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Ohio Free Printable Identity Theft Affidavit for 2021 Ohio Identity Theft Affidavit

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Identity Theft Affidavit
Identity Theft Affidavit

Reset Form Personal Icome Tax IT TA P.O. Box 182847 Rev. 07/20 Columbus, OH 43218-2847 (800) 282-1780 Fax: (253) 234-1371 Ohio Relay Service (TDD/TTY) (800) 750-0750 tax.ohio.gov 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 IT TA Contact Us Online Notice Response Service Form Name: Income/Expense Verification IT TA Rev. 07/20 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 ● http://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: 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 To respond electronically to this notice, visit tax.ohio.gov IT TA Contact Us Online Notice Response Service Form Name: Income/Expense Verification
Extracted from PDF file 2020-ohio-form-it-ta.pdf, last modified November 2018

More about the Ohio Form IT TA Individual Income Tax TY 2020

We last updated the Identity Theft Affidavit in March 2021, so this is the latest version of Form IT TA, fully updated for tax year 2020. 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.

Other Ohio Individual Income Tax Forms:

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 1040 Ohio Individual Income Tax Return
Form IT SD 100 School District Income Tax Return
Form IT 1040ES Income Tax Estimated Payment Vouchers and Instructions
Form IT 40P Income Tax Payment Voucher
Form IT 1040EZ Ohio Individual Income Tax EZ Return

Download all OH tax forms 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 March 2021.

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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 six 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:


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

Identity Theft Affidavit 2014 Form IT TA

Identity Theft Affidavit_FI_092214 - Copy.indd


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