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                                                                                Indiana Department of Revenue
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06                                                                              IT-6WTH
07                                                                              For Use of Tax Year 2023
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09                                                                              08/2022
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43 Cut on line before mailing
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46                                     IT-6WTH             0920    
47 XXXXXBusinessNameXXXXXXXXXXXXX
48 XXXXXAddressLine1XXXXXXXXXXXXX
49 XXXXXAddressLine2XXXXXXXXXXXXX                          Printed Name of Officer              Title
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51                                     6W
52 Federal ID Number         Due Date                      Signature of Officer                 Title
53 999 99 9999               99 99 9999
54                                                         Date                    Daytime Phone
55                           Calendar or Fiscal Year Ending
56                           XXX 9999
57                                                                                              Enter Total Tax Below
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59 INDIANA DEPARTMENT OF REVENUE
60 P.O. BOX 6032
                                                                                                        .
61 INDIANAPOLIS, IN 46206-6032
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63                                     089999999999999990169999999999999999999
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