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’sPayment of Ohio Tax Withheld                                          OHIO IT 501                   Do NOT fold check or voucher. 
    Ohio Withholding Acct. No.                                         Federal Employer I.D. No.            Month                Year 

  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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