Calendar Year IT EF OPT OUT
                                                                                                         Rev. 8/18

                                                         10211411

                   Preparer Request for Exclusion from 
                 Electronic Filing Requirement for Personal Income Tax

This completed form is a request to be excluded from the requirement to transmit tax returns electronically as 
outlined in Ohio Revised Code section 5747.082. Required tax preparer information and reasons supporting the 
request must be outlined below.

Please complete all questions on this form to prevent your request from being returned as incomplete and denied.

1. Name of your tax preparation business

2. Contact person name and phone number

3. Business address

4. Preparer’s PTIN (if self employed, enter your SSN)    

5. Enter your EIN

6. How many original returns did you or your fi rm prepare last calendar year?             

7. Outline in detail the reasons for this request

Firm or tax preparer responsible party                                                    Date

                   For tax department use only. Do not complete information below this line.

Tax Commissioner – Approved / Denied                                                      Date

Notes

Please mail this form (completed in its entirety) to:  Ohio Department of Taxation
                                                         Electronic Filing Unit
                                                         P.O. Box 2476
                                                         Columbus, OH  43216-2476

                                        Federal Privacy Act Notice
 Because we require you to provide us with a Social Security number, the Federal Privacy Act of 1974  requires us to inform you that 
 providing us with your Social Security number is mandatory. Ohio Revised Code sections 5703.05, 5703.057 and 5747.08 authorize 
 us to request this information. We need your Social Security number in order to administer this tax.