Tbor1 Form

TBOR 1 Rev. 12/13 Reset Form P. O. Box 1090 Columbus OH 43216-1090 Declaration of Tax Representative Taxpayer s name Business name Address City State ZIP code FEIN or Social Security number Only use Social Security number if requesting individual income tax representative or if business does not have a FEIN. Representative Information Telephone number Fax number E-mail address Authorized Signature The taxpayer identi ed above authorizes the representative identi ed above to represent the taxpayer before the Department of Taxation. This authorization includes the authority to view and receive copies of returns reports or other documents led by the taxpayer or prepared by the Department of Taxation concerning the business property or transactions of the taxpayer request alternative methods of taxation present evidence or legal arguments to any employee of the Department of Taxation raise objections to audit ndings or assessments le petitions or applications and waive statutes of limitation. This authorization does not authorize the tax representative to sign any form or declaration where the Ohio Revised Code speci cally requires that the form or declaration be signed by the taxpayer. The taxpayer understands that the acts of the authorized representative may increase or decrease the taxpayer s tax liabilities and legal rights. The taxpayer must indicate all restrictions if any to this authorization in the space below. I certify under penalties of perjury that I am the taxpayer or that I am a corporate of cer LLC member general partner guardian tax manager or similar employee authorized to act on tax matters executor receiver administrator or trustee on behalf of the taxpayer and that I have the authority to execute this form on behalf of the taxpayer. If this form is not properly completed this Declaration of Tax Representative will not be processed* Signature Date Name print Title Restrictions to this Declaration The following restrictions are placed on this Declaration of Tax Representative Expiration Date This declaration is valid until expire one year after the date that it is signed* E-mail TBOR1 tax. state. oh. us Fax 206 888-4377. If no expiration date is given this declaration will Use the same method to revoke declaration* Most secure method. The taxpayer understands that the acts of the authorized representative may increase or decrease the taxpayer s tax liabilities and legal rights. The taxpayer must indicate all restrictions if any to this authorization in the space below. I certify under penalties of perjury that I am the taxpayer or that I am a corporate of cer LLC member general partner guardian tax manager or similar employee authorized to act on tax matters executor receiver administrator or trustee on behalf of the taxpayer and that I have the authority to execute this form on behalf of the taxpayer. The taxpayer must indicate all restrictions if any to this authorization in the space below. I certify under penalties of perjury that I am the taxpayer or that I am a corporate of cer LLC member general partner guardian tax manager or similar employee authorized to act on tax matters executor receiver administrator or trustee on behalf of the taxpayer and that I have the authority to execute this form on behalf of the taxpayer. If this form is not properly completed this Declaration of Tax Representative will not be processed* Signature Date Name print Title Restrictions to this Declaration The following restrictions are placed on this Declaration of Tax Representative Expiration Date This declaration is valid until expire one year after the date that it is signed* E-mail TBOR1 tax.