Form IA-81 PDF Details

For individuals and businesses navigating the complexities of tax refund issues in Georgia, the Replacement Check Request Form, known as Form IA-81, serves as a crucial tool. Revised in May 2012, this form is specifically designed for instances where a refund check is either not received, lost, stolen, destroyed, or has expired without being cashed for more than 180 days after its issuance. It is important for taxpayers to understand the stipulations set forth by this form, such as the necessity to wait a minimum of 15 business days from the mailing date before submitting a request, and allowing for a processing time of 10-15 business days once the form has been completed and submitted. This form encompasses various tax types including individual, sales and use, withholding, motor fuel IFTA, and corporate taxes. Providing detailed taxpayer information, including the primary taxpayer or business name, social security numbers, state tax identification number, and both past and current mailing addresses, is imperative for the processing of the form. In addition, a concise declaration requirement emphasizes the need for accuracy and truthfulness under penalties of perjury. For taxpayers represented by a third party such as an attorney or accountant, a Power of Attorney (Form RD-1061) must also be included. Submission of the form can be done via mail or fax to the Georgia Department of Revenue, ensuring a methodical approach to resolving the issue of a misplaced or expired check, and reinstating the rightful funds to the taxpayer.

QuestionAnswer
Form NameForm IA-81
Form Length1 pages
Fillable?Yes
Fillable fields18
Avg. time to fill out3 min 55 sec
Other namesE-mail, http dor georgia gov documents ia 81 replacement check request form, georgie state replacement check form taxes, check replacement form

Form Preview Example

(Revised 5/12)

Form IA-81

Replacement Check Request Form

GENERAL INSTRUCTIONS

•DO Use this form to replace a refund check that has been mailed but never received.

•DO Use this form to request a stop payment on a check that has been lost, stolen or destroyed.

•DO Use this form if you have a refund check that has expired and has not been cashed for more than 180 days after issuance.

•DON’T Request a replacement check if it has been less than 15 business days since the check was mailed.

•PLEASE Allow 10-15 business days processing time for your completed form.

REFUND TAX YEAR: _____________

REFUND AMOUNT: $_______________

Check Tax Type:

Individual

Sales and use tax

Withholding

Motor Fuel

IFTA

Corporate

TAXPAYER INFORMATION (E-mail: ____________________________________________)

Primary Taxpayer Name or Name of Business:

 

 

 

 

 

Spouse Name (if applicable):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SSN

 

 

 

 

 

 

 

 

 

 

SSN (spouse, if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State Tax Identification Number (STI)

 

Check Number (if known)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address on Return:

 

City

 

 

 

 

 

 

 

 

 

 

 

 

 

State

Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current Mailing Address: (if different from above)

City

 

 

 

 

 

 

 

 

 

 

 

 

 

State

Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Daytime Telephone Number

Fax Number

 

 

 

 

 

Name of Contact Person (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reasons for request (choose one):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check Never Received

Direct Deposit Never Received

 

 

 

Lost

Stolen

Expired

 

Destroyed

 

 

 

 

 

 

 

 

 

Other (Please Explain :__________________________________)

Note: A “STOP PAYMENT” will be issued on the original refund check upon receipt of this form. If you receive/find your original check after submitting this form, DO NOT CASH THE ORIGINAL CHECK. You must return the check to the Department.

DECLARATION:

I hereby declare, under penalties of perjury, that I have examined this request and, to the best of my knowledge and belief, it is true, correct and complete. If you are being represented by an attorney, accountant, or other third party, a properly executed Power of Attorney (Form RD-1061) authorizing the representative to act for the taxpayer must be included with this form.

Taxpayer’s Signature and Date

Spouse’s Signature and Date (if applicable)

Representative’s Name

Title (if applicable)

Representative’s Signature

Date

HOW TO SUBMIT YOUR FORM:

You may submit your completed request to the Department as follows:

Mail to: Georgia Department of Revenue, 1800 Century Center Blvd NE, Suite 3104, Atlanta, GA 30345-3212

Fax: 404-417-4391

Form IA-81 isn’t the one you’re looking for?

Related Documents