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					                Nomination for the State and Local Tax Hall of Fame
                                          Name of Nominee:




                 Positions Held:                                          Awards Received:




What contributions has the nominee made to the field of state and local taxation?




Submitted by:                      Date Submitted:
                                                                         Mail to:
Name:                                                                    Ohio Department of Taxation
                                                                         Ohio Tax Commissioner
Address:                                                                 Attn: Hall of Fame
                                                                         P.O. Box 530
Phone Number:                                                            Columbus, OH 43216-0530


                                   Please submit by December 10, 2004.

				
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posted:9/18/2012
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