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Prescribed Products Refund Form

Office of Vermont Attorney General
109 State Street
Montpelier, VT 05609-1001

Refund Requestor

Address

Information on Original Check

Certification

I hereby certify that the above manufacturer had no prescribed products disclosures to report for the period state above.
Refunds of registration fees may not be reviewed for approval and processing until 60 days after the reporting deadline

Please note: Anything you submit to the Attorney General’s Office may be subject to disclosure under Vermont’s Public Records Act.
 
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