Form Wh-1u - Underpayment Of Withholding Taxes 2003

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Form WH-1U
Underpayment of Withholding Taxes
Underpayment Form
State Form 49170 (8-03)
Business Name
DBA Name
Street address
City
Enter amount of the underpayment.
State
Zip
.
,
,
A.
Signature of Officer
Title
Enter amount of penalty & interest due.
(
)
Date
Daytime Phone #
.
,
,
B.
Taxpayer ID Number
Calendar Year Ending
Due Date
Enter amount being paid.
.
$
,
,
Mail to:
C.
INDIANA DEPARTMENT OF REVENUE
Do not include check stubs.
P.O. BOX 6192
INDIANAPOLIS, IN 46206-6192

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