DTE 23A
Rev. 10/17
Date Received by Treasurer
Date Received by Auditor
Application for the Remission of Real Property and
Manufactured Home Late-Payment Penalties (R.C. 5715.39)
Taxpayer Instructions: Complete the front of this form and le it with the county treasurer.
Attach a copy of all evidence to the form, complete the name and address blank and sign the
form. If penalties have accrued for more than one late payment, a separate application must be
led for each penalty. Please send completed form to the county treasurer of the county in which
the property is located. (The county treasurer may insert his or her name and address here or the
taxpayer may obtain the address at ohiocountytreasurers.org.)
Owner of property Parcel or I.D.# of property
Property tax type: Real Manufactured home Tax year First half Second half
Amount of penalty $ 5% penalty 10% penalty
Date taxes were due Date taxes and interest were paid Date entered into a payment plan
County
Case no.
Print name and address below
Taxpayer signature
Daytime phone number Date
E-mail address
Name
Address
City State ZIP
I declare under penalties of perjury that this report is true, correct
and complete.
Please check all the reasons the penalty should be remitted and explain below.
Tax was not paid by due date because of negligence or error of the auditor or treasurer (explain below).
Taxpayer did not receive a tax bill or a correct tax bill and attempted to obtain one on (date)
Tax was not timely paid because of serious injury, death or hospitalization of the taxpayer (within 60 days preceding the due date),
but was paid within 60 days after the due date. Taxpayer must submit proof of the above.
Tax payment was mailed on or before due date (submit evidence of timely mailing). A private meter postmark on the envelope is not
a valid postmark for establishing the payment date.
Taxpayer did not receive a tax bill because the mortgage lender failed to notify the treasurer that the mortgage was satised and the
bill was not sent to the taxpayer. The penalty waiver applies only to the rst tax bill after satisfaction of the mortgage.
Taxpayer’s failure to make timely payment of the tax was due to reasonable cause and not willful neglect (explain below).
Taxpayer statement (use additional pages if necessary):
File this form with the
county treasurer.
Reset Form
MEDINA COUNTY TREASURER JOHN BURKE
144 NORTH BROADWAY STREET
MEDINA, OH 44256
Instructions for Appeal to Board of Tax Appeals
The taxpayer has thirty (30) days from the mailing of the Board of Revision’s decision to appeal to the Board of Tax Appeals. The requirements for a proper
appeal to the Board of Tax Appeals are contained in R.C. 5717.01, which include ling through an online process. If the taxpayer does not follow all the
mandatory requirements to appeal, the taxpayer may lose his right to appeal. DTE Form 4 has been prescribed for this purpose and an electronic copy
may be found on the Board of Tax Appeal’s website. You must also send the Board of Revision a copy of the notice of appeal. The mailing address of the
Board of Tax Appeals is 30 East Broad Street, 24th Floor Columbus, Ohio 43215-3414. Its website is: bta.ohio.gov. Please contact the Board of Revision
to determine the acceptable methods of notication of an appeal.
County Treasurer Instructions
Review the form for completeness and verify the accuracy of the penalty amount and date that taxes were due and paid. If the taxpayer
has a late payment history, include the amount(s) and tax period(s) for the preceding three years. Retain a copy of the application
for your records. Forward the completed application with any attachments to the county auditor.
The county treasurer should check all that apply:
Penalty accrued because of the negligence or error of a county ocer (explain below). This would include the treasurer accepting a
change of address from someone other than the property owner.
Taxpayer failed to receive a tax bill or a correct bill and made a good faith eort to obtain the bill within 30 days after the due date.
Date of request
Tax was not timely paid because of the serious injury, death or hospitalization of the taxpayer within 60 days preceding the due date,
but was paid within 60 days after the due date.
Date of death or hospitalization Date of payment
Taxpayer demonstrated that timely payment was mailed. A private meter postmark is not valid for establishing the date of payment.
Taxpayer has not made a late payment for any real property taxes owed by the taxpayer during the preceding three years.
Treasurers comments (include late payment history for the preceding three years)
Recommendation: Grant
Deny Signature of treasurer Date
County Auditor Instructions
The auditor must consider each of the rst ve reasons on the form to remit the penalty even if the taxpayer has not checked
the corresponding box. The auditor cannot use reasonable cause to remit a late payment penalty. If the auditor does not grant
remission, the auditor must deliver the application to the Board of Revision for consideration. If the auditor grants remission, the
auditor must notify the taxpayer of its decision by completing the section below and returning a copy of the form to the taxpayer.
Decision of the County Auditor
Before the county auditor, the remission is hereby: Date:
Granted Denied
A copy of this decision was mailed to the taxpayer on:
Board of Revision Instructions
If the auditor forwards the application to the Board of Revision, the board must review the request for remission to determine whether the
late payment was due to the rst ve reasons on the form or reasonable cause and not the willful neglect of the taxpayer. The board must
notify the applicant and the property owner (if the applicant is not the owner) of its decision by completing the section below
and returning a copy of the completed form to the taxpayer by certied mail.
Decision of the Board of Revision
Before the Board of Revision, the remission is hereby: Date:
Granted Denied
A copy of this decision was mailed to the taxpayer on:
If the application is denied, state the reason for denial (use additional pages if necessary):
Signature of county auditor
Date
Signature of clerk of the Board of Revision
Date
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