistance.
Blanche H. Reeves Tucker
Fiscal Administrative Manager
Secretary of the State Main Linc
State Capitol Office
Deputy Secretary
of
the State
860
-
509
-
6200
Bus
iness Services Divisi
on
860-509-600
2 fax
860-509
-
6069
860
-
509
-6 12 1 fax
860
-
509
-
6209
L<-"g
islati
on
and
Election Administration
Di
vision
860
-
509
-G 100 fax
860-509
-G 1
27
860
-
509-6212
fax
860
-
509-6
t 31 Managem
ent
& Su
ppor
t Services
860
-
509-6
1
90
fax
860
-
509
-
6175
Int
erne
t Home Page:
www
.c
t.
gov/
sots
Office of the Secretary of the State
State of Connecticut
165 Capitol Avenue
P.O. Box 150470, Hartford, CT 06115- 0470
DENISE W. MERRILL
Secretary of the State
SCOTT D. BATES
Deputy Secretary of the State
Secretary of the State
165 Capitol Avenue
Ma
iling Address:
P.O. Box 150470
Hartford, CT 06115-0470
Refund Claim for Overpaid Fees
Refunds will not be processed unless they comply with Connecticut General Statues sec. 3-99a(c), which states in part that the amount
must be in excess of $5.00 and not have accrued for more than one year in order to be refunded.
Additionally, a copy of the front and back of the negotiated check, cash receipt or credit card receipt will be required in order to process
a refund claim along with any supporting documentation such as a rejection letter or notice of money on account.
The following information is required to accurately process a refund:
I
am the only person or entity having a valid claim to the monies being held on account at the office
of the Secretary of the State.
I request the check be made payable as follows:
(Mailing address, include your reference # if desired)
Work order # Customer ID #
Processing #
Refund Amount $
The forgoing is made under the penalties of false statement
Print Name:
Title:
Signature:
Date:
Below is for Official Use by The Office of The Secretary of The State of Connecticut
Amount
Orig. Dep. # Deposit Date Approved By List#
SOS-REF-08 Rev. 2/7/20
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Form 06: nn ecticut Office of the Se (State of ConnecticutDepartment of Administrative Services)

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Completed 13 August 2020

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