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Ohio Employer’s Annual Reconciliation of Income Tax Withheld, Form IT 941
Front side of Ohio form IT 941 Reset Form
Please cut on the dotted lines – DO NOT USE PENCIL to complete this form.
OHIO IT 941
IT 941 Rev. 10/14
Ohio Employer’s Annual Reconciliation
of Income Tax Withheld
Federal Employer ID No.
Ohio Withholding Acct. No.
Name
Tax Year
1. Ohio income tax withheld
Address
3. Balance due
$ $ $
4. Refund
$
2. Previous payments
City, state, ZIP code
Check here if amended return.
Due on or before:
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, correct and complete return and report. Signature of responsible party
Your Social Security number
Do NOT fold check or voucher.
Title
Telephone number
Date
DO NOT STAPLE OR OTHERWISE ATTACH YOUR CHECK OR CHECK STUB TO THIS FORM. DO NOT SEND CASH. Return this form 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.
If your refund is $1.00 or less, no refund will be issued.
If you owe $1.00 or less, no payment is necessary.
If possible, please print (duplex) this page as the reverse side of the Ohio form IT 941. If you are unable to duplex this page, please keep this second page for your records and only mail in the front side of the Ohio form IT 941. Do not mail this page in separately.
Reverse side of Ohio form IT 941
Month
Ohio Tax Withheld–Line 1
Ohio Gross Payroll
January February March April May June July August September October November December Annual Total
