To request a refund for a duplicate payment, complete the form below and attach one or more of the following:
- Copy of the front and back of cancelled check
- Monthly bank statement identifying date and amount paid
- Original receipt for cash payments made in person or at bank
- Copy of bank or credit card statement showing the date transaction was released for settlement
- Copy of the closing statement in addition to one of the above
Refund applications must be submitted on or before the five year statute of limitations, which begins on the date the payment was duplicated.
**IF YOU ARE NOT LISTED AS A PAYER OF THE INSTALLMENT DUPLICATED YOU CANNOT COMPLETE THIS FORM**
Please contact Vida Klepczarek at 815-740-4691 or firstname.lastname@example.org if you have questions regarding a duplicate payment or need further assistance.