Rev. 07/25/24

Scan Specifications for the Ohio 

Universal Payment Coupon (OUPC)

Important Note

The following document contains grids for placement of information 
on this specific tax form. To accurately print, do not reduce the size, 
rotate or center this document. Doing so will jeopardize the integrity 
of the grid. When printing from Adobe Reader, select “None” for  
“Page Scaling,” which is under “Page Handling.”

The OUPC must be initially submitted by August 30, 2024 and 
approved no later than Oct. 18, 2024.

Ohio Department of Taxation

4485 Northland Ridge Blvd.

Columbus, OH 43229

tax.ohio.gov

                     Ohio Department of Taxation Scannable Tax Forms

1.  Introduction:
 The Ohio Department of Taxation (ODT) prescribes the format of Ohio tax returns and forms. The 
 department’s primary objective is to ensure that the tax forms are compatible with the department’s 
 automated remittance processing systems and can be processed in an efficient, accurate and 
 economical manner.
 
 These guidelines are for computerized tax processors, software developers, computer programmers, 
 commercial printers, and others who develop and use substitute and reproduced tax forms.
2.  Definitions:
 2.01  Scannable Tax Forms 
    Software generated scannable forms are similar to the official ODT tax forms with the following 
    exceptions: 1) the taxpayer information layout, 2) a scanline that contains the taxpayers’ tax data, 
    and 3) a variable data 2D barcode that contains the taxpayer's data.
 2.02  Substitute Tax Forms 
    Software generated substitute forms are exact replicas of the official ODT tax forms. ODT must 
    be able to process substitute tax forms in the same manner as the official forms. Substitute tax 
    forms that are electronically produced must duplicate the appearance and layout of the official 
    form including size of margins, special keying symbols and line numbers.
 2.03 Demographic Fields 
    The area where the name, address, Individual Taxpayer Identification Number (ITIN)/Social 
    Security number (SSN) are printed.
 2.04  Static Text 
    The text, including item numbers, specifying the information to be entered into a data field. Static 
    text must not go into capture areas. *NEW* Return or Estimated payment verbiage added per 
    OUPC printed.
 2.05  OCR-Readable Field 
    The scanline field that will be read using Optical Character Recognition (OCR) technology. 
    Subsequent OCR fields include the three character last name field and payment amount.
 2.06  Record Layout 
    A 6-line-per-inch vertical (row) and 10-characters-per-inch horizontal (column) spacing grid,  
    specifying the exact placement of all fields and characters on the facsimile form, is provided 
    with each form specification to assist in proper spacing and alignment.
 
 2.07  Capture Area
    The specific space on the form where an OCR-Readable field is captured.

3.  Specifications: 
 3.01  Field Length 
    Each form must contain the exact number of Demographic Fields and Capture Areas as the 
    department-issued form.
 3.02  Name and Address 
    Name and address must be placed in the row and column specified in the grid format provided 
    with each form.
 3.03  SSN/ITIN
    The SSN or ITIN must be printed with spaces in the exact locations specified in the record layout. 
 3.04  Scanline Font 
    The OCR scanline must be printed using a fixed 10-pitch, OCR-A or Courier (12-point size) font. 
    No boldface or italicized font. No special characters. 

 3.05  Scanline Position 
  The bottom of the characters in the scanline must be ½ of an inch from the bottom edge of the 
  form and 11/16 inch from the right edge. See grid layout and Scanline Specifications Format for 
  exact location of scanline.
 3.06  Total Remittance Field 
  This field is read by our remittance-processing equipment and requires a dollar sign ($) followed 
  by a space preceding the remitted amount. The total remittance field must also include a decimal 
  point to separate the dollar and cents digits. (Example: $ 12345.00)
 3.07  OCR 
  Underlining or enclosing OCR readable data fields is not acceptable nor are vertical bars to be 
  used to separate dollar and cents fields.

 3.08  2D Barcode (PDF 417)
  Both the Schema and the 2D Barcode Instructions provided must be referenced for data 
  guidelines and placement within the 2D barcode. The PDF 417 barcode will measure 1.75" wide 
  X 1.25" high, follow grid layout for positioning.

