County of Lexington OFFICE OF THE TREASURER

[Pages:1]County of Lexington

OFFICE OF THE TREASURER

212 South Lake Drive, Ste 101 Lexington, South Carolina 29072

James R. Eckstrom County Treasurer

Contact: Cheryl Fry Phone: (803) 785-8412

LEASE PURCHASE REFUND APPLICATION

Application Date:

Refund Amount Requested:

Bill or TMS #:

Property Address:

Contact Phone:

TERMS AND CONDITIONS All Lease Purchase refund checks must be issued and mailed to the owner of record as shown when the check is issued. It is the taxpayer's responsibility to verify that all information is correct prior to completing this application. No refunds checks will be available for pick up at the Treasurer's Office. Refunds may take up to 30 days from receipt of this application. The taxpayer is responsible for making any changes (Homestead, Legal Residence, appeals, etc.) prior to submitting this application. All applications for Lease Purchase Refunds must be received no later than November 30, 2012. All remaining funds after that day will be forwarded to the South Carolina Unclaimed Property Program.

Owner Signature:

Owner Name (Print):

Applications must be turned in to the Treasurer's Office at 212 South Lake Drive, 1st Floor Accounting Department, Lexington, SC 29072 or by mail to the address and contact listed at the top of the page. Original signed document

only, no copies will be accepted. Please note that applications received by mail may delay processing.

FOR INTERNAL USE ONLY

Record Name: Record Address:

Check #: Check Amt: Check Date:

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