Form It-941 - Employer'S Annual Reconcilation Of Ohio Tax Withheld
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OHIO IT-941
EMPLOYER'S
EMPLOYER'S ANNUAL
ANNUAL RECONCILATION
RECONCILATION OF
OF OHIO
OHIO TAX
TAX WITHHELD
WITHHELD
11/97
For Departmental Use Only
Ohio Withholding Account #
Federal Employer's I.D. #
Calendar Year
"%
"%
Name
Dollars
Cents
1. Ohio Tax
Address
,
,
.
Withheld
City, State and Zip Code
2. Previous
Payments
.
,
,
Dollars Only
A.Gross
Wages
.
,
,
<FOLD HERE>
<FOLD HERE>
<FOLD HERE>
Due on or Before
3. Balance
,
,
.
Due ***
Make Check Payable to the Treasurer of State of
4. Credit
Ohio and Mail to:
,
,
.
Ohio Department of Taxation
P.O. Box 347
Columbus, Ohio 43216-0347
5. Refund
,
,
.
Signature of Reponsibility Party
Phone #
Code
For Departmental Use Only
Your Social Security Number
Date
-----------------------------------------------------------------------------------------------------------------
This is a two part form. Be sure to complete and attach the second page of this
form.
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