Tr-3 - Application For Refund Of Tire Fee
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1Tire Fee Form
TR-3 (Rev. 2/01)
P.O. Box 530= Columbus, OH 43216-0530
Application for Refund
Please Insert:
For State Use Only
of Tire Fee
State File No.
Account No.
For the period from
_________________________, 20 ___ to
Claimant’s File No.
_________________________, 20 ___, inclusive
1. Name __________________________________________________________________________________________
print name as shown on license
2. Business Address ________________________________________________________________________________
street
city
state
zip code
3. Mailing Address __________________________________________________________________________________
(if other than line 2)
street
city
state
zip code
4. Federal Employer Identification Account No.
Employer Identification Account No.
Social SecurityNo.
or Social Security Number
5. By an illegal or erroneous payment to Treasurer of State ........................................................ $ ____________________
6. Less discount, if applicable ..................................................................................................... $ ___________________
7. By an illegal or erroneous assessment:
Assessment No. ________________ .................... $ ___________________
10. Total Amount of Claim ............................................................................................................. $ ___________________
11. State full and complete reasons for above claim: ________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
I declare under penalties of perjury that this report, including any
For State Use Only
accompanying schedules and statements, has been examined by me
and, to the best of my knowledge and belief, is a true, correct and
To District _____________________________________
complete return and report.
Unpaid Assessments ____________________________
Claimant _______________________________________
Payable to Treasurer of State _____________________
Title ___________________________________________
Refund due Claimant ____________________________
Date __________________________________________
Instructions: An application for reimbursement of the total amount
cation for refund first shall be applied in satisfaction of the debt. A
indicated above must be filed in accordance with the provisions
warrant, up to the amount of such indebtedness, shall be drawn
relative thereto as set forth in Section 3734.905 of the Ohio Re-
payable to the Treasurer of State to satisfy the amount due to the
vised Code. The absence of complete records in support of the
state of Ohio as authorized by Section 3734.905(c) of the Revised
above application will constitute justifiable ground for disallowance
Code. Any amount in excess of such indebtedness shall be drawn
of the claim. Applications shall be filed with the tax commissioner,
payable to the applicant.
on the form prescribed by him for such purpose, within four years
from the date of such illegal or erroneous payment of the tax.
The applicant should assign a claim file number beginning with
No. 1 in the space provided. In this way, all claimants submitting
If the applicant who is entitled to a refund under Section 3734.905
claims will have a claim number sequence. The claim must be sent
of the Revised Code is indebted to the state of Ohio for any tax
to the Department of Taxation, Attn: Excise Tax & Assessment
administered by the tax commissioner, or any charge, penalties, or
Unit, P.O. Box 530, Columbus, OH 43216-0530.
interest arising from such tax, the amount allowable on the appli-
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