This form may be electronically filed and paid at www.columbus.gov/IncomeTaxDivision
                City of Columbus, Income Tax Division 
Form                                                                                       Date(s) Wages Paid
IT-15           Employer's Deposit of Income Tax Withheld

EIN/FID Number                                                   -W

Employer Name
                                                                   Year and quarter to  Tax Year         Quarter
                                                                   which this payment  
Address                                                            is to be applied  

                                                                   Columbus Tax 
City            State                                 Zip Code     payment           01    $

                                                                   Make checks payable to: CITY TREASURER 
                                                                   Mail to:                Employer Withholding Tax 
Rev. 09/29/2020                                                                            PO Box 182489 
                Reset Form                            Print Form                           Columbus, OH 43218-2489

                This form may be electronically filed and paid at www.columbus.gov/IncomeTaxDivision
                City of Columbus, Income Tax Division 
Form                                                                                       Date(s) Wages Paid
IT-15           Employer's Deposit of Income Tax Withheld

EIN/FID Number                                                   -W

Employer Name
                                                                   Year and quarter to  Tax Year         Quarter
                                                                   which this payment  
Address                                                            is to be applied  

                                                                   Columbus Tax 
City            State                                 Zip Code     payment           01    $

                                                                   Make checks payable to: CITY TREASURER 
                                                                   Mail to:                Employer Withholding Tax 
Rev. 09/29/2020                                                                            PO Box 182489 
                                                                                           Columbus, OH 43218-2489

                This form may be electronically filed and paid at www.columbus.gov/IncomeTaxDivision
                City of Columbus, Income Tax Division 
Form                                                                                       Date(s) Wages Paid
IT-15           Employer's Deposit of Income Tax Withheld

EIN/FID Number                                                   -W

Employer Name
                                                                   Year and quarter to  Tax Year         Quarter
                                                                   which this payment  
Address                                                            is to be applied  

                                                                   Columbus Tax 
City            State                                 Zip Code     payment           01    $

                                                                   Make checks payable to: CITY TREASURER 
                                                                   Mail to:                Employer Withholding Tax 
Rev. 09/29/2020                                                                            PO Box 182489 
                                                                                           Columbus, OH 43218-2489