St Ar Sales/use Tax Application For Refund
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ST AR
Rev. 5/16
For State Use Only
Sales/Use Tax
Overrides: Name Y
N
Address Y
N
Application for Refund
Sales Tax / Consumer
Sales Tax / Vendor
Use Tax
The following information refers to the person/entity submitting the application for refund of tax claimed to have been erroneously paid to the state of
Ohio/Clerk of Courts.
FEIN/SSN (do not use dashes)
Sales or use tax vendor's license number (if applicable)
Name of applicant (if business, print name as registered with the Internal Revenue Service)
Mailing address
City
State
ZIP code
Telephone
Fax
E-mail
Requested refund amount
Time period covered by the refund request (MM/DD/YY)
$
to
State full and complete reasons for the above claim. You must attach supporting documentation.
SIGN HERE (REQUIRED)
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 refund application.
Signature
Date (MM/DD/YY)
Name
Title
Taxpayer representative: The taxpayer will be represented in the matter by the following individual. Please attach a Declaration of
Tax Representative (Ohio TBOR 1), which can be found on the department’s Web site at tax.ohio.gov.
First name
M.I.
Last name
Telephone
Title
E-mail
FOR OFFICE USE ONLY
Examiner
Date
Amount recommended
Reviewer
Date
Manager
Date
Claimed
Inc/red
Deallocation
Xfer tax
Xfer int
Total approved
Int to txpr
Net to TP
Txpr ck
Please send this application and supporting documentation to: Ohio Department of Taxation,
Business Tax Division – SUT REF, P.O. Box 530 Columbus, OH 43216-0530.
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