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Form 14039 (SP) for Franklin Ohio: What You Should Know

The taxpayer also need to provide me with the following information: Name, Address, Telephone Number, Fax Number and Date of birth. If the person is under 18 or in prison, state the date they were convicted of a criminal offense. If the person was convicted of a criminal offense prior to January 1, 2010, the individual should provide their full name and sex. If the person's state of birth is unknown, the individual should provide their age, the appropriate social security number from file and the county in which they were or are registered to vote in. If the person is a non- citizen, the individual should sign their name as it appears on their passport. I also need the complete name, address, zip code and signature of the payee. This will be required to support payment of tax if the payment is to be made by a bank or check only. I also need the complete name, address, phone number, date of birth, address and license number of the person making this payment. This will be used by the bank or check-only payee to identify the person making the payment if a payee is included on the return. I also want the address of the business which is where I received the payment so that I can verify the amount transferred. I must receive the payment within 10 days, including the 10-day window for filing. Furthermore, I have the right to use this information, or any information I receive for this purpose and have the confidentiality and rights described below. Furthermore, I receive this information: for information to verify payments, to process payments, to apply the information to the return if necessary, to pay and receive payment; and for internal use only. Furthermore, I am responsible for maintaining the confidentiality of information received for my business needs. This information also may be used to obtain information directly from the person who paid. Acknowledgment Form 1. If the payment is made by check only, or if a payee is included on the return, you must sign the following: “I, (Taxpayer's Name), hereby acknowledge the receipt of the payment of (Taxpayer's Address) to the credit of S.M. (Taxpayer's Name) and I agree that this acknowledgment is not a statement, is not intended to create a contract or to have the force of law and is valid and binding on all parties to the amount or payments to which it relates. (Taxpayer's Address) (Signature of Payee) 2. You must sign this receipt before submitting it with your return.

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