Ohio Form It 1041p - Ohio Income Tax Payment Coupon For Estates And Trusts - 2012

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2012 Ohio IT 1041P
Federal Privacy Act Notice
Ohio Income Tax
Because we require you to provide us with a Social Se-
curity number, the Federal Privacy Act of 1974 requires
Payment Coupon for
us to inform you that providing us with your Social Secu-
Estates and Trusts
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.
Make your paper check or money order payable to Ohio Treasurer of State. Write
the taxpayer identifi cation number on your paper check or money order and include
Ohio form IT 1041P and your payment with Ohio form IT 1041.
DO NOT USE PENCIL
Please cut on the dotted line.
to complete this form.
OHIO IT 1041P
Reset Form
Rev. 12/12
Ohio Income Tax Payment Coupon For
For Taxable Year Beginning In
Do NOT fold
Estates and Trusts
2012
check
or coupon.
Federal Employer Identifi cation Number
TRUST
Check here for
amended return payment.
ESTATE
Social Security Number of Decedent (estates only)
$
.
Payment
0 0
Amount
Name of trust or estate
DO NOT STAPLE, PAPER CLIP OR OTHERWISE ATTACH YOUR CHECK
Fiduciary name and title
OR CHECK STUB TO THIS COUPON. DO NOT SEND CASH. Return this
coupon with check or money order made payable to OHIO TREASURER OF
Number, street, P.O. Box, suite or room number
STATE and mail to OHIO DEPARTMENT OF TAXATION, P.O. BOX 2619,
COLUMBUS, OH 43216-2619.
City, state, ZIP code
430

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