MARYLAND JUDICIARY CIRCUIT COURTS CLAIM FOR REFUND OF TAX AND LICENSE FEES ERRONEOUSLY PAID TO STATE OF MARYLAND THROUGH THE CLERKS OF COURT NOTE: To be eligible for a refund, a Claim for Refund must be submitted on or before 3 years from the date the tax or license fee was paid (Tax-Property Article '14-915). SECTION 1 � To be completed by Claimant To: Circuit Court to which erroneous payment was made Date: In accordance with provisions of the Annotated Code of Maryland, application is hereby made by: Name: Address: City, State, Zip: For refund of payment in the amount of Dollars ($ ) erroneously paid to your office. Give below the date of payment and nature of tax for which refund is requested, reason for requesting refund and other information pertinent to claim. Receipt issued by the Circuit Court on tax claimed to be erroneously paid should be attached hereto. NOTE: Mail form to the appropriate circuit court. See Instructions on page 2. Signature of Claimant SECTION 2 � To be completed by Clerk of the Circuit Court APPROVAL OF CLAIM The facts set forth in the above claim have been verified by me and I hereby certify that the claimant is entitled to refund in the amount of Dollars $ DENIAL OF CLAIM (See page 2 for an explanation of your appeal rights) The Claim for Refund is denied for the following reason: Maryland City or County Signature, Clerk of the Circuit Court Date AOC Form X-4 Revised 03/2015 Printed Name, Clerk of the Circuit Court American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 2 CLAIM FOR REFUND OF TAX AND LICENSE FEES ERRONEOUSLY PAID TO STATE OF MARYLAND THROUGH THE CLERKS OF COURT INSTRUCTIONS This form to be used when a taxpayer requests a refund of special taxes erroneously paid to the State of Maryland through the Clerk of the Circuit Court. A - Section 1 � To be completed by the claimant in duplicate and mailed to the Clerk of the Circuit Court to which the erroneous payment was made. (See Circuit Court directory at http://mdcourts.gov) RIGHT TO HEARING: Pursuant to Annotated Code of Maryland, Tax Property Article (ATP@) '14-911(c), a person who submits a written refund claim either for recordation tax under TP '14-907, or for transfer tax under TP '14-908, has a right to a hearing before the taxing authority. If a hearing is desired, attach a written request for hearing to this form when submitting it. B - Section 2 - To be completed by the Circuit Court Clerk who will approve or deny the claim. If approved, the Clerk will verify all facts in the claim, complete a disbursement transmittal, and send it with the X-4 Form to the Judiciary=s Department of Budget and Finance, Revenue Unit for processing. APPEAL RIGHTS RIGHT TO APPEAL: Pursuant to Annotated Code of Maryland, Tax-Property Article (ATP@) '14-512(d), the person who submitted a tax refund claim under TP '14-907 (for recordation tax) or '14-908 (for transfer tax) may appeal any final action taken under TP '14-911 to the Maryland Tax Court on or before 30 days from the date the person receives notice of disallowance. However, if a refund claim under '14-911 of this title is not allowed or disallowed on or before 6 months from the date of filing the claim, the person who filed the claim may deem the claim to be finally disallowed, and submit an appeal to the Maryland Tax Court. More information is available from the Tax Court at http://www.txcrt.state.md.us, or 410-767-4830. Clerk of Circuit Court: See TP '14-911(e) AOC Form X-4 Revised 03/2015 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com