Form Ft Ref - Application For Corporation Franchise Tax Refund

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hio
FT REF
Department of
Reset Form
Rev 7/10
Taxation
Application for Corporation Franchise Tax Refund
File this application with:

Type or print in ink.
Ohio Department of Taxation
Business Tax Division
Retain a copy for your records.
Corporation Franchise Tax Unit
See important information and law on
P.O. Box 2476
back.
Columbus, OH 43216-2476
For franchise tax report year(s)
based on accounting period(s) ending
1. Name
2. Address
3. City, state, ZIP code
4. Franchise tax ID #
Ohio charter/license #
FEIN
5. Total amount of refund claimed $
6. State full and complete reasons for above claim. Attach additional sheets, if necessary.
7. Payment of the amount upon which this refund claim is based, was made or included in the following remittance(s) (include
all payments made for the report year(s)). Attach additional payment schedule, if necessary:
Amount
Date
Amount
Date
=
$
Total Payments
Person responsible for the fi ling of this refund application. I declare under penalty of perjury that I'm the taxpayer or
that I'm an authorized agent of the taxpayer, having knowledge of the relevant facts in this matter to fi le this refund
application.
Name
Title
E-mail
Signature
Date
Phone no.
Contact person (if different from the person above responsible for fi ling this refund application).
Name
Title
Firm name
Daytime phone no.
Street address
Fax no.
City, state, ZIP code
E-mail address
For state use only
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