Nebraska Claim for Refund of Sales and Use Tax

Claim for Refund of Sales and Use Tax 
Form 7
Claim for Refund of Sales and Use Tax

Form

7

Attach supporting documents.
Nebraska ID Number

Please Do Not Write In This Space

Federal Employer ID or Social Security Number

PRINT FORM

RESET FORM

Claim Period
Beginning ______________________ , ________ and Ending ______________________ , ________
Name

Name and Location Address of Claimant

Name

Name and Mailing Address of Claimant

Legal Name
Street Address

Street or Other Mailing Address

City			State			Zip Code

City			State			Zip Code

	1	Amount of Nebraska sales and
		use tax paid . . . . . . . . . . . . . . 	

Amount Claimed
1

Provide Basis For Claim and Attach Appropriate
Documentation (See instructions.)

	2	Local sales and use tax paid:		
Local Taxing Jurisdiction

Amount of Local Tax Overpayment

	3	Total of line 2 . . . . . . . . . . . . . . 	 3
	4	Total of lines 1 and 3  . . . . . . . . 	 4
	 5	Select payment method:	 c Refund (complete information below) or 	 c Credit to sales/use tax account (do not use until credit appears on
account). Complete the routing and account information below to have your refund direct deposited. The Department of Revenue strongly
encourages all refunds to be direct deposited.
	

Routing Number (must be 9 digits)	

Check Type of Account:	 c (1) Checking	 c (2) Savings

Account Number (up to 17 digits)
	

c Check this box if the refund will go to a bank outside the United States.

	6	Person authorized to be contacted regarding this claim:
Authorized Contact Person (Please print.)
Title
Email Address
Phone Number
	
I declare under penalties of law that I have examined this claim, and to the best of my knowledge and belief, it is correct and complete. I also declare that
payment of this claim has not been previously made by the state, nor have I claimed or received a refund from the retailer. I understand if I send claim information
via email that I am accepting the risk and the possibility that emails may be intercepted by unintended third-parties.

sign
here

Authorized Signature (Owner, Partner, Member, Corporate
Phone Number
Officer, or Person Authorized by Attached Power of Attorney)

Signature of Preparer Other Than Taxpayer

Phone Number

Title (See instructions.)

Address

Date

Date

Action Taken by the Nebraska Department of Revenue

c	Approved
c	Approved as Revised
	 c See Amended Statement
	 c See Comments
	 c See Letter Dated

Comments:

For Dept. Use Only
Direct Voucher

Tax Cat.___________

Ref. Type __________ Date to
Finance
Force Code ________ _________________
Approved
	1
Code	
	2

	 ____________________

Amount

c	Disapproved
	 c See Comments
	 c See Letter Dated

	3

	 ____________________

Total
	4
Department’s Authorized Signature

Date

You may fax this form to 402-471-5927.
Mail this claim and supporting documentation to: Nebraska Department of Revenue, PO Box 98903, Lincoln, NE 68509-8903.
revenue.nebraska.gov, 800-742-7474 (NE and IA), 402-471-5729
Retain a copy for your records.
6-063-1967 Rev. 9-2017 Supersedes 6-063-1967 Rev. 7-2016

Instructions
This form, if not properly completed and adequately supported,
is not a valid claim for refund (claim) and may be returned.
Who May File. Any person who has made an overpayment of sales or use tax of $2 or more, may file
a claim.
When to File. A claim must be filed within the statute of limitations period (generally three years from the
20th day of the month following the close of the period for which the overpayment of tax was made). If the
overpayment of tax was the result of a deficiency determination issued by the Nebraska Department of Revenue
(Department), the claim must be filed within six months after the determination becomes final, or within six
months from the date of overpayment of tax with respect to the determination. The latest expiration date of
these three periods will be the last acceptable filing date.
Where to File. The claim must be filed with the Nebraska Department of Revenue, PO Box 98903, Lincoln,
NE 68509-8903. Or you may fax this claim to 402-471-5927 if there is limited documentation submitted to
support the claim.
Basis for a Valid Claim for Refund. A valid claim must have all of these items. If the space provided is not
sufficient, a letter of explanation must be attached.
1. All applicable lines on the form must be completed.
2. The claim must be signed by an authorized person, if authorized by a Power of Attorney, Form 33, a copy
must be included.
3. The claim must have adequate documentation for the Department to determine its validity. The minimum
requirements for adequate documentation include reference to either a specific state statute or regulation, in
support of each item claimed, and copies of all purchase invoices or documents for each item claimed, in the
format as set forth below.
4. If 50 or more invoices will be submitted in support of the claim:
a. Enclose a detailed listing of the invoices and indicate the amount of the sales and use taxes paid. The list
should be in alphabetical order by vendor. Submit the list in a spreadsheet on digital media. The list must
include the following information and be in the format shown 									
Name of		
Month	
Local
Total
Nebraska Local
Vendor
Item
Invoice Invoice Taxable Nebraska
									
