Form It 941 - Ohio Employer'S Annual Reconciliation Of Income Tax Withheld
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1
2Ohio Employer’s Annual
Reconciliation of Income
Tax Withheld, Form IT 941
Front side of Ohio form IT 941
Reset Form
DO NOT USE PENCIL
Please cut on the dotted lines –
to complete this form.
Ohio Employer’s Annual Reconciliation
OHIO IT 941
Do NOT fold check or voucher.
of Income Tax Withheld
Ohio Withholding Acct. No.
Federal Employer ID No.
Tax Year
Name
1. Ohio income
$
tax withheld
Address
2. Previous
$
payments
City, state, ZIP code
$
3. Balance
due
Due on or before:
Check here if
amended return.
$
4. Credit
I declare under penalties of perjury that this return, including any accompanying schedules and
$
statements, has been examined by me and to the best of my knowledge and belief is a true, cor-
5. Refund
rect and complete return and report.
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
Signature of responsible party
Title
Telephone number
OHIO DEPARTMENT OF TAXATION, P.O. BOX 182667, COLUMBUS, OHIO 43218-2667.
Your Social Security number
Date
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