Common use of ORIGINAL PAYMENT Clause in Contracts

ORIGINAL PAYMENT. ✁ Cut on the dotted lines. Use only black ink. OHIO IT 40P Original Income Tax Payment Voucher Tax Year First name M.I. Last name Spouse’s first name (only if joint filing) M.I. Last name Address City, State, ZIP code 2020 • Do NOT send cash • Do NOT fold, staple, or paper clip Use UPPERCASE letters ⏵ ⏵ to print the first three letters of Make payment payable to: Ohio Treasurer of State Sending with return - Mail to: Ohio Department of Taxation, X.X. Xxx 0000, Xxxxxxxx, XX 00000-0000 Sending without return - Mail to: Ohio Department of Taxation, Taxpayer’s SSN Spouse’s SSN (only if joint filing) ⏶, ⏶, . 0 Amount of Taxpayer’s last name Spouse’s last name (only if joint filing) X.X. Xxx 000000, Xxxxxxxx, XX 00000-0000 402 Payment $ hio Do not staple or paper clip.‌ Department of Taxation 2021 Ohio IT 1040 Individual Income Tax Return Use only black ink/UPPERCASE letters. 21000102 Sequence No. 1 AMENDED RETURN - Check here and include Ohio IT RE. NOL CARRYBACK - Check here and include Schedule IT NOL. Primary taxpayer's SSN (required) ✔If deceased Spouse’s SSN (if filing jointly) ✔If deceased School district # First name Spouse's first name (if filing jointly) Address line 1 (number and street) or P.O. Box X.X. X.X. Last name Last name

ORIGINAL PAYMENT. ✁ Cut on the dotted lines. Use only black ink. OHIO IT 40P Original Income Tax Payment Voucher Tax Year First name M.I. Last name Spouse’s first name (only if joint filing) M.I. Last name Address City, State, ZIP code 2020 • Do NOT send cash • Do NOT fold, staple, or paper clip Use UPPERCASE letters ⏵ ⏵ to print the first three letters of Make payment payable to: Ohio Treasurer of State Sending with return - Mail to: Ohio Department of Taxation, X.X. Xxx 0000P.O. Box 2057, XxxxxxxxColumbus, XX 00000OH 43270-0000 2057 Sending without return - Mail to: Ohio Department of Taxation, Taxpayer’s SSN Spouse’s SSN (only if joint filing) ⏶, ⏶, . 0 Amount of Taxpayer’s last name Spouse’s last name (only if joint filing) X.X. Xxx 000000P.O. Box 182131, XxxxxxxxColumbus, XX 00000OH 43218-0000 2131 402 Payment $ hio Do not staple or paper clip.‌ Department of Taxation 2021 Ohio IT 1040 Individual Income Tax Return Use only black ink/UPPERCASE letters. 21000102 Sequence No. 1 AMENDED RETURN - Check here and include Ohio IT RE. NOL CARRYBACK - Check here and include Schedule IT NOL. Primary taxpayer's SSN (required) ✔If deceased Spouse’s SSN (if filing jointly) ✔If deceased School district # First name SpouseXxxxxx's first name (if filing jointly) Address line 1 0 (number and streetxxxxxx xxx xxxxxx) or P.O. Box X.X. X.X. Last name Last namename Address line 2 (apartment number, suite number, etc.) City State ZIP code Ohio county (first four letters) Foreign country (if the mailing address is outside the U.S.) Foreign postal code Residency Status – Check only one for primary Part-year Resident resident Check only one for spouse (if filing jointly) Nonresident ⏵⏵ Filing Status – Check one (as reported on federal income tax return) Single, head of household or qualifying widow(er) Indicate state Married filing jointly Resident Part-year resident Nonresident ⏵⏵ Indicate state Spouse’s SSN Married filing separately Ohio Nonresident Statement – See instructions for required criteria Primary meets the five criteria for irrebuttable presumption as nonresident. Federal extension filers - check here. Spouse meets the five criteria for irrebuttable presumption as nonresident. If someone can claim you (or your spouse if filing jointly) as a dependent, check here. Do not staple or paper clip.