 3.09  Back of Form  
  Coupons must be printed on one side only. 
 3.10  Shading 
  The use of shading or solid black areas for sidebars, headings or other areas is not permitted 
  unless specified on tax return samples.
 3.11  Reference Marks 
  On all scannable returns and coupons there are target marks on the form. Exact locations of 
  the target marks are listed on the grid layout for each form. Target marks must be a solid black 
  circle and should be .25” in diameter.
 3.12  Software Developer Identification  
  The software developer identification is a two-digit vendor registration number (VRN) that 
  will be assigned to each developer. The identification will be assigned to you by the Ohio 
  Department of Taxation. The two-digit VRN refers to the developer who designs the software 
  to perform the tax calculations not to the developer who designs the form templates. The 
  VRN must be printed on each document in the exact area specified on the form grid. The use 
  of a standard font size is acceptable. This is the same two-digit number assigned to you on 
  your full-page scannable forms. For any questions or VRN assignments, email: Forms@tax.
  ohio.gov
 3.13 Date Generated 
  Indicates the date the coupon was generated.

4.  Testing: 
 4.01 Pre-release testing
  All documents must be tested on ODT equipment before production runs. ODT will 
  accept PDFs of coupon submissions. Testing instructions and information can be 
  found on the “2D Barcode Instructions” page.  

 4.02 Printed Coupon
  Vendors must reference the scanline and testing process sections of these specifications for    
  additional information.

5.  Approval Process: 
 The Forms Unit will confirm receipt of the submission by e-mail. The Forms Unit will send notification 
 of your approval status by e-mail when your submittal has been reviewed and tested. Allow up to 10 
 business days for the submission to be completely reviewed. 

6.  Check Digit Routine (Modulus 10) For Scanline

   1)            Multiply each digit of the number by 1 or 2, starting from the left and going to the 
                 right.  You will start with a 1 then 2, and continue this pattern to the end of that 
                 number.
   2)            Add all the digits together. Do not add the sum of the totals. For example, if your 
                 numbers are 1, 3, 4 and 19 your answer will be: 1 + 3 + 4 + 1 + 9 = 18.
   3)            Divide the total from the digits by 10.
   4)            Subtract the remainder from 10. The answer is your check digit. If your  
                 remainder is zero, your check digit will always be zero.

   Note:  This same procedure is followed for all check digit calculations throughout these  
                specifications.

Example:

Check digit calculation for ID Number & Reporting Period:
 
Step 1 – Multiply each digit in the number by weights 121212.

        0  0  0  0  0 1   2  3  4  5  6  7  8   9   1  2  2  4                                     (ID Number      & Reporting Period )
  X 1  2  1  2  1 2  1  2  1  2  1  2  1   2   1  2  1  2                                        X  1   2    1    2
         00  0  0  0  2   2  6  4 10 6 14 8 18 1  4  2  8                              2  10   0  18

Step 2 – The digits of the individual products are summed.

             0 + 0 + 0 + 0 + 0 + 2 + 2 + 6 + 4 + 1 + 0 + 6 + 1 + 4 + 8 + 1 + 8 + 1 + 4 + 2 + 8 = 58 

Step 3 – Divide the sum by the modulus (10):

                                                                  5 (quotient)                                         
                         (Modulus) 10   58 (sum)                        
                                                       50                                                 
                                                       8 (remainder)                                            

Step 4 – To compute the check digit:

   Modulus – Remainder = Check Digit 

   10 - 8 =     (This is your check digit.) 2

Step 5 – Append a space and the check digit to the right of the number: The complete form for the ID 
Number & Reporting Date are 000001234567891224 2.  

                        2D Barcode (PDF 417) Instructions

                               General Information

• The Ohio OUPC must be enabled for a PDF 417 2D barcode to include variable taxpayer data
• A form enabled for 2D barcode must not allow users or practitioners the option to turn off/on the 
  2D barcode function
• The minimum error correction code level is 4
• Optimal dpi level is 300 dpi. The minimum dpi level is 200 dpi
• Refer to schema and specifications on field length and character guidelines.

