ASSIGNMENT OF RIGHT TO REFUND
To the Comptroller of Public Accounts for the State of Texas (hereinafter “Comptroller”):
(1) My name is ______________________________________ , and I am a duly authorized representative of
__________________________________________ (the “Assignor”). By executing this Assignment of Right
to a Refund (“Assignment”), the Assignor assigns all rights and interest to the tax refund herein described that
the Assignor may have to ______________________________ (the “Assignee”), subject to the limitation noted
herein. The Assignee’s Taxpayer Number is ____________________ (if permitted in Texas).
(2) Assignor hereby assigns the Assignee (check whichever is applicable):
_____ a. The right to file a request for a refund and to receive the refund.
_____ b. The right to receive the refund only.
(3) The tax refund that is the subject of this Assignment is described as follows:
Tax Type: ________________________________________
(Attach schedule, if necessary.)
Other specific limitations: _________________________________________________________________
(4) The Assignor understands that the Comptroller may require both parties to provide documents or information
necessary for the Comptroller to verify the validity of the refund claim and/or to transfer any verified amount to
(5) By executing this Assignment, the Assignor affirms that the Assignor has neither previously claimed a refund
nor taken a credit on a return for taxes that are subject of this Assignment, and further affirms that the Assignor
will not claim a refund or a credit for those taxes in the future.
Executed _______ day of _________________ , 20 ____ .
Assignor Entity Name
Assignor Taxpayer Number