Form St Ar - Application For Sales/use Tax Refund
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ST AR
For State Use Only
Rev. 6/10
Overrides: Name Y__N__
Address Y__N__
For State Use Only
Bnkrptcy
P.O. Box 530
Cubs
Columbus, OH 43216-0530
State File No.
R625
Application for Sales/Use 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/Clerk of Courts. Additional information is on the back. THE ORIGINAL AND ONE
COPY OF THE ST AR MUST BE FILED. Only one set of backup documents is needed.
Please type or print clearly.
1. Sales or use tax vendor’s license or account number, if applicable
2. Time period covered by the refund request
to
3. Name of applicant
If business, print name as registered with the Internal Revenue Service
4. Address
Street
City
State
ZIP code
5. Federal employer identifi cation 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 to vendor
$
b) Erroneous payment made on tax return or voluntary payment
$
c) Erroneous payment made on assessment and/or case #
$
d) Erroneous payment made to the Clerk of Courts (form ST AR S supporting
$
schedule and all documentation requested on the form must also be included).
7. State basis for claiming refund. In order for your claim to be considered, the information requested on the reverse side
must be furnished.
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
Printed name
Address
Signature/date
Telephone
Fax
Telephone
Fax
E-mail
E-mail
FOR OFFICE USE ONLY
Field Investigation
Date completed
Amount recommended
Agent
Group supervisor
Audit Review
Reviewer
Central Offi ce 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
Total Approved
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Parent category: Financial