ORIGINAL PAYMENT. ✁ Cut on the dotted lines. Use only black ink. OHIO IT 40P Original Income Tax Payment Voucher Tax Year First name M.I. Last name Spouse’s first name (only if joint filing) M.I. Last name Address City, State, ZIP code 2020 • Do NOT send cash • Do NOT fold, staple, or paper clip Use UPPERCASE letters ⏵ ⏵ to print the first three letters of Make payment payable to: Ohio Treasurer of State Sending with return - Mail to: Ohio Department of Taxation, X.X. Xxx 0000, Xxxxxxxx, XX 00000-0000 Sending without return - Mail to: Ohio Department of Taxation, Taxpayer’s SSN Spouse’s SSN (only if joint filing) ⏶, ⏶, . 0 Amount of Taxpayer’s last name Spouse’s last name (only if joint filing) X.X. Xxx 000000, Xxxxxxxx, XX 00000-0000 402 Payment $ hio Do not staple or paper clip.‌ Department of Taxation 2021 Ohio IT 1040 Individual Income Tax Return Use only black ink/UPPERCASE letters. 21000102 Sequence No. 1 AMENDED RETURN - Check here and include Ohio IT RE. NOL CARRYBACK - Check here and include Schedule IT NOL. Primary taxpayer's SSN (required) ✔If deceased Spouse’s SSN (if filing jointly) ✔If deceased School district # First name SpouseXxxxxx's first name (if filing jointly) Address line 1 (number and street) or P.O. Box X.X. X.X. Last name Last namename Address line 2 (apartment number, suite number, etc.) City State ZIP code Ohio county (first four letters) Foreign country (if the mailing address is outside the U.S.) Foreign postal code Residency Status – Check only one for primary Part-year Resident resident Check only one for spouse (if filing jointly) Nonresident ⏵⏵ Filing Status – Check one (as reported on federal income tax return) Single, head of household or qualifying widow(er) Indicate state Married filing jointly Resident Part-year resident Nonresident ⏵⏵ Indicate state Spouse’s SSN Married filing separately Ohio Nonresident Statement – See instructions for required criteria Primary meets the five criteria for irrebuttable presumption as nonresident. Federal extension filers - check here. Spouse meets the five criteria for irrebuttable presumption as nonresident. If someone can claim you (or your spouse if filing jointly) as a dependent, check here. Do not staple or paper clip.

ORIGINAL PAYMENT. ✁ Cut on the dotted lines. Use only black ink. OHIO IT 40P Original Income Tax Payment Voucher Tax Year First name M.I. Last name Spouse’s first name (only if joint filing) M.I. Last name Address City, State, ZIP code 2020 • Do NOT send cash • Do NOT fold, staple, or paper clip Use UPPERCASE letters ⏵ ⏵ to print the first three letters of Make payment payable to: Ohio Treasurer of State Sending with return - Mail to: Ohio Department of Taxation, X.X. Xxx 0000, Xxxxxxxx, XX 00000-0000 Sending without return - Mail to: Ohio Department of Taxation, Taxpayer’s SSN Spouse’s SSN (only if joint filing) ⏶, ⏶, . 0 Amount of Taxpayer’s last name Spouse’s last name (only if joint filing) X.X. Xxx 000000, Xxxxxxxx, XX 00000-0000 402 Payment $ hio Do not staple or paper clip.‌ Department of Taxation 2021 clip. 2020 Ohio IT 1040 Individual SD 100 School District Income Tax Return Use only black ink/UPPERCASE letters. 21000102 Sequence No20020102 File a separate Ohio SD 100 for each taxing school district in which you lived during the tax year. 1 AMENDED RETURN - Check here and include if this is an amended return. Include the Ohio IT SD RE. NOL CARRYBACK - Do NOT include a copy of the previously filed return. Check here and include if claiming an NOL carryback. Include Schedule IT NOL. Primary taxpayer's ’s SSN (required) ✔⏵⏵ If deceased check box Spouse’s SSN (if filing jointly) ✔⏵⏵ If deceased check box School district # for this return (see instructions). SD#⏵⏵ First name SpouseXxxxxx's first name (only if married filing jointly) Address line 1 (number and street) or P.O. Box X.X. X.X. Last name Last namename Address line 2 (apartment number, suite number, etc.) City State ZIP code Ohio county (first four letters) Foreign country (if the mailing address is outside the U.S.) Foreign postal code