Form It Ar - Application For Personal Income Tax Refund
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IT AR
Department of
Rev. 9/08
Taxation
Application for Personal Income Tax Refund
File this application in duplicate with:
Please type or print in ink.
Ohio Department of Taxation
Retain a copy for your records.
Attn: Income Tax Division – Form IT AR
See important information and law on
P.O. Box 2476
page 2.
Columbus, OH 43216-2476
For year beginning
, 20
and ending
, 20
1. Name
2. Address
3. Social Security #
Spouse's Social Security #
(if married filing jointly)
4. Amount of refund claimed:
a. By payment of an illegal or erroneous assessment:
Assessment date
Assessment serial #
$
b. By other payment to Ohio Treasurer of State ......................................................................... $
c. Total amount of refund claimed (prior to calculation of interest) .............................................. $
5. State full and complete reasons for above claim. Attach additional sheets, if necessary.
6. Here's a listing of my income tax payments for the year (attach additional payment schedule, if necessary):
Type
Type
Amount
Amount
Any additional income tax paid
Tax withheld
Less: Refund(s) previously claimed
Estimated tax paid and overpayment
(
)
(even if not yet received)
carryforward from previous year
Net Payments
$
Tax paid with original return
Person responsible for the filing of this refund application. I declare under penalty of perjury that I am the taxpayer or that
I am an authorized agent of the taxpayer and I have knowledge of the relevant facts in the matter to file this refund
application.
Signature
Date
Telephone number
Contact person (if different from the person responsible for filing this refund application).
Name
Title
Address
Fax number
City, state, ZIP code
Daytime phone number
E-mail
For state use only
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