                        Size and Placement on the Form
• 2D barcode must be placed in the designated area indicated in the grid layout
• The 2D barcode will be PDF 417 with a maximum size of 1.75 inches wide by 1.25 inches in height. 
  The 2D barcode must fit within the designated space in the grid layout
• 2D barcode must not be bigger than the allocated area
                               Barcode Layout
• Data included in the 2D barcode can be broken down into three general sections
  Header 
  From ID
         • 222XX. 222 = OUPC; XX = ODT Assigned VRN Number
  Form Specific Data – Please see encoding schemas for form specific data
  Tax Type
         • 440=PIT and 441=SDI
  ID Type
         • 01=SSN and 02=ITIN
  ID Number
         • 5 leading zeros and the 9 digit SSN/ITIN of the Primary Taxpayer
  Reporting Period
         • MMYY. Will be 1224 for payments applied to 2024 returns.  Will be 1225 for 2025 
           estimated payments.
  Coupon Type
         • 54=Return payment and 55=Estimated payment
  School District Number
         • Required, Mandatory field. If tax type=441, must be valid taxing School District. If tax 
           type=440, send 0000.
  First Three Letters of the Primary Taxpayer’s Last Name
         •  First three letters of the Primary Taxpayer’s last name. See schemas for allowed special 
           characters.
  Amount of Payment
         • Amount of the payment, including cents.  Numeric only, up to 11 characters total.
         •  Must be greater than one dollar

                            Examples of 2D Barcode data streams

     Header                                                    22299<CR>
     Tax Type                                                  440<CR>
     ID Type                                                   01<CR>
     ID Number                                                 00000123456789<CR>
     Reporting Period                                          1224<CR>
     Coupon Type                                               54<CR>
     School District Number                                    0000<CR>
     1st 3 Characters of Primary Taxpayer’s Last Name          CIT<CR>
     Amount of Payment (including cents)                       12345678900<CR>                     
                                                        *EOD*<CR>

                             Submission Process

 • The deadline for Ohio OUPC approval is October 18th, 2024
 • OUPCs may be submitted by email to Forms@tax.ohio.gov
 • The email subject line must include the vendor number, product name, tax year and coupon 
   number in that order e.g. 99_ABCTax_ 24_222
 •  Submissions must include
   • One (1) full field sample in a PDF format
   •  Test scenarios for the Ohio OUPC provided by the Ohio Department of Taxation. 
 •  Each test scenario must be in a separate PDF using the following naming convention: vendor 
   number, product name, tax year, coupon number, test number 99_ABCTax_24_222_Test 1
 • An emailed confirmation is sent to the vendor indicating the packet was received
 •  Submissions missing any of the items above will be rejected

                             Testing Process

 • Testing of the Ohio OUPC commences on July 29th, 2024. 
 • Coupons are reviewed in three (3) content areas - printed forms, 2D barcode data, and scanline 
   data
 •  A submission is approved in its entirety once all sample documents pass in all areas

 Printed forms
 • Vendor full field matches template provided in the specifications
 • All fields are present, formatted properly and aligned with grid layout
 • Test scenarios contain values specified by Ohio Department of Taxation

 2D Barcode Data
 •  Barcodes read as valid
 •  All test scenarios can be decoded and match test scenario data exactly

 Scanline Data
 • Must meet requirements specified in scanline guidelines section of these specifications

                                     Notifications

• Communications regarding submissions are sent from Forms@tax.ohio.gov to the vendor email 
  address(es) on file for the product
• If forms are released prior to approval, vendors must ensure that the users cannot print coupons 
  containing 2D barcodes and must include a visual indicator to alert the taxpayer that the coupon 
  cannot be filed
• An emailed confirmation is sent to the vendor indicating the coupon was approved
• An email confirmation is sent to the vendor for packets that are rejected
• Feedback is provided regarding the errors found
•  Resubmissions of coupons must include all test scenarios
• After the third submission of test materials, the department cannot guarantee timeliness of the 
  review
• Coupons will be tested with applicable long form submissions. If a coupon changes before 
  January 1, 2025, long form test scenarios will be updated to reflect the changes. Vendors will be 
  notified of applicable changes and required to submit revised coupons within their long form test 
  packets

7. Scanline Specifications Format:        OUPC (All Years)        Size: 8.5” X 3.667”
       This OUPC is for the following vouchers: IT 40P, IT 40XP, SD 40P, SD 40XP, IT 1040ES, SD 100ES.

