Ohio Payment Voucher for Pass-Through Entity/Fiduciary Income Tax

Payment Voucher for Pass-Through Entity/Fiduciary Income Tax
PIT_IT40P_2018_ORIGINALPAYMENT_083018.indd
Ohio IT 1041 UPC for Pass-Through
Entity/Fiduciary Income Tax

Print blank form

Include the coupon below with your payment. If this is the first estimated payment for this entity & form type
(IT-1041), please include the registration form found here to ensure payments are applied to your account correctly.

Important
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•
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•

Do NOT staple or paper clip
Do NOT send cash.
Make payment payable to: Ohio Treasurer of State
Mail this coupon and payment to: Ohio Department of Taxation, P.O. Box 2619, Columbus, OH 43216-2619

Entity Type Codes
Simple trust = 6
Complex trust = 7
Bankruptcy estate = 8
Decedent’s estate = 9

Electronic Payment Options

Payments may be remitted by electronic funds transfer (EFT) through the Ohio Treasurer of State, or by ACH
Debit through an approved software program when filing electronically. For questions regarding the EFT payment
program, please contact the Ohio Treasurer of State’s office at 30 E. Broad St., 9th Floor, Columbus, OH 43215
or call toll-free at 1-877-338-6446.

Note

The reporting period is the annual calendar or fiscal year accounting period to which this payment is to be applied
for the corresponding tax year’s return.
Federal Privacy Act Notice
Because we require you to provide us with a Social Security number, the Federal Privacy Act of 1974 requires us to inform you that providing
us with your Social Security number is mandatory. Ohio Revised Code 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.

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

Ohio Universal Payment Coupon (UPC)
Pass-Through Entity/Fiduciary Income Tax

•	Do NOT staple or paper clip.

• Do NOT send cash.

Rev. 08/19

Clear Form

Print

Reporting Period

(Annual Period Start Date)

Name of trust or estate
Fiduciary name and title

Do NOT fold check or coupon.

Reporting Period

(Annual Period End Date)

Number, street, P.O. Box, suite or room number

FEIN (08)

City, State, ZIP code

SSN (09)

Check One Only:

IT 1041P: Estates (847)
IT 1041P: Trust (850)

IT 1041ES: Estates (854)
IT 1041ES: Trust (855)

• Make payment payable to: Ohio Treasurer of State
•Mail this coupon and payment to:
Ohio Department of Taxation
P.O. Box 2619
Columbus, OH 43216-2619
000 0 00

Entity Type(see instructions)

Amount of
Payment

00000000000000

$

.00
000000 0 555