Indiana Department of Revenue
                                                                             IT-6WTH
                                                                             For Use of Tax Year 2025
                                                                             08/2024

Cut on line before mailing

                                   IT-6WTH              0824    

                                                        Printed Name of Officer              Title

                                   6W
Federal ID Number         Due Date                      Signature of Officer                 Title

                                                        Date                    Daytime Phone
                          Calendar or Fiscal Year Ending

                                                                                             Enter Total Tax Below

INDIANA DEPARTMENT OF REVENUE
P.O. BOX 6032
                                                                                                     .
INDIANAPOLIS, IN 46206-6032