Form St Vda - Request For Sales Or Use Tax Voluntary Disclosure Agreement (Vda)
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Prescribed 4/11
Request for Sales or Use Tax Voluntary Disclosure Agreement (VDA)
A taxpayer is not required to reveal its identity in order to request a VDA. A representative may submit an anonymous re-
quest on the taxpayer's behalf. Alternately, a taxpayer may initiate its own request and provide the company name and other
information on the appropriate lines.
Representative name
Representative address
City
State
ZIP code
Email
Telephone
Fax
Company name
Company address
City
State
ZIP code
Email
Telephone
Fax
Type of VDA requested (check all that apply):
Sales tax
Consumer’s use tax
Seller’s use tax (out-of-state sellers only)
Type of business
Type of products or services sold in Ohio
Method of marketing products or services in Ohio
Any other nexus-creating activities in Ohio
Date activities began in Ohio
Has sales tax been collected?
Yes
No
If already registered for sales or use tax, provide registration number
Estimated sales tax liability
Estimated use tax liability
Has the company been contacted by the Ohio Department of Taxation regarding a sales or use tax audit, enforcement ac-
tion or otherwise?
Yes
No
If yes, please describe nature of contact by the department
Signature
Date
Submit completed application to:
Ohio Department of Taxation
Sales & Use Tax Division
P.O. Box 530
Columbus, Ohio 43216-0530
OR
E-mail: SalesVDA@tax.state.oh.us
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