Form Pr - Petition For Reassessment - Ohio Department Of Taxation
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1
2Reset Form
PR
Rev. 10/14
Petition for Reassessment
Complete all applicable blanks and type or print in ink. See instructions for completing this form.
A. General information
Taxpayer name(s)
Assessment serial #
Date of assessment
Address
Account #
Tax period(s)
City
State
ZIP
Disputed amount(s)
Tax type (e.g., personal income, sales)
Federal emp. I.D.# (FEIN)
Daytime phone #
E-mail address
If personal income tax, include Social Security number(s) (SSN).
Fax #
SSN – Self
Spouse
B. Please note: The tax commissioner may correct the assessment by issuing a “corrected assessment” pursuant to Ohio
Revised Code 5703.60. This process is not available for property tax and some public utility tax matters. This streamlined
procedure may result in a more timely resolution of this matter.
D. Select one of the following boxes:
Check this box if this petition
E.
C.Check this box if you do NOT
Please decide this matter based
want the “corrected assessment”
is in response to a “corrected
upon the information submitted.
procedure used.
assessment.”
No hearing is requested.
I request a hearing by telephone.
I request a personal appearance
hearing.
(Hearings are held in Columbus, Ohio.)
F. Basis for fi ling this petition for reassessment (petition must list specifi c issues/objections):
Basis for petition continued on attached. This is page one of
pages.
G. Person responsible for the fi ling of this petition. I declare under penalty of perjury that I’m the taxpayer or that I’m an
authorized agent of the taxpayer having knowledge of the relevant facts in this matter to fi le this petition for reassessment.
Signature
Date
Name
Title
Tel. #
H. Contact person (if different from the person above responsible for fi ling this petition for reassessment)
Name
Title
Address
Fax #
Daytime tel. #
City
State
ZIP
E-mail address
I. Mail this form to:
If excise or energy taxes, including motor fuel or public utility:
For all other taxes:
Ohio Department of Taxation
Ohio Department of Taxation
Excise & Energy Tax Division
Administrative Review Section
P.O. Box 530
P.O. Box 1090
Columbus, OH 43216-0530
Columbus, OH 43216-1090
For Department Use Only
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