Form SV 4 Application for Refund of Severance Tax - Ohio

Form SV4 or the "Application For Refund Of Severance Tax" is a form issued by the Ohio Department of Taxation.

The form was last revised in April 1, 2008 and is available for digital filing. Download an up-to-date Form SV4 in PDF-format down below or look it up on the Ohio Department of Taxation Forms website.

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Ohio
Department of
Taxation
Reset Form
SV 4
Rev. 4/08
P.O. Box 530
Columbus, OH 43216-0530
For State Use Only
Please Insert
State File No.
Account No.
Application for Refund
Claimant’s File No.
of Severance Tax
For the period from
, 20
to
, 20
, inclusive.
1. Name
Print name as shown on license
2. Business address
Street
City
State
ZIP code
3. Mailing address
(if other than line 2)
Street
City
State
ZIP code
4. Federal employer identification account number
Employer Identifi cation Account No.
Social Security No.
or Social Security number ................................
5. By an illegal or erroneous payment to Ohio Treasurer of State .................................................. $
6. By an illegal or erroneous assessment: Assessment no.
...................... $
7. Total amount of claim .................................................................................................................. $
8. State full and complete reasons for above claim
I declare under penalties of perjury that this report, includ-
For State Use Only
ing any accompanying schedules and statements, has been
examined by me and, to the best of my knowledge and belief,
To district
is a true, correct and complete return and report.
Unpaid assessments
Claimant
Payable to Treasurer of State
Title
Refund due claimant
Date
Instructions: An application for reimbursement of the total
which is due and payable shall be certified to the auditor of
amount indicated above must be filed in accordance with the
state by the tax commissioner with his determination upon
provisions relative thereto as set forth in Ohio Revised Code
the application for refund. A warrant, up to the amount of
section (R.C.) 5749.08. The absence of complete records
such indebtedness, shall be drawn payable to the Ohio
in support of the above application will constitute justifiable
Treasurer of State to satisfy the amount due the state of Ohio
ground for disallowance of the claim.
as authorized by R.C. section 5749.09. Any amount in excess
of such indebtedness shall be drawn payable to the applicant.
Applications shall be filed with the tax commissioner, on the
form prescribed by him for such purpose, within 90 days from
The applicant must assign a claim file number beginning
the date it is ascertained that the payment or assessment
with No. 1 in the space provided above so as to maintain a
was illegal or erroneous; provided, however, that in any event
refund claim file number sequence for reference purposes.
the application must be filed within four years from the date
The claim must be sent to the Department of Taxation, Attn:
of such illegal or erroneous payment of the tax.
Excise and Energy Tax Division, P.O. Box 530, Columbus,
OH 43216-0530. If you have any questions regarding this
If the applicant who is entitled to a refund under R.C. section
application, please call (855) 466-3921.
5749.08 is indebted to the state of Ohio for any tax payable to
the General Revenue Fund, the amount of such indebtedness
Ohio
Department of
Taxation
Reset Form
SV 4
Rev. 4/08
P.O. Box 530
Columbus, OH 43216-0530
For State Use Only
Please Insert
State File No.
Account No.
Application for Refund
Claimant’s File No.
of Severance Tax
For the period from
, 20
to
, 20
, inclusive.
1. Name
Print name as shown on license
2. Business address
Street
City
State
ZIP code
3. Mailing address
(if other than line 2)
Street
City
State
ZIP code
4. Federal employer identification account number
Employer Identifi cation Account No.
Social Security No.
or Social Security number ................................
5. By an illegal or erroneous payment to Ohio Treasurer of State .................................................. $
6. By an illegal or erroneous assessment: Assessment no.
...................... $
7. Total amount of claim .................................................................................................................. $
8. State full and complete reasons for above claim
I declare under penalties of perjury that this report, includ-
For State Use Only
ing any accompanying schedules and statements, has been
examined by me and, to the best of my knowledge and belief,
To district
is a true, correct and complete return and report.
Unpaid assessments
Claimant
Payable to Treasurer of State
Title
Refund due claimant
Date
Instructions: An application for reimbursement of the total
which is due and payable shall be certified to the auditor of
amount indicated above must be filed in accordance with the
state by the tax commissioner with his determination upon
provisions relative thereto as set forth in Ohio Revised Code
the application for refund. A warrant, up to the amount of
section (R.C.) 5749.08. The absence of complete records
such indebtedness, shall be drawn payable to the Ohio
in support of the above application will constitute justifiable
Treasurer of State to satisfy the amount due the state of Ohio
ground for disallowance of the claim.
as authorized by R.C. section 5749.09. Any amount in excess
of such indebtedness shall be drawn payable to the applicant.
Applications shall be filed with the tax commissioner, on the
form prescribed by him for such purpose, within 90 days from
The applicant must assign a claim file number beginning
the date it is ascertained that the payment or assessment
with No. 1 in the space provided above so as to maintain a
was illegal or erroneous; provided, however, that in any event
refund claim file number sequence for reference purposes.
the application must be filed within four years from the date
The claim must be sent to the Department of Taxation, Attn:
of such illegal or erroneous payment of the tax.
Excise and Energy Tax Division, P.O. Box 530, Columbus,
OH 43216-0530. If you have any questions regarding this
If the applicant who is entitled to a refund under R.C. section
application, please call (855) 466-3921.
5749.08 is indebted to the state of Ohio for any tax payable to
the General Revenue Fund, the amount of such indebtedness

Download Form SV 4 Application for Refund of Severance Tax - Ohio

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