                                                              Number          Character 
 Description 
                                                           of Positions         Length
 Tax Type                                                       1-4             3
 Check Digit for Tax Type                                       5-6             1
 ID Type                                                        7-9             2
 Check Digit for ID Type                                      10-11             1
 ID Number                                                    12-30             18
 Check Digit for ID Number                                      31-32           1 
 Coupon Type                                                    33-35           2
 Check Digit for Coupon Type                                    36-37           1
 School District Number                                         38-42           4
 Check Digit for School District Number                         43-44           1
 Form Type                                                      45-48           3

 Placement of the Scanline: Start on line 63 at position 32 and end at position 78. Blank spaces 
 must be as noted. Print zeros in fields that contain no data. The scanline font is OCR-A or Courier  
 (12-point size), 10 pitch (pica spacing).
  Example:     440 8 01 8 000001234567891224 2 54 7 0000 0 222
                                                                              Important Note: 
                                             5.3                              Make sure 
       
               1 2 3     4  5.1       5.2        5.4 6 7   8    9    10   11  that there is 
                                                                              no masking of 
1. Tax Type: (3 digits and a space)                                           numbers, except 
  a) The Tax Type for Individual Income Taxes is "440."                       where specified.
  b) School District Income Taxes is "441."
 
2. Check Digit for Tax Type: (1 digit and a space) The check digit for "440" is 8; the check digit for 
    "441" is 7.
3. ID Type: (2 digits and a space)
    a) The ID Type for a Social Security Number (SSN) is "01".
  b) The ID Type for a Taxpayer Identification Number (ITIN) is "02" 
4. Check Digit for ID Type: (1 digit and a space) Check digits are 8 for "01" and 6 for "02" 
5. ID Number: (18 digits and a space)
   5.1: The first 5 digits are always zeros. 
  5.2: The sixth through the fourteenth digits are the SSN/ITIN.
  5.3: The fifteenth and sixteenth digits represent the period end month (MM).
  5.4: The seventeenth and eighteenth digits represent the period end year (YY).
6. Check Digit for ID Number (1 digit and a space) See section 6 for Modulus 10 calculation.
7. Coupon Type: (2 digits and a space)
  a) The Coupon Type for a return payment is "54."
  b) The Coupon Type for an estimated payment is "55."
8. Check Digit for Coupon Type: (1 digit and a space) Check digits are 7 for "54" and 4 for "55".
9. School District Number:  Required, Mandatory field. If tax type=441, must be valid taxing School 
    District (see instructions booklet for complete list.) If tax type=440, send 0000. (4 digits and a 
    space)
10.Check Digit for School District Number: Will be "0" on 440 tax types (1 digit and a space)
11.Form Type: This will remain a constant “222” on all coupons. (3 digits)

Ohio Universal Payment Coupon (OUPC)                  Tax Year
                                                              88 88 88
Return Payment
                                                      2024
Individual Income Tax                 440

ID Type  01           Coupon Type                54                   Using UPPERCASE letters, 
                                                                      print the first three letters of 
                                                                      thetaxpayer’s last name.
John Q. CitizenXXXXXXXXXXXXXXXXXXXX
1234 Any StreetXXXXXXXXXXXXXXXXXXXX
Any CityXXXXXXXXXXXX, US 12345-2345                                   CIT

                                                                Taxpayer’s SSN/ITIN
Note: Pay online at tax.ohio.gov/pay                99
Make payment payable to: Ohio Treasurer of State                      123 45 6789
Mail to: Ohio Department of Taxation,               Amount of
P.O. Box 182131, Columbus, OH  43218-2131           Payment   $ 123456789.00

