Form It 941x - Amended Ohio Employer'S Annual Reconciliation Of Income Tax Withheld

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Generic IT 941X
Month
Payment Date
Gross Payroll
Tax Withheld – Line 1
Payments – Line 2
As Amended
Credit From Prior Year
January
February
March
April
May
June
July
August
September
October
November
December
Totals
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OHIO IT 941X
Amended Ohio Employer’s Annual Reconciliation of Income Tax Withheld
IT 941X
Rev. 12/06
Ohio Withholding Account Number
Federal Employer Number
Tax Year
As Filed
As Amended
1. Ohio income
Name
tax withheld
2. Previous
payments
Address
3. Balance
$
$
due
City, state, ZIP code
4. Credit
5. Refund
Signature of responsible party
Title
Telephone number
DO NOT STAPLE OR OTHERWISE ATTACH YOUR CHECK OR CHECK STUB TO
THIS COUPON. DO NOT SEND CASH. Return this coupon with check or money order
made payable to Ohio Treasurer of State and mail to Ohio Department of Taxation, P.O.
Box 182667, Columbus, Ohio 43218-2667.
Your Social Security number
Date

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