Form Wt Oor - Opt Out Request Form For Electronic Filing And/or Payment Of Employer Withholding And/or School District Withholding

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WT OOR
Rev. 11/14
Opt Out Request Form for Electronic Filing and/or Payment of Employer
Withholding and/or School District Withholding
Employer withholding number
FEIN
Business name
Address
City, state, ZIP code

Withholding tax type(s):
State income tax
School district income tax
Effective Jan. 1, 2015, Ohio Administrative Code rule 5703-7-19 requires employer and school district income tax withholding
returns to be fi led and payments to be made electronically using the Ohio Business Gateway or any other electronic means
prescribed by the tax commissioner. This rule was adopted in accordance with Ohio Revised Code section 5703.059.
Section (B) of the rule allows any person to apply to the tax commissioner to be excused from the requirement to fi le and
pay electronically. The tax commissioner may excuse the person from the requirement to fi le and pay electronically and may
permit the person to fi le their returns by nonelectronic means for good cause.
Note: The opt out request for electronic payment cannot be granted with respect to the payment of state income taxes withheld
by employers who are required to make such payments electronically by Electronic Funds Transfer (EFT) to the Treasurer of
State in accordance with Ohio Revised Code sections 5747.07 (I) and 5747.072. Any such opt out requests will be denied.
Please describe in detail the reason(s) for your request to be excluded from the electronic fi ling and payment provisions. We
will notify you by letter if your request has been approved or denied.
I declare under penalty of perjury that I am the taxpayer or the taxpayer’s authorized agent having knowledge of the relevant
facts in this matter to fi le this request to fi le and/or pay by paper.
Signature/Title
Date
Phone number
Taxpayer representative: The taxpayer will be represented in the matter by the following individual. Please attach a
Declaration of Tax Representative (Ohio form TBOR 1), which can be found on the department’s Web site at tax.ohio.gov.
Name
Title
Please print
Phone number
E-mail
Please send this request to: Ohio Department of Taxation,
P.O. Box 182388, Columbus, OH 43218-2388

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