Form Fit Fbp - Request To File By Paper
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FIT FBP
Rev. 10/13
Request to
Please do not
File By Paper
use staples.
FIT account number
Ohio charter or license number
FEIN/SSN
Use only UPPERCASE letters.
Reporting person's name
Street address (number and street)
City
State
ZIP code
Contact's fi rst name
M.I.
Last name
Telephone
Fax
Title
E-mail
Ohio Revised Code section 5726.03 requires that all FIT fi lers remit each tax payment and corresponding report electronically. Ad-
ditionally, a person required by that section to remit taxes or fi le reports electronically may apply to the tax commissioner, on the form
prescribed, to be excused from that requirement for good cause.
Please select and describe in detail the reason(s) the above-referenced taxpayer requests to be excluded from the electronic fi ling
requirement. The department will respond by letter indicating either approval or denial.
File by paper
Pay by check
File by paper and pay by check
SIGN HERE (required)
I declare under penalty of perjury that I am the taxpayer or the taxpayer’s authorized agent having knowledge of the relevant facts in
this matter to fi le this request to fi le by paper.
Signature
Date (MM/DD/YY)
Name
Title
Taxpayer representative: The taxpayer will be represented in the matter by the following individual. Please attach a Declaration of
Tax Representative (Ohio form TBOR 1), which can be found on the department’s Web site at tax.ohio.gov.
First name
M.I.
Last name
Telephone
Title
E-mail
Please send this request to: Ohio Department of Taxation, Business Tax Division,
Financial Institutions Tax Unit, P.O. Box 2476, Columbus, OH 43216-2476 or fax to (206) 666-4462.
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