Municipality		
Use Tax	
Sales
Tax
Tax
Sales
Tax
Use
Tax
Use
Tax
Name Description Number Date Amount
									
or County		
Remitted	
Paid
Paid
Paid
Paid
Paid

b. Attach a legible copy of every invoice on the list. Arrange the invoice copies in the same order
that the invoices appear on the list. The invoices need to clearly show the total purchase price and
the amount of Nebraska and, if applicable, local sales tax paid. The invoices may be attached in
PDF format.
5. If fewer than 50 invoices or documents will be submitted in support of the claim, attach a legible copy of
every invoice or document that clearly describes the item purchased, the total purchase price, and the
amount of Nebraska and, if applicable, local sales tax paid. If claiming a refund of sales and use taxes paid
on a motor vehicle, you must include a copy of the Nebraska Sales/Use Tax and Tire Fee Statement for
Motor Vehicle and Trailer Sales, Form 6, which was validated by the county treasurer; or a copy of the motor
vehicle registration showing sales tax was paid.
6. Claims for sales and use taxes paid on manufacturing machinery and equipment. In addition to the information
listed in 4 or 5 above, you must provide the model number and a detailed description of how the machinery
or equipment is used in your manufacturing process. Include a reference to the specific section of Nebraska
Sales and Use Tax Regulation 1-107, Manufacturing Machinery and Equipment Exemption, which applies
to the use of the equipment.
Claims for sales and use taxes paid on repair and replacement parts for manufacturing machinery and
equipment. You must provide information as to which piece of manufacturing machinery or equipment the
part is used on.

7.	 Retailers filing a claim must attach:
•	

Copies of the original invoices;

•	

Credit memos issued to customers; and

•	

Exemption certificates, if issued.

The claim will be reduced by the amount of collection fee for the portion of the tax on the original
return when it was filed.
8.	 Contractors who have been issued a Purchasing Agent Appointment, Form 17, before any materials are
annexed, may file a claim for sales or use tax paid on those materials annexed to real estate in the exempt
project. If the Form 17 was not issued prior to the annexation, the refund claim must be filed by the exempt
organization. The exempt organization must show the actual amount of tax paid by the contractor with
certified statements from the contractor accompanying the claim for refund. A supplier/vendor of building
materials sold to a contractor may not receive a refund of tax on those materials when a Form 17 is received
after the purchase is made. Instead, the contractor or exempt entity must apply for the refund.

Failure to provide the information outlined above may result in the claim being returned as an invalid claim.
Payment Method. You may elect to receive the approved refund either as a direct deposit, or as a credit to
offset a future sales or use tax liability. To have your refund deposited directly into your checking or
savings account, enter the routing number and account number. The routing number and account number are
found on the bottom of the checks used with the account. The Department strongly encourages all refunds to be
direct deposited.
New banking rules regarding International ACH Transactions (IATs) require that the Department must be
notified whenever a refund will go to a bank account outside the U.S. The box in line 5 must be checked if the
bank is outside the U.S. These refunds cannot be processed as direct deposits and instead will be mailed.
Processing Procedure. The Department must approve or deny a claim within 180 days of its filing unless:
•	

The claimant and the Department have agreed in writing to extend the 180-day period; or

•	

The claimant requests a hearing in writing which waives the 180-day period.

The Department must send the claimant notice of the denied portion of a claim within 30 days after the denial.
Appeal Procedure. The denial of a claim in its entirety, or in part, is considered a final determination of the
Department and may be appealed. If the Department’s final action is appealed, the claimant must file its
appeal with the District Court in Lancaster County within 30 days after the mailing of the Department’s final
determination. If an appeal is not made within 30 days, the determination of the Department becomes final.

Specific Instructions
Line 1. Enter the amount of state sales or use tax paid.
Line 2. Enter the name of each local taxing jurisdiction and the amount of local sales or use tax paid. If the
space provided is not sufficient, attach a schedule listing the additional information.
Line 5. Check the appropriate box to select how you would like to receive the approved amount. A credit to your
sales or use tax account may be used to offset future sales or use tax liabilities. If you anticipate the approved
credit will be greater than your reported tax liabilities over the next 24 months, you should request a refund. If
no election is made, a refund will be issued.
Line 6. An Authorized Contact Person designated on line 6 will have the authority to receive and discuss
confidential information regarding this claim. By including an email address for the Authorized Contact Person,
you accept the risk of loss of confidentiality associated with this method of communication.
Signatures. The claim submitted to the Department must be signed by the owner/taxpayer, partner, member,
or corporate officer. If another person signs this claim, there must be a power of attorney attached to this form,
or the Department will be unable to process this claim.
Any person who is paid for preparing a taxpayer’s claim must also sign the claim as preparer.