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Ohio Identity Theft Affidavit
Extracted from PDF file 2023-ohio-form-it-ta.pdf, last modified November 2018Identity Theft Affidavit
Reset Form Personal Income Tax IT TA P.O. Box 182847 Rev. 10/21 Columbus, OH 43218-2847 (800) 282-1780 Fax: (253) 234-1371 Ohio Relay Service (TDD/TTY) (800) 750-0750 tax.ohio.gov/idtheft 13240106 Identity Theft Affidavit Ohio IT TA Section 1: Name and Contact Information of Identity Theft Victim Full legal name First name M.I. Last name Address City State SSN (only the last four digits are required) ZIP code Daytime phone E-mail address Section 2: Identity Theft Victim Details I am submitting the Ohio IT TA for myself. I am submitting the Ohio IT TA in response to a “Notice” or “Letter” received from the Ohio Department of Taxation. Please provide “Notice” or “Letter” number(s) I am submitting the Ohio IT TA on behalf of my dependent child or dependent relative. I am submitting the Ohio IT TA as the appointed conservator or due to being awarded power of attorney. I am submitting the Ohio IT TA on behalf of a deceased taxpayer. (If yes, include a copy of the death certificate.) Section 3: Reason for Filing This Form Someone used my information to file taxes. I don’t know if someone used my information to file taxes, but I am a victim of identity theft. How did you learn of the identity theft? Section 4: Identity Theft Details What tax year(s) are you claiming your identity was stolen? Were you an Ohio resident during the year your identity was stolen? Yes No Were you required to file an Ohio individual income tax return? Yes No Were you incarcerated during the tax year(s) in question? Yes No Yes No Date(s) of incarceration: Location(s) of incarceration: Section 5: Employer or Preparer Data Breach Was your identity compromised because of an employer or preparer data breach? If yes, include a copy of the notification letter or e-mail provided by your employer or preparer. What is the name of your employer or preparer? What is the best contact number for your employer or preparer? If known, when and how did the data breach occur? To respond electronically to this notice, visit tax.ohio.gov/ONRS IT TA Form Name: Income/Expenses Verification IT TA Rev. 10/21 13240206 Section 6: Additional Steps Recommended After Submission 1. Contact the Internal Revenue Service (IRS). ● Include a copy of the Federal Form 14039 (Identity Theft Affidavit), if required by the IRS to be completed. 2. File a police report with your local police department. ● Include a copy of the police report. 3. Contact the following organizations to notify them that your identity was stolen: ● Federal Trade Commission: www.ftc.gov ● Social Security Administration: www.socialsecurity.gov or call 1-800-772-1213 ● Credit Bureaus or call 1-877-438-4338 ● Equifax: www.equifax.com or call 1-800-525-6285 ● Experian: www.experian.com or call 1-888-397-3742 ● TransUnion: www.transunion.com or call 1-800-680-7289 4. Visit the following Web pages for additional identity theft resources: ● www.identitytheft.gov ● www.idtheftcenter.org Section 7: Penalty of Perjury Statement and Signature Under penalty of perjury, I declare that, to the best of my knowledge and belief, the information entered on this Ohio IT TA is true, correct, complete and made in good faith. Signature of taxpayer, representative, conservator, parent or guardian Date signed (MM/DD/YY) Printed name of taxpayer Last four digits of taxpayer’s SSN Please allow the Department at least 60 days to review your response upon receipt. Failure to provide all the required documents in this affidavit may delay the resolution and/or render your claim unsubstantiated. Submitting Affidavit Without Paper Income Tax Return Submitting Affidavit With Paper Income Tax Return Mail to: Personal Income Tax Manual Review Unit P.O. Box 182847 Columbus, OH 43218-2847 Fax to: (253) 234-1371 NO Payment Included – Mail to: Ohio Department of Taxation P.O. Box 2679 Columbus, OH 43270-2679 Payment Included – Mail to: Ohio Department of Taxation P.O Box 2057 Columbus, OH 43270-2057 To respond electronically to this notice, visit tax.ohio.gov/ONRS IT TA Form Name: Income/Expenses Verification
Identity Theft Affidavit
More about the Ohio Form IT TA Individual Income Tax TY 2023
We last updated the Identity Theft Affidavit in February 2024, so this is the latest version of Form IT TA, fully updated for tax year 2023. You can download or print current or past-year PDFs of Form IT TA directly from TaxFormFinder. You can print other Ohio tax forms here.
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TaxFormFinder has an additional 82 Ohio income tax forms that you may need, plus all federal income tax forms.
| Form Code | Form Name |
|---|---|
| Form IT 1040ES | Income Tax Estimated Payment Vouchers and Instructions |
| Individual Tax Instructions | Individual Income Tax Instruction Booklet |
| Income Tax Instructions | Income Tax Instruction Booklet |
| Form IT 1040 | Ohio Individual Income Tax Return Bundle |
| Form IT SD 100 | School District Income Tax Return |
View all 83 Ohio Income Tax Forms
Form Sources:
Ohio usually releases forms for the current tax year between January and April. We last updated Ohio Form IT TA from the Department of Taxation in February 2024.
About the Individual Income Tax
The IRS and most states collect a personal income tax, which is paid throughout the year via tax withholding or estimated income tax payments.
Most taxpayers are required to file a yearly income tax return in April to both the Internal Revenue Service and their state's revenue department, which will result in either a tax refund of excess withheld income or a tax payment if the withholding does not cover the taxpayer's entire liability. Every taxpayer's situation is different - please consult a CPA or licensed tax preparer to ensure that you are filing the correct tax forms!
Historical Past-Year Versions of Ohio Form IT TA
We have a total of nine past-year versions of Form IT TA in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:
2023 Form IT TA
Identity Theft Affidavit
2022 Form IT TA
Identity Theft Affidavit
2021 Form IT TA
Identity Theft Affidavit
2020 Form IT TA
Identity Theft Affidavit
2019 Form IT TA
Identity Theft Affidavit
2018 Form IT TA
Identity Theft Affidavit
2016 Form IT TA
Identity Theft Affidavit_FI_092214 - Copy.indd
2015 Form IT TA
Identity Theft Affidavit_FI_092214 - Copy.indd
2014 Form IT TA
Identity Theft Affidavit_FI_092214 - Copy.indd
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