(FORM 38, Page 2.)

"

DEPUTY COLLECTOR'S AFFIDAVIT IN REGARD TO INVESTIGATION. I, Deputy Collector, being duly sworn according to law, depose and say that I have personally investigated the statements made in the within affidavit, and from the best information I can obtain, after careful inquiry, I believe such statements to be [Signature] Deputy Collector, Division

, District,

Sworn to and subscribed before me this

A. D. 189.

day of
[Signature]

COLLECTOR'S CERTIFICATE AND RECOMMENDATION.

I hereby certify that the facts set forth in the within affidavit have been carefully investigated under my direction and am satisfied that the statements are and I respectfully recommend

"

District,

that the request of the claimant be

Dated

189. (See Instruction No. 1, page 623.)

Date of purchase.

COLLECTOR'S CERTIFICATE AS TO PURCHASE OF SPIRIT, TOBACCO, BEER, AND OLEOMARGARINE STAMPS.

[Signature] Collector,

I hereby certify that it appears from the records of my office that the stamp referred to in the within claim w purchased as follows: ·

By whom purchased.

Date of
Issue.

Kind
of Stamps.

Kind Serial of NumStamp. bers.

Denomina-
tion.

Dated

189.

[Signature] Collector, District, (See Instruction No. 1, page 623.)

COLLECTOR'S CERTIFICATE AS TO PURCHASE OF SPECIAL-TAX STAMPS.

To whom
issued.

I hereby certify that it appears from the records of my office that the stamp referred to in the within claim w follows:

purchased as

For period commencing.

Dated

189.

"

(See Instruction No. 1, page 623.)

[Signature] Collector,

District,

(FORM 38, PAGE 3.)

INSTRUCTIONS IN REGARD TO PREPARATION OF CLAIM.

No. 1. The collector's "Certificate and Recommendation" and collector's certificates as to purchase of stamps, on page 2, must be signed by the collector, acting collector, or deputy collector in charge.

No. 2. Certificates of purchase of stamps should include all stamps referred to in the claim; also payments of all special taxes upon kinds of business mentioned liable thereto, and when paid in duplicate.

No. 3. Affidavits may be made before any internal revenue officer authorized to administer oaths without fee. Any other person administering an oath or affirmation must show, by seal or certificate from the proper authority, that he is qualified to do so. An officer in signing a jurat should give the title of his office.

No. 4. In claims arising on account of special-tax stamps, it is not sufficient to state that the claimant has done no business requiring the payment of the tax. The affidavit should traverse the definition as found in the statute imposing the for instance, in the case of a dealer in manufactured tobacco: That from he neither "sold nor offered for sale any manufactured tobacco, snuff, or cigars." Or, in the case of a retail liquor dealer: That from

tax;

to

to

66

he neither sold nor offered for sale any foreign or domestic distilled spirits, wines, or malt liquors in less quantities than five wine gallons at the same time."

No. 5. In cases where two special-tax stamps of the same kind have been issued for the same period and place to the same person or firm, an affidavit as above should be furnished, adding thereto the words "except in one place (or more, as the case may be), for which he ha paid the special tax required by law."

No. 6. Where, in case of dissolution of a firm which had paid special tax, the remaining partner or partners have been required to pay new special tax for the unexpired portion of the time for which tax was paid by the original firm, and claim the refunding of the tax paid, it should be established that, from

to

the successor carried on the same business as the original firm, and that during such period no person, not a member of the original firm, was taken into partnership.

No. 7. If the period for which the stamp was issued has expired, the affidavit furnished under instructions Nos. 4 and 6 should cover the whole period. If the period has not expired, the affidavit should cover the period from the first day of the first month for which the stamp was issued to the time of making the affidavit.

No. 8. In cases where brewers who have closed business present beer stamps for redemption, the collector should forward with the claim a copy of the brewer's last monthly report, Form 18, securely attached to the claim.

No. 9. Where a brewer or rectifier has purchased a special-tax stamp for 500 barrels or more, and has manufactured or rectified less than 500 barrels, and claims the refunding of the excess of special tax paid, the collector should furnish his certificate of the monthly production of fermented liquors, or rectification of distilled spirits, by the claimant during the period covered by the stamp.

No. 10. Stamps should in all cases be forwarded with the claims. If they cannot be forwarded, the reasons therefor should be stated in the affidavit.

No. 11. Stamps will only be redeemed when presented by a bona fide owner, or an agent or representative of such owner. When a claim is made by an 66 agent" or attorney," a formal power of attorney must be filed, together with the sworn statement of the principal that he is not indebted to the United States. (See Instructions, No. 12). When the claimant asks redemption of stamps in a representative capacity, as executor, administrator, guardian, trustee, or receiver, a certificate in proper form of the clerk of the court from which the representative derived his appointment must be filed as evidence of such appointment.

