Form It 1040x - Ohio Amended Individual Income Tax Return For Year 2014 Page 3
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6Ohio IT 40XP
Electronic Payment Available
You can eliminate writing a paper check by using any of
our electronic payment methods. Go to our Web site at
tax.ohio.gov for all electronic payment options.
Federal Privacy Act Notice
Because we require you to provide us with a Social Se-
curity number, the Federal Privacy Act of 1974 requires
us to inform you that providing us with your Social Secu-
rity number is mandatory. Ohio Revised Code sections
5703.05, 5703.057 and 5747.08 authorize us to request
this information. We need your Social Security number in
order to administer this tax.
OHIO IT 40XP
DO NOT STAPLE YOUR PAYMENT TO THIS VOUCHER.
Taxable Year
Do NOT fold check or voucher.
DO NOT SEND CASH.
20__
Amended Income Tax Payment Voucher
Please use UPPERCASE letters
to print the fi rst three letters of
Taxpayer’s
Spouse’s last name
First name
M.I.
Last name
last name
(only if joint fi ling)
Spouse’s fi rst name (only if joint fi ling)
M.I.
Last name
Your Social
Security
Address
number
Spouse’s Social
Security number
(only if joint fi ling)
City, state, ZIP code
Mail this voucher and paper check or money order (payable to Ohio Treasurer of State) with
AMOUNT OF
,
,
.
0
0
$
your amended income tax return to Ohio Department of Taxation, P.O. Box 1460, Columbus,
PAYMENT
OH 43216-1460.
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