Calendar Year     IT EF OPT OUT
                                                                                                               Rev. 7/19

                                                           10211411

                         Request for Exclusion from the Income  
                         Tax Return Electronic Filing Requirement

Paid preparers may use this form to request an exclusion from the requirement to transmit income tax returns 
electronically. Do not complete this form if you prepared fewer than 11 original returns in the previous calendar 
year. See R.C. 5747.082. 

Failure to provide all requested information may result in denial of your request. The Department will send you written 
notice of its decision.

 Business name                                                                      PTIN

 Business address, city, state and ZIP code

 Contact name                                                                       Contact number 

 FEIN                                      # of original returns prepared last calendar year

Reason(s) for request for exclusion from electronic filing:

Sign here (required)                                                                        Date

                       Federal Privacy Act Notice                                   Mail this form to:
 Because we require you to provide us with a Social Security number, the Federal    Ohio Department of Taxation
 Privacy Act of 1974 requires us to inform you that providing us with your Social   Electronic Filing Unit
 Security number is mandatory. Ohio Revised Code sections 5703.05, 5703.057         P.O. Box 2476
 and 5747.08 authorize us to request this information. We need your Social Security Columbus, OH 43216-2476
 number in order to administer this tax.