FT REF 
               Department of                                                                                Rev 7/10
hio            Taxation 
            
                         Application for Corporation Franchise Tax Refund 

             File this application with: 
               Ohio Department of Taxation                    Type or print in ink. 
              Business Tax Division                            Retain a copy for your records. 
               Corporation Franchise Tax Unit                  See important information and law on 
               P.O. Box 2476                                     back. 
               Columbus, OH 43216-2476

For franchise tax report year(s)              based on accounting period(s) ending 
1. Name  
2. Address 
3. City, state, ZIP code 
4. Franchise tax ID #                      Ohio charter/license #                           FEIN 
5. Total amount of refund claimed  $ 
6. State full and complete reasons for above claim. Attach additional sheets, if necessary. 

7. Payment of the amount upon which this refund claim is based, was made or included in the following remittance(s) (include 
all payments made for the report year(s)). Attach additional payment schedule, if necessary: 

         Amount                          Date                          Amount                          Date 

                                                                 Total Payments =           $ 

Person responsible for the fi ling of this refund application. I declare under penalty of perjury that I'm the taxpayer or 
that I'm an authorized agent of the taxpayer, having knowledge of the relevant facts in this matter to fi le this refund 
application. 

Name Title E-mail 

Signature Date Phone no. 

Contact person (if different from the person above responsible for fi ling this refund application). 

Name Title 

Firm name                                                     Daytime phone no. 

Street address                                                Fax no. 

City, state, ZIP code                                         E-mail address 

For state use only 

                                              - 1 -

                                                                                                                        FT REF 
                           Information and Pertinent Law Sections                                                       Rev 7/10 

To the extent that a refund is granted on this application, either   such amount to the director of budget and management 
in whole or in part, the Department of Taxation will calculate       and treasurer of state for payment from the tax refund fund 
and include the appropriate amount of interest in the refund         created by R.C. section 5703.052. 
payment made to the applicant. The applicant should not 
include such interest in the "Total amount of refund claimed"        (C) "Ninety days" shall be substituted for "three years" in 
  figure on line 5. Ohio Revised Code (R.C.) section 5733.26(B)       division (B) of this section if the taxpayer satisfi es both of 
provides for the payment of interest as follows:                     the following: 
Interest shall be allowed and paid at the rate per annum             (1) The taxpayer has applied for a refund based in whole 
prescribed by R.C. section 5703.47 upon amounts re-                  or in part upon R.C. section 5733.0611; 
funded with respect to the tax imposed by R.C. section               (2) The taxpayer asserts that the imposition or collection 
5733.06. The interest shall run from whichever of the fol-           of the tax imposed or charged by R.C. section 5733.06  
lowing dates is the latest until the date the refund is paid:        or any portion of such tax violates the Constitution of 
the date of the illegal, erroneous or excessive payment;             the United States or the constitution of this state. 
the ninetieth day after the final date the annual report un-
der R.C. section 5733.02 was required to be fi led; or the            (D)(1) Division (D)(2) of this section applies only if all of the 
ninetieth day after the date that report was filed.                   following conditions are satisfied: 
If the overpayment results from the carryback of a net               (a) A qualifying pass-through entity pays an amount of 
capital loss to a previous taxable year, the overpayment             the tax imposed by R.C. section 5733.41; 
is deemed not to have been made prior to the fi ling date, 
including any extension thereof, for the taxable year in             (b) The taxpayer is a qualifying investor as to that qualify-
which the net capital loss arises.                                   ing pass-through entity; 
Corporation franchise tax refunds are governed by R.C. sec-          (c) The taxpayer did not claim the credit provided for in 
tion 5733.12, which provides in pertinent part as follows:           R.C. section 5733.0611 as to the tax described in 
                                                                     division (D)(1)(a) of this section; 
(B) Except as otherwise provided under divisions (C) and 
(D) of this section, an application to refund to the corpo-          (d) The three-year period described in division (B) of this 
ration the amount of taxes imposed under R.C. section                section has ended as to the taxable year for which the  
5733.06 that are overpaid, paid illegally or erroneously, or         taxpayer otherwise would have claimed that credit. 
paid on any illegal, erroneous, or excessive assessment,             (2) A taxpayer shall fi le an application for refund pursuant 
with interest thereon as provided by R.C. section 5733.26,           to this division within one year after the date the payment 
shall be fi led with the tax commissioner, on the form pre-           described in division (D)(1)(a) of this section is made. An 
scribed by the commissioner, within three years from the             application fi led under this division shall only claim refund 
date of the illegal, erroneous, or excessive payment of the          of overpayments resulting from the taxpayer's failure to 
tax, or within any additional period allowed by division (C)         claim the credit described in division (D)(1)(c) of this sec-
(2) of R.C. section 5733.031, division (D)(2) of R.C. section        tion. Nothing in this division shall be construed to relieve a 
5733.067, or division (A) of R.C. section 5733.11.                   taxpayer from complying with the provisions of division (I) 
On the fi ling of the refund application, the commissioner            (14) of R.C. section 5733.04. 
shall determine the amount of refund due and certify        

                                                           - 2 -