Form St Ar Dbs - Application For Compensation Of Expenses Incurred For Destination-Based Sourcing Tax Collections
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1
2ST AR DBS
Rev. 8/05
Reset Form
P.O. Box 530
Columbus, OH 43216-0530
tax.ohio.gov
Application for Compensation of Expenses Incurred
for Destination-Based Sourcing Tax Collections
This application is for submitting a request for compensation authorized under Ohio Revised Code section 5739.123.
Additional instructions are on page 3.
. Only one set of back-up
THE ORIGINAL AND ONE COPY OF THIS FORM MUST BE FILED
documents is needed.
In order to qualify for compensation for expenses incurred as a result of switching to taxing transactions based on
destination (e.g., delivery of goods), as opposed to the rate imposed at the retail store, the following criteria must be
met:
• The switch to tax collected based on destination sourcing has been made for at least six months.
• This claim for compensation must be filed within 60 days after the end of the reporting period that includes the last day
of the last month of the six-month period.
• The license(s) for which the expenses were incurred was active before May 1, 2006.
• All sales tax return(s) (form UST 1) for the six-month period that destination sourcing was used have been timely filed
and paid.
• The compensation requested is for expenses incurred to comply with destination-based sourcing.
• This is a one-time compensation request. All expenses incurred to comply with destination-based sourcing must be
included on one compensation request per legal entity noted in #5 below. Any future compensation request filed will be
denied.
• You must have at least one permanent location in Ohio.
• Transient, delivery and service vendors qualify for reimbursement if they also have at least one permanent location in
Ohio. The reimbursement would only be granted for the costs to switch to destination-based sourcing for the permanent
location(s).
• The period ending June 2008 will be the last filing period that compensation will be available.
If the above criteria have not been met, you do not qualify for compensation of expenses incurred for collecting
tax based on destination and an application for compensation cannot be filed.
Please type or print clearly
1. License number(s) on return used to remit destination-based sourcing tax
2. First six months tax based on destination sourcing was remitted
to
3. Name of applicant
4. Address
Street
City
State
ZIP
5. Federal employer identification number or social security number
6. Total cost to switch to destination-based sourcing
7. Amount requested for compensation on purchase(s). See #4 on page 3 for calculation instructions.
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
Central Office Processing
Claimed
Inc/Reduc
Xfer Ref
Net to Txpr
Reviewer
Date
Ck Amt
Ttl Approved
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