File No.  ________ 
                                                     
                   VOLUNTARY DISCLOSURE AGREEMENT  
                     EMPLOYER WITHHOLDING TAX 
 
The Ohio Department of Taxation is committed to promoting taxpayer compliance.  As a 
part of this effort, this Voluntary Disclosure Agreement is entered into between Joseph 
W. Testa, Tax Commissioner for the State of Ohio  (“Commissioner”) and 
___________________________________________ (“Employer”) federal ID number 
(FEIN) ____________.  This agreement applies only to Employer’s obligations with 
regard to the Ohio employer withholding tax, which includes both individual income tax 
withholding and school district income tax withholding. 
 
The Commissioner has statutory responsibility for administering the Ohio employer 
withholding tax.   
 
Employer represents that it is noncompliant with the employer withholding tax laws of 
Ohio either because it has not previously registered for Ohio employer withholding tax 
purposes and has failed to file employer withholding tax returns and remit employer 
withholding tax to the State of Ohio, or because upon review of its records, it has found 
that it owes employer withholding tax obligations to Ohio.    
 
Employer represents that it is not under audit by Ohio for employer withholding tax and 
that it has not otherwise been contacted by this Department regarding possible 
outstanding employer withholding tax liability.  Employer further represents that, to the 
best of its knowledge, it is not under investigation by the Criminal Investigations Division 
of the Ohio Department of Taxation.   
 
In exchange for bringing itself to the attention of the Commissioner, voluntary disclosure 
allows Employer to come into compliance on substantially more favorable terms than it 
would have faced if discovered to be in noncompliance by the Commissioner.  Although 
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Employer agrees to pay interest  on the tax amount owed as noted below, no additional 
penalties will be assessed on the tax due for the disclosure period, provided the 
Employer, in good faith, complies with the terms of this agreement. 
 
Employer desires to enter into this agreement to become current on its tax compliance 
responsibilities.  Accordingly, Employer agrees to the following terms: 
 
1.  Employer will disclose to the Commissioner all withholding tax during the disclosure 
period by filing all employer withholding returns (including monthly or quarterly returns 
as appropriate, and all annual returns), required to be filed, for each tax year ending 
within the disclosure period.  The disclosure period for this agreement will be 1/1/2012 
through 12/31/2015. 

1
  The statutory interest rate is 3% for calendar years 2012 and thereafter. 

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2.  Employer  will  make a voluntary payment to the State of Ohio of all employer 
withholding tax due during the disclosure period.   
 
3.  Employer will make a voluntary payment to the State of Ohio of interest, which will 
be calculated on the total  amount of employer withholding  tax due.  Employer 
acknowledges that it has been informed that the interest amount is due by statute and 
that the interest cannot be reduced or waived. 
 
4.  Employer will file the appropriate registration forms with the Secretary of State and 
become registered in Ohio.  Once properly registered, Employer agrees to stay in 
compliance with the laws of Ohio. 
 
5.  Employer agrees that it will not file any amended returns or refund claims for any 
employer withholding tax amounts paid to Ohio with respect to the disclosure period as 
set forth in this agreement. 
 
6. Employer agrees it will timely file and pay its Ohio employer withholding tax returns 
for all future tax periods, to the extent required by Ohio law. 
 
Upon Employer’s completion of the terms above, the Commissioner agrees to forgo any 
potential or actual past employer withholding tax liability, including tax, penalty and 
interest, as well as any collection and remittance responsibility that Employer may have 
for its employer withholding tax liability in this state incurred prior to the disclosure 
period. 
 
The Commissioner reserves the right to review the documentation presented by 
Employer and any other records that gave rise to the disclosure, in order to confirm that 
the amount of the voluntary payment being made by Employer is accurate. 
 
Both Employer and the Commissioner agree to maintain the confidentiality of this 
agreement.  The parties agree that they shall not disclose the fact of this agreement’s 
existence or any term of the agreement except as required by law.  
 
This agreement is not binding on the Commissioner until signed by the Commissioner.   
Prior to signing the agreement, the Commissioner will review his records to determine 
that Employer has not been contacted for audit by the Ohio Department of Taxation, is 
not under investigation by the Criminal Investigations Division of the Ohio Department of 
Taxation, and/or has not otherwise been previously contacted by the Ohio Department 
of Taxation with regard to its employer withholding tax liability.   
 
All payments and filings must be made contemporaneously with the submission of two 
(2) signed copies of this agreement.  This agreement will not be accepted, or if 
accepted will be void, if Employer: 1) fails to remit the required payments and filings with 
the agreement, 2) is not eligible for the Voluntary Disclosure program, or 3) does not 
substantially comply with terms of the agreement.  This includes, but is not limited to, 
failure to remit interest on amounts due under the agreement, failure to pay any 
additional amounts found due for the tax years covered by this agreement after the 
Commissioner’s review of the submission, a lack of good faith in the participation of the 

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Voluntary Disclosure program or the execution of this agreement, and/or failure to file 
tax returns and pay tax in subsequent years.   
 
If the Commissioner does not accept the agreement, or the agreement subsequently 
becomes void, the Commissioner can issue assessments for all tax and interest due 
under Ohio law, along with all appropriate penalties. 
 
This agreement is intended to bind the parties in the absence of fraud or material 
misrepresentation of fact.   
 
The person signing below for Employer knowingly does so with the authority to bind 
Employer to the terms of this Agreement. 
 
                                               _____________________________ 
                                                                            
  _______________________________              _____________________________ 
                                                                            
                                               _____________________________ 
  Joseph W. Testa, Tax Commissioner        Signature, Name and Title of 
                                               Employer’s officer or agent 
                                                                            
  ______________________________               _____________________________ 
   Date                                               Date 
 
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