                                                 440 8 01 8 000001234567891224 2 54 7 0000 0 222

   1 2 3 4 5 6 7 8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84   85
45
46         Ohio Universal Payment Coupon (OUPC)                                                                             Tax Year
                                                                                                                                                             88 88 88
           Return Payment
47                                                                                                                             2024
48         Individual Income Tax                                         440
49
50         ID Type          01          Coupon Type                               54                                                                                                 Using UPPERCASE letters, 
                                                                                                                                                                                     print the first three letters of 
51                                                                                                                                                                                   the  taxpayer’s last name.
52         John Q. CitizenXXXXXXXXXXXXXXXXXXXX
53         1234 Any StreetXXXXXXXXXXXXXXXXXXXX
54         Any CityXXXXXXXXXXXX, US 12345-2345                                                                                                                                       CIT
55
56                                                                                                                                                                                   Taxpayer’s SSN/ITIN
57               Pay online at tax.ohio.gov/pay                                                                       99
           Note: 
58                                             Ohio Treasurer of State                                                                                                               123 45 6789
           Make payment payable to:
59         Mail to: Ohio Department of Taxation, 
60                                                                                                                       Amount of
61         P.O. Box 182131, Columbus, OH  43218-2131                                                                     Payment                          $     123456789.00
62
63                                                                                   440 8 01 8 000001234567891224 2 54 7 0000 0 222
64
65
66

Ohio Universal Payment Coupon (OUPC)                  Tax Year
                                                              88 88 88
Estimated Payment
                                                      2025
Individual Income Tax                 440

ID Type  01           Coupon Type                55                   Using UPPERCASE letters, 
                                                                      print the first three letters of 
                                                                      thetaxpayer’s last name.
John Q. CitizenXXXXXXXXXXXXXXXXXXXX
1234 Any StreetXXXXXXXXXXXXXXXXXXXX
Any CityXXXXXXXXXXXX, US 12345-2345                                   CIT

                                                                Taxpayer’s SSN/ITIN
Note: Pay online at tax.ohio.gov/pay                99
Make payment payable to: Ohio Treasurer of State                      123 45 6789
Mail to: Ohio Department of Taxation,               Amount of
P.O. Box 182131, Columbus, OH  43218-2131           Payment   $ 123456789.00

                                                 440 8 01 8 000001234567891225 9 55 4 0000 0 222

   1 2 3 4 5 6 7 8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84   85
45
46         Ohio Universal Payment Coupon (OUPC)                                                                             Tax Year
                                                                                                                                                             88 88 88
           Estimated Payment
47                                                                                                                             2025
48         Individual Income Tax                                         440
49
50         ID Type          01          Coupon Type                               55                                                                                                 Using UPPERCASE letters, 
                                                                                                                                                                                     print the first three letters of 
51                                                                                                                                                                                   the  taxpayer’s last name.
52         John Q. CitizenXXXXXXXXXXXXXXXXXXXX
53         1234 Any StreetXXXXXXXXXXXXXXXXXXXX
54         Any CityXXXXXXXXXXXX, US 12345-2345                                                                                                                                       CIT
55
56                                                                                                                                                                                   Taxpayer’s SSN/ITIN
57               Pay online at tax.ohio.gov/pay                                                                       99
           Note: 
58                                             Ohio Treasurer of State                                                                                                               123 45 6789
           Make payment payable to:
59         Mail to: Ohio Department of Taxation, 
60                                                                                                                       Amount of
61         P.O. Box 182131, Columbus, OH  43218-2131                                                                     Payment                          $     123456789.00
62
63                                                                                   440 8 01 8 000001234567891225 9 55 4 0000 0 222
64
65
66

Ohio Universal Payment Coupon (OUPC)                  Tax Year               School district
                                                               88 88 88
Return Payment                                                               number
                                                      2024
School District Income Tax            441                                    2307

ID Type  01           Coupon Type         54                           Using UPPERCASE letters, 
                                                                       print the first three letters of 
                                                                       thetaxpayer’s last name.
John Q. CitizenXXXXXXXXXXXXXXXXXXXX
1234 Any StreetXXXXXXXXXXXXXXXXXXXX
Any CityXXXXXXXXXXXX, US 12345-2345                                    CIT

