This form may be electronically filed and paid at crisp.columbus.gov
               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       2023

                                                                  Columbus Tax 
City           State                                 Zip Code     payment           01    $

                                                                  Make checks payable to: CITY TREASURER 
                                                                  Mail to:                Employer Withholding Tax 
Rev. 1/3/2023                                                                             PO Box 182489 
               Reset Form                            Print Form                           Columbus, OH 43218-2489

               This form may be electronically filed and paid at crisp.columbus.gov
               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       2023

                                                                  Columbus Tax 
City           State                                 Zip Code     payment           01    $

                                                                  Make checks payable to: CITY TREASURER 
                                                                  Mail to:                Employer Withholding Tax 
Rev. 1/3/2023                                                                             PO Box 182489 
                                                                                          Columbus, OH 43218-2489

               This form may be electronically filed and paid at crisp.columbus.gov
               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       2023

                                                                  Columbus Tax 
City           State                                 Zip Code     payment           01    $

                                                                  Make checks payable to: CITY TREASURER 
                                                                  Mail to:                Employer Withholding Tax 
Rev. 1/3/2023                                                                             PO Box 182489 
                                                                                          Columbus, OH 43218-2489