Ohio IT4

Enter Personal Information

Last Name:

First Name:

Middle Initial:

Social Security Number:

Address:

City:

State:

Zip Code:

School District of Residence, See The Finder for assistance:

School district number (####):

You are entitled to one exemption. Check the box to claim it.

If you are married and your spouse does not claim his/her exemption, Check the box to claim it.

Number of dependents.

Additional Ohio income tax withholding per pay period (optional):

I am a full-year resident of Indiana, Kentucky, Michigan, Pennsylvania, or West Virginia.

I am a resident military servicemember who is stationed outside Ohio on active duty military orders.

I am a nonresident military servicemember who is stationed in Ohio due to military orders.

I am a nonresident civilian spouse of a military servicemember and I am present in Ohio solely due to my spouse’s military orders.

I am exempt from Ohio withholding under R.C. 5747.06(A)(1) through (6).

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