                                                                 Taxpayer’s SSN/ITIN
Note: Pay online at tax.ohio.gov/pay                99
Make payment payable to: School District Income Tax                    123 45 6789
Mail to: Ohio Department of Taxation,               Amount of
P.O. Box 182389, Columbus, OH  43218-2389           Payment    $ 123456789.00

                                                    441 7 01 8 000001234567891224 2 54 7 2307 7 222

   1 2 3 4 5 6 7 8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84   85
45
46         Ohio Universal Payment Coupon (OUPC)                                                                             Tax Year                                                             School district
                                                                                                                                                             88 88 88
           Return Payment                                                                                                                                                                              number
47                                                                                                                             2024
48         School District Income Tax                                    441                                                                                                                           2307
49
50         ID Type          01          Coupon Type                               54                                                                                                 Using UPPERCASE letters, 
                                                                                                                                                                                     print the first three letters of 
51                                                                                                                                                                                   the  taxpayer’s last name.
52         John Q. CitizenXXXXXXXXXXXXXXXXXXXX
53         1234 Any StreetXXXXXXXXXXXXXXXXXXXX
54         Any CityXXXXXXXXXXXX, US 12345-2345                                                                                                                                       CIT
55
56                                                                                                                                                                                   Taxpayer’s SSN/ITIN
57               Pay online at tax.ohio.gov/pay                                                                       99
           Note: 
58                                             School District Income Tax                                                                                                            123 45 6789
           Make payment payable to:
59         Mail to: Ohio Department of Taxation, 
60                                                                                                                       Amount of
61         P.O. Box 182389, Columbus, OH  43218-2389                                                                     Payment                          $     123456789.00
62
63                                                                                   441 7 01 8 000001234567891224 2 54 7 2307 7 222
64
65
66

Ohio Universal Payment Coupon (OUPC)                  Tax Year               School district
                                                               88 88 88
Estimated Payment                                                            number
                                                      2025
School District Income Tax            441                                    2307

ID Type  01           Coupon Type         55                           Using UPPERCASE letters, 
                                                                       print the first three letters of 
                                                                       thetaxpayer’s last name.
John Q. CitizenXXXXXXXXXXXXXXXXXXXX
1234 Any StreetXXXXXXXXXXXXXXXXXXXX
Any CityXXXXXXXXXXXX, US 12345-2345                                    CIT

                                                                 Taxpayer’s SSN/ITIN
Note: Pay online at tax.ohio.gov/pay                99
Make payment payable to: School District Income Tax                    123 45 6789
Mail to: Ohio Department of Taxation,               Amount of
P.O. Box 182389, Columbus, OH  43218-2389           Payment    $ 123456789.00

                                                    441 7 01 8 000001234567891225 9 55 4 2307 7 222

   1 2 3 4 5 6 7 8  9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84   85
45
46         Ohio Universal Payment Coupon (OUPC)                                                                             Tax Year                                                             School district
                                                                                                                                                             88 88 88
           Estimated Payment                                                                                                                                                                           number
47                                                                                                                             2025
48         School District Income Tax                                    441                                                                                                                           2307
49
50         ID Type          01          Coupon Type                               55                                                                                                 Using UPPERCASE letters, 
                                                                                                                                                                                     print the first three letters of 
51                                                                                                                                                                                   the  taxpayer’s last name.
52         John Q. CitizenXXXXXXXXXXXXXXXXXXXX
53         1234 Any StreetXXXXXXXXXXXXXXXXXXXX
54         Any CityXXXXXXXXXXXX, US 12345-2345                                                                                                                                       CIT
55
56                                                                                                                                                                                   Taxpayer’s SSN/ITIN
57               Pay online at tax.ohio.gov/pay                                                                       99
           Note: 
58                                             School District Income Tax                                                                                                            123 45 6789
           Make payment payable to:
59         Mail to: Ohio Department of Taxation, 
60                                                                                                                       Amount of
61         P.O. Box 182389, Columbus, OH  43218-2389                                                                     Payment                          $     123456789.00
62
63                                                                                   441 7 01 8 000001234567891225 9 55 4 2307 7 222
64
65
66