Form Ft-Re - Application For Corporation Franchise Tax Refund -11/2001 printable pdf download

Form Ft-Re - Application For Corporation Franchise Tax Refund -11/2001

FT-REF

PPLICATION FOR

(Rev 11/01)

ORPORATION

RANCHISE

EFUND

File this application in duplicate with:

Ohio Department of Taxation

Please type or print in ink.

Audit Division

Retain a copy for your records.

P.O. Box 530

See important information and law on back.

Columbus, OH 43216-0530

For franchise tax report year(s) _________________ based on accounting period(s) ending __________________

1. Name ________________________________________________________________________________________

2. Address _______________________________________________________________________________________

street or p.o. box

city

state

zip code

3. Franchise Tax ID No. ___________________ Ohio Charter/License No. ___________________ FEIN _____________

4. Total amount of refund claimed $ _____________________

5. State full and complete reasons for above claim. Attach additional sheets, if necessary.

6. 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

If the above payments include the payment of an assessment or any portion of an assessment, furnish the assessment

serial number ______________________________ and the assessment date ______________________.

Claimant ______________________________________

The Corporation will be represented in this matter by

(complete, if known):

By ___________________________________________

Name _________________________________________

Address _______________________________________

Date __________________________________________

_____________________________________________

For state use only

Form Ft-Re - Application For Corporation Franchise Tax Refund -11/2001