YOUR REFUND Sample Clauses

YOUR REFUND. ⏵27. . Sign Here (required): I have read this return. Under penalties of perjury, I declare that, to the best of my knowledge and belief, the return and all enclosures are true, correct and complete. ⏵Primary signature Phone number ⏵Spouse’s signature Date (MM/DD/YY) Check here to authorize your preparer to discuss this return with the Department.
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YOUR REFUND. 27. . Sign Here (required): I have read this return. Under penalties of perjury, I declare that, to the best of my knowledge and belief, the return and all enclosures are true, correct and complete.Your signature Phone number Spouse’s signature Date (MM/DD/YY) If your refund is $1.00 or less, no refund will be issued. If you owe $1.00 or less, no payment is necessary. NO Payment Included – Mail to: Ohio Department of Taxation X.X. Xxx 0000 Xxxxxxxx, XX 00000-0000 Check here to authorize your preparer to discuss this return with Taxation Preparer's printed name Phone number Preparer's TIN (PTIN) Payment Included – Mail to: Ohio Department of Taxation X.X. Xxx 0000 Xxxxxxxx, XX 00000-0000 Do not staple or paper clip. Rev. 10/18 2018 Ohio Schedule A Income AdjustmentsAdditions and Deductions Use only black ink. SSN of primary filer 18000302 Additions (add income items only to the extent not included on Ohio IT 1040, line 1)
YOUR REFUND. 18. , Schedule A – Traditional Tax Base School District Amounts (see instructions) Complete this schedule only if filing a traditional tax base school district return. , , . 0 0 , . 0 0 , , . 0 0 , , . 0 0 , , . 0 0 19. Ohio income tax base reported on line 5 of Ohio IT 1040. Place a negative sign (“-“) in the box at the right if the amount is less than -0- ......................................................................................... ... 19. 20. Business income deduction add-back (see instructions) 20.

Related to YOUR REFUND

  • Your Rights If You Are Dissatisfied With Your Credit Card Purchases If you are dissatisfied with the goods or services that you have purchased with your credit card, and you have tried in good faith to correct the problem with the merchant, you may have the right not to pay the remaining amount due on the purchase. To use this right, all of the following must be true:

  • Your Rights When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.  Get an electronic or paper copy of your medical record You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost- based fee.  Ask us to correct your medical record You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. We may say “no” to your request, but we’ll tell you why in writing within 60 days.  Request confidential communications You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say “yes” to all reasonable requests.  Ask us to limit what we use or share You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.  Get a list of those with whom we’ve shared information You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.  Get a copy of this privacy notice You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.  Choose someone to act for you If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.  File a complaint if you feel your rights are violated You can complain if you feel we have violated your rights by contacting our Clinical Director and Privacy Officer, Xxxxx Xxxxxx, LCSW at 314.336.1041. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 000 Xxxxxxxxxxxx Xxxxxx, X.X., Xxxxxxxxxx, X.X. 00000, calling 1-877- 000-0000, or visiting xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxx/. We will not retaliate against you for filing a complaint. Your Choices For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to:  Share information with your family, close friends, or others involved in your care  Share information in a disaster relief situation If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety. In these cases we never share your information unless you give us written permission:  Marketing purposes  Most sharing of psychotherapy notes  In the case of fundraising, we may contact you for fundraising efforts, but you can tell us not to contact you again.

  • Your Right to Reject Arbitration You may reject this Arbitration provision by sending a written rejection notice to us at: American Express, P.O. Box 981556, El Paso, TX 79998. Go to xxxxxxxxxxxxxxx.xxx/xxxxxx for a sample rejection notice. Your rejection notice must be mailed within 45 days after your first card purchase. Your rejection notice must state that you reject the Arbitration provision and include your name, address, Account number and personal signature. No one else may sign the rejection notice. If your rejection notice complies with these requirements, this Arbitration provision and any other arbitration provisions in the cardmember agreements for any other currently open American Express accounts you have will not apply to you, except for Corporate Card accounts and any claims subject to pending litigation or arbitration at the time you send your rejection notice. Rejection of this Arbitration provision will not affect your other rights or responsibilities under this Claims Resolution section or the Agreement. Rejecting this Arbitration provision will not affect your ability to use your card or any other benefit, product or service you may have with your Account.

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