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Ohio Free Printable Identity Theft Affidavit for 2020 Ohio Identity Theft Affidavit

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Identity Theft Affidavit
Identity Theft Affidavit

Reset Form IT TA Rev. 11/18 Manual Review Unit P.O. Box 182847 Columbus, OH 43218-2847 Phone: (800) 282-1780 eFax: (253) 234-1371 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 1. I am submitting the Ohio IT TA for myself. 2. I am submitting the Ohio IT TA in response to a “Notice” or “Letter” received from the Ohio Department of Taxation. a. Provide “Notice” or “Letter” number(s) 3. I am submitting the Ohio IT TA on behalf of my dependent child or dependent relative. 4. I am submitting the Ohio IT TA as the appointed conservator or due to being awarded power of attorney. 5. 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 1. Someone used my information to file taxes. 2. I don’t know if someone used my information to file taxes, but I am a victim of identity theft. 3. How did you learn of the identity theft? Section 4: Identity Theft Details 1. What tax year(s) are you claiming your identity was stolen? 2. Were you an Ohio resident during the year your identity was stolen? Yes No 3. Were you required to file an Ohio individual income tax return? Yes No 4. Were you incarcerated during the tax year(s) in question? Yes No a. Date(s) of incarceration: b. Location(s) of incarceration: Section 5: Employer or Preparer Data Breach 1. Was your identity compromised because of an employer or preparer data breach? Yes No a. If yes, include a copy of the notification letter or e-mail provided by your employer or preparer. 2. What is the name of your employer or preparer? 3. What is the best contact number for your employer or preparer? 4. If known, when and how did the data breach occur? IT TA Rev. 11/18 13240206 Section 6: Additional Steps Recommended After Submission 1. Contact the Internal Revenue Service (IRS). a. 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. a. Include a copy of the police report. 3. Contact the following organizations to notify them that your identity was stolen: a. Federal Trade Commission: www.ftc.gov or call 1-877-438-4338 b. Social Security Administration: www.socialsecurity.gov c. Credit Bureaus i. Equifax: www.equifax.com or call 1-800-525-6285 ii. Experian: www.experian.com or call 1-888-397-3742 iii. TransUnion: www.transunion.com or call 1-800-680-7289 or call 1-800-772-1213 4. Visit the following Web pages for additional identity theft resources: a. www.identitytheft.gov b. 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 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
Extracted from PDF file 2019-ohio-form-it-ta.pdf, last modified November 2018

More about the Ohio Form IT TA Individual Income Tax TY 2019

We last updated the Identity Theft Affidavit in January 2020, so this is the latest version of Form IT TA, fully updated for tax year 2019. 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 1040ES Income Tax Estimated Payment Vouchers and Instructions
Form IT 1040EZ Ohio Individual Income Tax EZ Return
Form IT 40P Income Tax Payment Voucher
Form IT SD 100 Individual Income and School District Income Tax Publication

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 January 2020.

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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 five 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:


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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