Form Tr 3 - Application For Refund Of Tire Fee printable pdf download

TR 3

Rev. 4/08

•

P.O. Box 530

Columbus, OH 43216-0530

Application for Refund of Tire Fee

For State Use Only

Account No.

State File No.

for the period from

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 number

Employer Identification Account No.

Social Security No.

or Social Security number ................................

5. By an illegal or erroneous payment to Ohio Treasurer of State ....................................................$

6. Less discount, if applicable ......................................................................................................... $

7. By an illegal or erroneous assessment: Assessment no.

..................... $

8. Total amount of claim .................................................................................................................. $

9. State full and complete reasons for above claim:

I declare under penalties of perjury that this report, including

For State Use Only

any accompanying schedules and statements, has been ex-

amined by me and, to the best of my knowledge and belief, is

To district

a true, correct and 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

application for refund first shall be applied in satisfaction of the

amount indicated above must be filed in accordance with the

debt. A warrant, up to the amount of such indebtedness, shall

provisions relative thereto as set forth in Ohio Revised Code

be drawn payable to the Ohio Treasurer of State to satisfy the

section (R.C.) 3734.905. The absence of complete records in

amount due to the state of Ohio as authorized by R.C. section

support of the above application will constitute justifiable ground

3734.905(c). Any amount in excess of such indebtedness shall

for disallowance of the claim. Applications shall be filed with

be drawn payable to the applicant.

the tax commissioner, on the form prescribed by him for such

The applicant should assign a claim file number beginning

purpose, within four years from the date of such illegal or erro-

with No. 1 in the space provided. In this way, all claimants

neous payment of the tax.

submitting claims will have a claim number sequence. The

If the applicant who is entitled to a refund under R.C. section

claim must be sent to the Department of Taxation, Attn: Ex-

3734.905 is indebted to the state of Ohio for any tax adminis-

cise Tax Section, P.O. Box 530, Columbus, OH 43216-0530.

tered by the tax commissioner, or any charge, penalties or

If you have any questions regarding this application, please

interest arising from such tax, the amount allowable on the

call (614) 466-7026.

Form Tr 3 - Application For Refund Of Tire Fee

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