OHIO IT 40P Rev.

11/09 Taxable Year

Do NOT fold check or voucher.
Income Tax Payment Voucher
2009
DO NOT ATTACH
YOUR PAYMENT TO
THIS VOUCHER. Please use UPPERCASE letters
DO NOT SEND CASH.
to print the first three letters of

Taxpayer’s Spouse’s last name

last name (only if joint filing)
DAVID L STRIKER
STR
431 CIRCLE DRIVE Your Social
NITRO, WV 25143 Security 236 17 0108
Number
Spouse’s Social
Security Number
(only if joint filing)
Include this voucher and check or money order (payable to Ohio Treasurer of
State) with your Ohio income tax return. If you are not enclosing this voucher
with your Ohio income tax return, then mail this voucher to Ohio Department of
Taxation, P.O. Box 182131, Columbus, Ohio 43218-2131.
Amount of
Vendor’s
Registration
Payment $ 39.00
Number 080
236170108 8 0509 0 000000000 0 402