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Rev. 8/20
Department of ST AR
Taxation For State Use Only
hio Overrides: Name Y N Address Y N Sales/Use Tax
Application for Refund
Sales Tax / Consumer Sales Tax / Vendor Use Tax
The following information refers to the person/entity submitting the application for refund of tax claimed to have been erroneously paid to the state of
Ohio/Clerk of Courts.
FEIN/SSN (do not use dashes) Sales or use tax vendor's license number (if applicable)
Name of applicant (if business, print name as registered with the Internal Revenue Service)
Mailing address
City State ZIP code
Telephone Fax
E-mail
Requested refund amount Time period covered by the refund request (MM/DD/YY)
$ , , . M M D D Y Y to M M D D Y Y
State full and complete reasons for the above claim. You must include supporting documentation.
SIGN HERE (REQUIRED)
I declare under penalty of perjury that I am the taxpayer or the taxpayer’s authorized agent having knowledge of the relevant facts in
this matter to file this refund application.
Signature Date (MM/DD/YY)
Name Title
Taxpayer representative: The taxpayer will be represented in the matter by the following individual. Include a Declaration of Tax
Representative (Ohio form TBOR 1), which can be found on the department’s website at tax.ohio.gov.
First name M.I. Last name
Telephone Title
E-mail
Please submit this application and supporting documentation using one of the following options:
Electronically: tax.ohio.gov – Contact Us - Online Notice Response Service or gateway.ohio.gov – Online Notice Response Service:
eFax – 206-333-1087;Mail: Ohio Department of Taxation, Business Tax Division - SUT REF, P.O. Box 530, Columbus , OH 43216-0530
FOR OFFICE USE ONLY
Examiner Date Amount recommended
Reviewer Date Manager Date
Claimed Inc/red Deallocation
Xfer tax Xfer int Total approved
Int to txpr Net to TP Txpr ck