No. 12. Each claim must be accompanied by evidence that the party who is the actual bona fide owner of the stamp presented is not indebted to the United States.

(FORM 46, REVISED JUNE 3, 1880, PAGE 1.)

CLAIM UNDER SERIES 7, No. 14, FOR TAXES IMPROPERLY PAID.

State of

9

County of of the *

of

;

said, being duly that he W day of

and State and County aforeaccording to law, deposes and says that † engaged in the business of ; that upon the A. D. 18 he W assessed an internal revenue tax of dollars,+ which amount he afterwards, on the day of A. D. 18 paid to Esq., Collector of Internal Revenue for the which assessment and payment of the aforesaid tax was, as this deponent verily believes, erroneous and improper, for the following reasons, viz. :

9

District of

ss.:

Sworn and subscribed before me, this A. D. 189.

And this deponent now claims that, by reason of the aforesaid erroneous assessment and payment of the said sum of dollars, he justly entitled to have the sum of dollars refunded, and he now ask and demand the same. And this deponent further makes oath that he has not heretofore presented any claim for the refunding of the above amount or any part thereof.§ [Signature]

*Here give post-office address.

If a member of a firm, state the fact here.

day of
|| [Signature]

Here state for or upon what the tax was assessed.

§ If a claim has been presented before, state the fact in lieu of this. Affidavit must be made before a revenue officer or an officer with a seal.

(FORM 46, PAGE 2.)

I.

Division,

District, being

DEPUTY COLLECTOR'S AFFIDAVIT. Deputy Collector, duly sworn according to law, depose and say, that I have personally investigated the statements made in the within affidavit,* and, from the best information I can obtain after careful inquiry, believe such statements to be in all respects just and true. [Signature] Deputy Collector,

Division,

Sworn to and subscribed before me, this

day of

18

CERTIFICATE OF CLERK IN CHARGE OF RECORDS IN OFFICE OF COMMISSIONER OF INTERNAL REVENUE.

189.

9

"

"

9

I hereby certify that, from present personal examination, I find the sum of dollars and cents reported against the said on page line of the list on Form for 189; also the sum of dollars and cents reported against on page line of the list on Form for 18 now on file in the office of the Commissioner of Internal Revenue; and that the tax Collector's aggregate receipt for the said list transmitted to the Commissioner of Internal Revenue. Said receipt amount to $ [Signature] Clerk in Charge of Records.

"

2,

included in the

Dated

dollars and

of the list on Form

line

•

in my office; and that the same w

of

District.

A. D.

COLLECTOR'S CERTIFICATE.

I hereby certify that I have carefully investigated the matters set forth in the within affidavit, and am satisfied that the statements are, in all respects, just and true; and I further certify, upon personal examination, that I find the sum of dollars and

"

cents reported against the said
of the list on Form

on page
18

line
; and also the sum of

for

9

9

cents reported against

"

9

9

9

on page for 18 now on file paid to me on the day of

18, and

9

9

"

9

18 and on the cluded in my aggregate receipts for said lists, the receipts amounting to $ and $ respectively, and transmitted to the Commissioner of Internal Revenue; and that no claim for the assessment herein complained of has heretofore been presented.† The money herein claimed was not paid on a compromise.

[Signature] Collector,

District,

"

[Signature]

day in

Dated

189. "

*See instructions in Series 7, No. 14, page 61.

If the claim has been presented before, the fact should be stated. When two or more assessments are referred to in the claim, the page, line, and form of each and every assessment should be given as indicated in the above certificates.

(FORM 47, REVISED JULY 11, 1894, PAGE 1.)

CLAIM UNDER SERIES 7, No. 14, FOR REMISSION OF TAXES ABATABLE UNDER SECTION 3220 OR SECTION 3221 R. S., OR SECTION 6, ACT OF MARCH 1, 1879.

State of

, County of

SS.:

"

of the town [

] of * , and State and County according to law, deposes and says engaged in the business of

; that he

w

"

aforesaid, being duly that † that upon the day of internal revenue tax of ment of the aforesaid tax should, as this deponent verily believes, be abated, for the following reasons, viz. :

A. D. 18 dollars upon

he W assessed an which assess

And this deponent now claims that, for the reasons above stated, he justly entitled to have dollars of the aforesaid assessment remitted, and he now ask and demand the same. [Signature] day of [Signature]

§ Sworn to and subscribed before me, this A. D. 189.

* Give post-office address.

† If a member of a firm, state the fact.

State for or upon what the tax was assessed.

§ The party making the claim, and the deputy collector certifying to the same, should make oath before a revenue officer when possible.

When a claim is returned for amendment of the affidavit, the amendment should be sworn to.

N. B. Claims for remission of assessments against distillers should give the number of the distillery and the month in which the tax accrued.