(c) In lieu of filing an amended return, a verified claim for a refund of an overpayment of income tax may be filed on the taxpayer's letterhead, provided the following information is contained in the verified claim:

1. (1) The federal employer identification number (FEIN) of the taxpayer;
2. (2) The name of the taxpayer;
3. (3) The address of the taxpayer (street or P.O. box, city, state, and zip code);
4. (4) The tax year end (month, day, and year) of the original return for which the verified claim is filed;

5. (5) A schedule detailing the original reported, net change, and corrected amounts for the following figures:

   1. (A) Total income;
   2. (B) Total deductions;
   3. (C) Net operating loss;
   4. (D) Taxable income;
   5. (E) Tax;
   6. (F) Estimated tax paid;
   7. (G) Business and incentive tax credits;
   8. (H) Tax paid with original return; and
   9. (I) Amount of overpayment;
6. (6) Grounds upon which the refund is claimed;

7. (7)

   1. (A) The verified claim must be signed by an authorized officer or agent of the taxpayer.
   2. (B) An agent must attach an executed power of attorney issued by an authorized officer of the taxpayer; and
8. (8) Any other information relative to the payment as may be required by the Department of Finance and Administration.