2014 Ohio IT 1041P
Federal Privacy Act Notice
Because we require you to provide us with a Social Se-                                           Ohio Income Tax 
curity number, the       Federal Privacy Act of 1974 requires 
us to inform you that providing us with your Social Secu-                                        Payment Coupon for 
rity number is mandatory. Ohio Revised Code sections                                             Estates and Trusts
5703.05, 5703.057 and 5747.08 authorize us to request 
this information. We need your Social Security number in 
order to administer this tax.

                     Make your paper check or money order payable to Ohio Treasurer of State. Write 
                     the taxpayer identifi cation number on your paper check or money order and include 
                     Ohio form IT 1041P and your payment with Ohio form IT 1041.

                              Please cut on the dotted line. DO NOT USE PENCIL to complete this form.

OHIO IT 1041P                                  Rev. 7/14

Ohio Income Tax Payment Coupon For                      Do NOT fold For Taxable Year Beginning In
Estates and Trusts
                                                        check         2014
Federal Employer I.D. Number                            or coupon.
                                                                    TRUST                                Check here for 
                                                                                                      amended return payment.
Social Security Number of Decedent (estates only)                   ESTATE

                                                                               Payment 
Name of trust or estate                                                        Amount            $         ,,. 0 0
Fiduciary name and title                                                       DO NOT STAPLE OR OTHERWISE ATTACH YOUR CHECK OR CHECK STUB 
                                                                               TO THIS COUPON. DO NOT SEND CASH. Return this coupon with check or 
                                                                               money order made payable to OHIO TREASURER OF STATEand mail to OHIO 
Number, street, P.O. Box, suite or room number                                 DEPARTMENT OF TAXATION, P.O. BOX 2619, COLUMBUS, OH  43216-2619.
City, state, ZIP code

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