Rev 41 0104E Form PDF Details

Filling out forms can be one of the most confusing and tedious tasks in any business setting, but understanding the Rev 41 0104E Form is essential for accurate filing with your local taxing authorities. This form outlines important sales tax requirements such as filing frequency, taxing rate adjustments, permit renewals, and more; get it wrong or miss a step and you risk facing severe penalties from the government. We'll walk you through everything you need to know about this crucial document and make sure you are confident when submitting your taxes.

Form NameRev 41 0104E Form
Form Length2 pages
Fillable fields0
Avg. time to fill out30 sec
Other namesBuyersDeclar washington state declaration of buyer and seller form

Form Preview Example

Department of Revenue

Buyer’s Declaration

for Refund of Retail Sales Tax

Name of Buyer






Buyer’s Tax Registration Number








Name of Seller






Seller’s Tax Registration Number









Seller’s Address















Date of Sale


Sales Price

Amount of Retail


Location of Sale

Description of Items Purchased


(Before Tax)

Sales Tax Paid


(Use 4-digit code)





































































Buyer’s Declaration and Authorization

Subject to penalty of perjury, I affirm that the attached retail sales tax refund claim is being submitted to the State of Washington Department of Revenue without the participation of the seller for the following reason (check as applicable):

The buyer attempted in good faith to obtain a Seller’s Declaration, but could not locate the seller.

The buyer attempted in good faith to obtain a Seller’s Declaration, but the seller no longer exists.

The buyer attempted in good faith to obtain a Seller’s Declaration, but the seller refused to sign the form.

By signing this declaration, I authorize the State of Washington Department of Revenue to contact the seller regarding these purchases, and confirm that I have not obtained a refund or credit for these purchases from the seller nor will I seek such a refund or credit for these purchases from the seller in the future. This authorization is made pursuant to

RCW 82.32.330, and I waive all my rights to prior notice of disclosure of tax information specified in RCW 82.32.330.



Buyer’s Signature




Name and Title (print)


Mail this form with the Application for Refund or Credit to:

Attn: Refunds


State of Washington Department of Revenue


PO Box 47476


Olympia WA 98504-7476

For tax assistance, visit or call 1-800-647-7706. To inquire about the availability of this document in an alternate format for the visually impaired, please call (360) 705-6715. Teletype (TTY) users may call 1-800-451-7985.

REV 41 0104e (12/27/07)

Instructions for Completing the Buyer’s Declaration Form

1.When should a buyer file this form?

A buyer should complete this form when the buyer is filing a refund or credit claim and has paid retail sales tax in error, but is unable to obtain a signed Seller’s Declaration for any of the following reasons:

The buyer cannot locate the seller.

The seller no longer exists.

The seller refuses to sign the Seller’s Declaration form.

2.What if I have located the seller but the seller refuses to sign the Seller’s Declaration?

Complete the Buyer’s Declaration for Refund for Retail Sales Tax, and check the corresponding checkboxes in the “Buyer’s Declaration and Authorization” section.

The Department may contact the seller to determine why the seller refused to sign the Seller’s Declaration.

3.What information needs to be completed on the form?

All applicable sections must be fully completed, and the form must be signed.

4.What will happen if this form is not fully completed or signed?

You will be notified that your retail sales tax refund claim was not accepted.

5.How can I get the 4-digit code for the “Location of Sale” if I don’t know it?

The 4-digit location code can be obtained on our website at by clicking on the

FIND THE SALES TAX RATE (GIS) link, on the homepage.

6.What documentation needs to be attached to the form?

RCW 82.32A.030 requires taxpayers to substantiate refund claims. Supporting documentation may include the following items:


Resale certificates

Sales tax exemption certificates

Proof that sales tax has been paid

Contracts and other sales documents

7.What if I have a refund claim for purchases from more than one seller?

Provide supporting documentation and either a Seller’s Declaration or a Buyer’s Declaration for each individual seller.

8.What if the records to substantiate my claim contain too many pages to attach them all?

Provide a detailed spreadsheet containing the transaction information supporting your claim.

When possible, submit the information electronically using Secure Messaging from the Department’s website at

9.What if my company is currently under an audit conducted by the Department of Revenue?

Present the completed application and required documentation directly to the Revenue Auditor.

10.What if I have questions about this form?

Call the Department of Revenue by phone at 1-800-647-7706, or send an email inquiry to

11.Where do I mail this form and supporting documents once they are completed?

Attach this form, and all supporting documents, to

your Application for Refund or Credit claim form and mail to the following address:

Attn: Refunds

Washington State Department of Revenue

PO Box 47476

Olympia WA 98504-7476

REV 41 0104e (12/27/07)

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In an effort to complete this document, ensure that you enter the information you need in every single blank field:

1. The Rev 41 0104E Form necessitates particular details to be inserted. Ensure the next blanks are complete:

Stage number 1 for filling in Rev 41 0104E Form

2. Once the previous part is filled out, proceed to type in the relevant details in these: The buyer attempted in good faith, Name and Title print, Buyers Signature, Date, Attn Refunds State of Washington, and For tax assistance visit.

Filling in segment 2 of Rev 41 0104E Form

Always be very careful when filling out Attn Refunds State of Washington and Name and Title print, as this is the section in which a lot of people make some mistakes.

Step 3: Prior to finishing the document, ensure that all form fields were filled in the proper way. Once you are satisfied with it, press “Done." After setting up a7-day free trial account here, you'll be able to download Rev 41 0104E Form or email it without delay. The PDF will also be easily accessible in your personal cabinet with all of your modifications. FormsPal guarantees your data privacy by using a secure method that in no way saves or distributes any type of personal data used in the file. Feel safe knowing your paperwork are kept protected when you use our service!