Form It Ar - Application For Personal Income Tax Refund
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1IT AR
Rev. 1/15
Reset Form
Application for Personal Income Tax Refund
Please type or print in ink.
File this application in duplicate with:
Retain a copy for your records.
Ohio Department of Taxation
Personal income tax refunds are governed by
Attn: Income Tax Division – Form IT AR
Ohio Revised Code (R.C.) section 5747.11
P.O. Box 2476
Payment of interest at the rate prescribed
Columbus, OH 43216-2476
by R.C. section 5703.47 is issued on all
refunds granted
For year beginning
, 20
and ending
, 20
1. Name
2. Address
3. Social Security #
Spouse's Social Security #
(if married fi ling jointly)
4. Amount of refund claimed:
a. By payment of an illegal or erroneous assessment:
Assessment date
Assessment serial #
$
b. By other payment to Ohio Treasurer of State .........................................................................$
c. Total amount of refund claimed (prior to calculation of interest) .............................................$
5. State full and complete reasons for above claim. Attach additional sheets, if necessary.
6. Here's a listing of my income tax payments for the year (attach additional payment schedule, if necessary):
Type
Type
Amount
Amount
Tax withheld
Any additional income tax paid
Estimated tax paid and overpayment
Less: Refund(s) previously claimed
(
)
carryforward from previous year
(even if not yet received)
Tax paid with original return
Net Payments
$
Person responsible for the filing of this refund application. I declare under penalty of perjury that I am the taxpayer or
that I am an authorized agent of the taxpayer and I have knowledge of the relevant facts in the matter to fi le this
refund application.
Signature
Date
Telephone number
Contact person (if different from the person responsible for filing this refund application).
Name
Title
Address
Fax number
City, state, ZIP code
Daytime phone number
E-mail
For state use only
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