Form St-Pr - Petition For Reassessment Sales And Use Taxes

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ST-PR
(Rev 02/01)
Petition for Reassessment
S
U
T
ALES AND
SE
AXES
Regarding the Sales or Use Tax Assessment Against:
Name(s) ____________________________________________
Assessment Serial No. ________________________________
-
Address ____________________________________________
Account No. _______________________________________
City _____________________ State _____ Zip ____________
Date Assessed ____________ Date Received _____________
-
Federal Employer Identification No. _____________________
Date Paid ___________________________________________
Social Security No. ____________________________________
Amount Paid _________________________________________
I, _________________________________, hereby object to the Sales or Use Tax Assessment noted above. The items objected
to and the reasons for objection are indicated below in accordance with the provisions of the Revised Code. (See information on
next page concerning pertinent parts of these provisions.)
(Attach additional sheets for objections and reasons if necessary.)
I, ___________________________________, respectfully request that the Tax Commissioner review the assessment and issue
a final determination in accordance with the objections contained herein. (See Instruction 3, on next page.)
Check one:
c
I wish to have a determination made without
presenting my objections at a hearing.
c
I request that a personal appearance
(Please choose city from drop down box.)
hearing be held in:
Youngstown
Zanesville
I will be represented in this matter by:
I am the party assessed or the authorized agent of the party
assessed, and I have knowledge of the relevant facts in this
(Complete if known. Type or print.)
matter. I declare under penalties of perjury that the above
(including any attachments) has been examined by me and to
Name ______________________________________________
the best of my knowledge and belief is a true, correct, and
complete statement.
Address ____________________________________________
City _____________________ State _____ Zip ____________
Signature ________________________ Date _____________
Telephone No. _______________________________________
Name ______________________________________________
Title _______________________ Phone _________________
For State Use Only
Please complete all blanks. Please type or print in ink.
Please file this petition in duplicate with:
Ohio Department of Taxation
Billings/Assessment Division
P.O. Box 1090
Columbus, OH 43216-1090

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