Form Tr 3 - Application For Refund Of Tire Fee
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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
, 20
to
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 identifi cation account number
Employer Identifi cation 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, includ-
For State Use Only
ing any accompanying schedules and statements, has been
examined by me and, to the best of my knowledge and belief,
To district
is 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 fi rst shall be applied in satisfaction of
amount indicated above must be fi led in accordance with the
the debt. A warrant, up to the amount of such indebtedness,
provisions relative thereto as set forth in Ohio Revised Code
shall be drawn payable to the Ohio Treasurer of State to
section (R.C.) 3734.905. The absence of complete records
satisfy the amount due to the state of Ohio as authorized
in support of the above application will constitute justifi able
by R.C. section 3734.905(c). Any amount in excess of such
ground for disallowance of the claim. Applications shall be
indebtedness shall be drawn payable to the applicant.
fi led with the tax commissioner, on the form prescribed by
The applicant should assign a claim fi le number beginning
him for such purpose, within four years from the date of such
with No. 1 in the space provided. In this way, all claimants
illegal or erroneous 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: Excise
3734.905 is indebted to the state of Ohio for any tax admin-
Tax Section, P.O. Box 530, Columbus, OH 43216-0530. If
istered by the tax commissioner, or any charge, penalties or
you have any questions regarding this application, please
interest arising from such tax, the amount allowable on the
call (855) 466-3921.
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