What information does the refund request ask for?

It asks for the applicant’s name and mailing address, the number of stamps, the reason for the refund, and the applicant’s signature.

Do I need a notary for the Cigarette Tax Stamp Refund Request Form?

No. The form has no notary block; the applicant signs a certification under penalty of perjury. No notarized attachment or separate sworn step is listed.

Berryville, VA · Clarke County

No notary required

Cigarette Tax Stamp Refund Request Form

Berryville applicants use this form to request a refund for cigarette tax stamps and certify that the information provided is true and correct.

What this form is

The Town of Berryville uses this form to process requests for refunds of cigarette tax stamps. Applicants enter their name, mailing address, number of stamps, and reason for the refund, then sign a certification under penalty of perjury. The form calculates the refund at $0.10 per stamp and states that refunds of $5.00 or less will not be made.

Who needs it

Anyone applying to the Town of Berryville for a refund of cigarette tax stamps can use this form.

How to submit it

Send the form to the Town of Berryville at 101 Chalmers Court, Suite A, Berryville, VA 22611, or email it to [email protected].

About notarization

This form has no notary block; the applicant signs the certification under penalty of perjury, and no notarized attachment or separate sworn step is listed.

How to submit this form

1
Download the Form
Download the Cigarette Tax Stamp Refund Request Form.
2
Complete the Request
Enter your name, mailing address, number of stamps, and reason for the refund.
3
Sign the Certification
Sign the certification stating that the information is true and correct to the best of your knowledge.
4
Submit to the Town
Send the form to the Town of Berryville address or email listed on the form.

Frequently asked questions

Who can use the Cigarette Tax Stamp Refund Request Form?: Anyone applying to the Town of Berryville for a refund of cigarette tax stamps can use the form.
What information does the refund request ask for?: It asks for the applicant’s name and mailing address, the number of stamps, the reason for the refund, and the applicant’s signature.
Do I need a notary for the Cigarette Tax Stamp Refund Request Form?: No. The form has no notary block; the applicant signs a certification under penalty of perjury. No notarized attachment or separate sworn step is listed.
How do I submit the Cigarette Tax Stamp Refund Request Form?: Send it to the Town of Berryville at 101 Chalmers Court, Suite A, Berryville, VA 22611, or email [email protected].

Need something notarized?

This Cigarette Tax Stamp Refund Request Form doesn’t need a notary — but if you have another Berryville form that does, a commissioned online notary can help.