IT WHC
                        Change of Ohio Employer, Name, Address or Status                                          Rev. 1/08
Please use the top and bottom of this form to report any changes of mailing address, name, merger information or out-of-business informa-
tion. If this change is because you are out of business, you must fi le a fi nal reconciliation for the fi nal period you were in business on form 
IT 941. If a change in ownership or a change in business status (such as changing from a sole proprietorship to a corporation) occurs, 
and you receive a new federal employer identifi cation number (FEIN), you must fi le a fi nal reconciliation form IT 941 for the old account 
and complete the bottom of this form to obtain a new Ohio withholding account number. If a merger has taken place, the nonsurvivor must 
fi le a fi nal reconciliation form IT 941 and complete the merger information on the bottom of this form.
                                   Ohio Tax ID No.                                FEIN

        Previous Business Name and Mailing Address             New Name, Mailing and Location Address
 Business name                                                 Business name

 Address                                                       Owner’s name/responsible party

 City State  ZIP code                                          New mailing address

                                                               City State  ZIP code
Please send your completed form to us by fax or by mail.
                                                               Physical location (street address and number)      
Fax to:  614-387-1851 or
Mail to:  Ohio Department of Taxation                          City State  ZIP code
         Taxpayer Services Division
 Registration Section                                          NAICS code                        Telephone number
         P.O. Box 182215
         Columbus, OH  43218-2215

 Indicate changes or additions only by checking the appropriate box and entering the information requested.

 Out of business            Effective date M M D D Y Y         No employees at this time –
                                                               inactivate account

 Merged                     Effective date M M D D Y Y         Survivor’s name 

 Survivor’s                                             Survivor’s 
 federal ID                                             Ohio ID

 Business status            Effective date M M D D Y Y         New business type
 change                     
                                                                
 New federal ID                                                New name 
 to be registered

 Form  IT 941, the fi nal reconciliation, is enclosed.