Form Ft-Pr - Petition For Reassessment - Corporation Franchise Tax - 2001
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1FT-PR
(Rev 02/01)
Petition for Reassessment
C
F
T
ORPORATION
RANCHISE
AX
Regarding the Corporation Franchise Tax Assessment Against:
Name ______________________________________________
Assessment Serial No. ________________________________
Address ____________________________________________
Tax Years ___________________________________________
City _____________________ State _____ Zip ____________
Date Assessed ____________ Date Received _____________
-
Franchise Tax ID No. __________________________________
Date Paid ___________________________________________
Ohio Charter or License No. ____________________________
Amount Paid _________________________________________
-
State of Incorporation __________________________________
Fed. Empl. ID No. _____________________________________
Note: Failure to comply with the Ohio Revised Code (ORC) section 5733.11 can result in dismissal of your petition. ORC
Section 5733.11(B) and (E) may require payment of all or a portion of the assessment within sixty days of receipt
of the assessment. See important information on back of this form.
Indicate below the Corporation's objections to the assessment. Attach additional sheets, if necessary.
Check one:
c
The corporation waives a hearing.
(Please choose city from drop down box.)
c
The corporation requests a hearing in:
Youngstown
Zanesville
The corporation will be represented in this matter by:
I am the authorized agent of the corporation, and I have
(Complete if known. Type or print.)
knowledge of the relevant facts in this matter.
Name ______________________________________________
Signature ________________________ Date _____________
Address ____________________________________________
Name ______________________________________________
City _____________________ State _____ Zip ____________
Title _______________ Telephone No. __________________
Telephone No. _______________________________________
Please complete all blanks. Please type or print in ink.
For State Use Only
Please file this petition in duplicate with:
Ohio Department of Taxation
Billings/Assessment Division
P.O. Box 1090
Columbus, OH 43216-1090
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