Ohio Form IT 501
                                                                                                           Employer’s Payment
                                                                                                           of Ohio Tax Withheld

 Please cut on the dotted lines – DO NOT USE PENCIL to complete this form.
  Employer’s Payment of Ohio Tax Withheld                                  OHIO IT 501                      Do NOT fold check or voucher.
  Ohio Withholding Acct. No.                                     Federal Employer I.D. No.            Month      Year                        Reset Form

  Name                                                                                        Due on or before:                Filing status:
  Address
                                                                                           1. Ohio tax
  City, state, ZIP code                                                                     withheld       $ 
  I declare under penalties of perjury that this return, including any accompanying sched- 2. TOTAL DUE    $ 
  ules 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.
                                                                                           DO NOT STAPLE OR OTHERWISE ATTACH YOUR CHECK OR CHECK 
                                                                                           STUB TO THIS COUPON. DO NOT SEND CASH. Return this coupon with 
  Signature of responsible party                           Title                           check or money order made payable to OHIO TREASURER OF STATE and 
                                                                                           mail to OHIO DEPARTMENT OF TAXATION, P.O. BOX 347, COLUMBUS, 
                                                                                           OHIO 43216-0347.
  Social Security number                                   Telephone number

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