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

Payment Voucher for Pass-Through Entity/Fiduciary Income Tax
Form IT 1041 UPC
Pass-Through Entity & Fiduciary
Income Tax Registration

10211411

Note:
This form contains information necessary to create a PTE account with the Department. If you are a first-time Ohio PTE filer, this form
must accompany your first estimated payment and UPC voucher. This form is not required if your first contact with the Department is
filing a PTE return (IT 4708, IT 4738, IT 1041, or IT 1140); since these returns contain the same information to create the PTE account.
Federal Employer Identification Number (FEIN) (Required. “Applied for” is not acceptable)
SSN of Decedent (estates only)
Name
Address, city, state and ZIP code
Foreign Address (if applicable)
Foreign Country Code (if applicable)
Type of Organization: (check the one box that applies)
S Corp
LLC
Partnership (All types including limited (LP), limited liability (LLP), general (GP), etc.)
Trust (check all that apply)
Simple		
or		
Resident 	

Complex

or		

Nonresident

or		

Decedent

Irrevocable
Testamentary
Estate
Bankruptcy	
Other (explain:

)

I Intend to File the Following Forms (check all that apply):
Fiduciary Income Tax Trust (Form IT 1041)
Fiduciary Income Tax Estate (Form IT 1041)
Pass-Through Entity & Trust Withholding Tax (Form IT 1140)
Pass-Through Entity Composite Income Tax (Form IT 4708)
Electing Pass-Through Entity Income Tax (Form IT 4738)
Date of first operations in Ohio:			

NAICS code:

Financial year begin date:				

Financial year end date:

Contact Information:
	

Name			

Title		

Phone#			

Email			

Date

If you have never filed a PTE return, but have already made your first estimated payment, please submit this form using one of the
methods below as soon as possible:
Online Notice Response Service:		
eFax: (206) 984-1685			
tax.ohio.gov - Contact Us			
Email: [email protected]		
-or- gateway.ohio.gov								
											
											

Mail:
Ohio Department of Taxation			
Pass-Through Entity & Fiduciary Income Tax Division
P.O. Box 2476
Columbus, OH 43216-2476

Form Name: Application - Registration (PTE). Rev. 7/23