Ohio Application for Personal Income Tax Refund

Application for Personal Income Tax Refund
Form IT AR
Clear Form
Tax Year

2023
10211411

IT AR

Individual and School District Income Tax Refund Application
You must submit a separate application for each tax year/type for which you are requesting a refund. Additionally, you cannot request a
refund of erroneously withheld Ohio or school district income tax using this form; you must file a properly completed IT 1040 or SD 100.
Taxpayer SSN

Taxpayer Name

Spouse's SSN

Spouse's Name

Address, City, State, and ZIP code

Contact number

Email address

Tax Type (check one):
Individual Income

Assessment no. (if applicable)
School District Income

Refund Requested: Use this section to calculate your refund. Refer to your Ohio IT 1040 or SD 100 for these amounts.
1.	 Ohio or school district income tax withheld................................................................................................1.
2. Estimated and extension payments and credit carryforward from a previous tax year..............................2.
3.	 Amounts previously paid with original and/or amended returns or an assessment...................................3.
4.	 Refundable credits (individual income tax only).........................................................................................4.
5.	 Total payments (add lines 1 through 4)......................................................................................................5.
6.	 Refunds previously requested....................................................................................................................6.
7.	 Net payments (line 5 minus line 6).............................................................................................................7.
	8. Total Ohio or school district tax liability.......................................................................................................8.
9. Refund requested prior to the calculation of interest (line 7 minus line 8)................................................9.
State the full and complete reasons for the above claim. You may attach additional sheets and/or supporting documentation.

Sign Here (required): I have reviewed this refund application and all attachments. Under penalties of perjury, I declare
that, to the best of my knowledge and belief, the return and all enclosures are true, correct and complete.

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Primary signature		

Phone number

Spouse’s signature 			

Date

The following individual represents the taxpayer in this matter. Please attach form TBOR 1.
Preparer name	
PTIN
Contact number 		

Mail this application along with all
supporting documentation to:
Ohio Department of Taxation
Attn: Income Tax Division – Ohio IT AR
P.O. Box 182847
Columbus, OH 43218-2847

Email address

Federal Privacy Act Notice: Because we require you to provide us with a Social
Security number, the Federal Privacy Act of 1974 requires us to inform you that
providing us with your Social Security number is mandatory. Ohio Revised Code
sections 5703.05, 5703.057 and 5747.08 authorize us to request this information.
We need your Social Security number in order to administer this tax.

Department Use Only:

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