Form It-1 - Application For Registration As An Ohio Withholding Agent

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State of Ohio
Form IT-1
(Rev. 11/95)
Department of Taxation
P.O. Box 2476, Columbus, OH 43216-2476
If this is a refile for
Application for Registration
an account number,
please check here.
For Department Use Only
As An Ohio Withholding Agent
Federal Employer Identification No.
Federal Business Code
Ohio Liquor Permit Number
Date Ohio Payroll Anticipated
Trade Name, if any
(Please type or print)
Name
Mailing Address
Type of Business
Individual
Partnership
Corporation
(Ohio Corporate Tax ID)
LLC
Other
(designate)
Check box if you are also required to file school district income tax:
Name and Title of individual responsible for filing returns and payment
of Ohio Withholding Tax
Signature of Responsible Party
Title
Your Social Security No.
Date

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