Reset Form
RT AR
Rev. 8/11
Application for Resort Tax Refund
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. Additional information is on the back. THE ORIGINAL AND ONE
COPY OF THE RT AR MUST BE FILED. Only one set of backup documents is needed.
Please type or print clearly.
1. Resort tax account number, if applicable________________________________________________________
2. Time period covered by the refund request___________________________to__________________________
3. Name of applicant__________________________________________________________________________
4. Address__________________________________________________________________________________
5. Federal employer identification number or Social Security number____________________________________
6. Only one amount should be included in this section. Please see instruction #2 on page 2.
a) Erroneous payment made on tax return or voluntary payment
$_____________________
b) Erroneous payment made on assessment and/or case #
$_____________________
7. State basis for claiming refund. In order for your claim to be considered
8. I hereby attest that I am the taxpayer(s) or their authorized agent. I declare under penalties of perjury that this
claim (including any accompanying schedules and statements) has been examined by me and to the best of
my knowledge and belief is true, correct and complete.
The taxpayer(s) will be represented in this matter by:
Name_____________________________________
Taxpayer_____________________________________
Address___________________________________
Signature/date_________________________________
Telephone_______________Fax_______________
Telephone_______________ Fax__________________
E-mail_____________________________________
E-mail_______________________________________
FOR OFFICE USE ONLY
Central Office Processing
Claimed____________________Inc/red_____________ Deallocation___________________________________
Xfer tax____________________ TOS Ck_____________
Xfer int____________________ Net to txpr___________ Approved: Date__________Agent_________________
Int to txpr__________________ Txpr ck______________ Reviewed: Date__________Agent_________________