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Rhode Island Department of State
Gregg M. Amore
Secretary of State
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Refund Request Form
Payer Information
Entity/Individual Name
Entity Id
Type of Filing
Contact Information
Name
Entity Email
Phone
Refund Details
Reason
Please select a reason
OverPayment
Duplicate Payment
Other
Please select something
Confirmation/Receipt Number
Payment Type
Check
Credit card
Cash
Please select an option
Attachments
?
(.jpg,.jpeg,.gif,.png,.pdf)
Refund to be issued to
Name
Address/Street Address
City
State
Zip Code
Instructions to Fill Refund Request Form