Form St 26 - Application For Cumulative Return Authority Page 2
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1
2ST 26
Rev. 12/09
Page 2
The license numbers and addresses of each business location to be reported under the Cumulative Return Author-
ity must be listed in numerical sequence. Those business locations not yet licensed should also be listed indicating
“applied for” in the license number column and the address in the address column.
License Number
Street Address
City and ZIP Code
Federal Privacy Act Notice
Because we require you to provide us with a Social Security number, the Federal Privacy Act of
1974 requires us to inform you that providing us with your Social Security number is mandatory.
Ohio Revised Code sections 5703.05, 5703.057 and 5747.08 authorize us to request this informa-
tion. We need your Social Security number in order to administer this tax.
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Parent category: Financial