Tax Year    IT Waiver
                                                                                                                Rev. 9/19

                                           18340102

                   Individual Waiver from the Income Tax 
                                   Return Electronic Filing Requirement

Paid preparers who prepare more than 11 Ohio income tax returns for the calendar year must electronically file all returns. 
If you use a paid preparer but you are unwilling or unable to file electronically, you must include a copy of this form 
when filing your income tax return.

Part I – To be completed by the taxpayer
Taxpayer SSN    Taxpayer Name

Spouse’s SSN (if filing jointly)   Spouse’s Name (if filing jointly)

By signing below, I acknowledge that I do not want my preparer to electronically file my Ohio income tax return.

Taxpayer signature                                    Spouse’s signature (if filing jointly)

Part II – To be completed by the preparer
Business name (or preparer’s name if self-employed)                                  FEIN

Business address, city, state and ZIP code

Preparer Name           PTIN

MEF rejection error code(s) (if applicable)

                                           Federal Privacy Act Notice
Because we require you to provide us with a Social Security number, the Federal Privacy Act of 1974 requires us to inform you that providing 
us with your Social Security number is mandatory. Ohio Revised Code sections 5703.05, 5703.057 and 5747.08 authorize us to request this 
information. We need your Social Security number in order to administer this tax.