Scan Specifi cations for the 2016 Ohio IT 1040

Rev. 11/4/16

Scan Specifications for the 2016 Ohio IT 1040

Important Note

The following document (2016 Ohio IT 1040) contains grids for placement of information on this specific tax form. To accurately print, do not reduce the size, rotate or center this document. Doing so will jeopardize the integrity of the grid. When printing from Adobe Reader, please select "None" for "Page Scaling," which is under "Page Handling."

Ohio Department of Taxation 4485 Northland Ridge Blvd. Columbus, OH 43229 tax.

Grid layout with notations

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85

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Do not use staples. Use only black ink and UPPERCASE letters.

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New! The date the return was gen-

2016 Ohio IT 1040

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erated by the taxpayer (MM DD YY).

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Rev. 9/16

Individual Income Tax Return

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88 88 88

Note: This form encompasses the IT 1040, IT 1040EZ and amended IT 1040X.

9

10

X X Is this an amended return? Yes No If yes, include Ohio IT RE (do noPtlainceclmudenetaofcthoepy1Dofbtahrecopdrevainodustalyx yfieleadr irsectruitrinca) l.

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Make sure to follow the grid positions for layout. Do

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X X Is this a Net Operating Loss (NOL) carryback?

Yes

No If yes, includneotSfochrgeedtutloe gITetNyOouLr bar code(s) assignments for

13

Taxpayer's SSN (required)

If deceased Spouse's SSN (ifevfielinrygfojormin,tlyve) rsion and page. If deceased Enter school district # for

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888 88 8888

X

888 88 8888

X

this return (see instructions).

15

check box

check box SD# 8888

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First name

M.I. Last name

17

JOHNXXXXXXXXXXX

Q PUBL I CXXXXXXXXXXXXXX

18

19

Spouse's first name (only if married filing jointly)

M.I. Last name

20

JANEXXXXXXXXXXX

Q PUBL I CXXXXXXXXXXXXXX

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Mailing address (for faster processing, use a street address)

22

23

8888 CHERRY LANEXXXXXXXXXXXXXXXXXXX

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City

25

State ZIP code

Ohio county (first four letters)

26

CITYXXXXXXXXXXXXXXXX

OH 88888

PICK

27

Home address (if different from mailing address) ? do NOT include city or state

ZIP code

Ohio county (first four letters)

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8888 BERRY AVEXXXXXXXXXX

88888

FRAN

29

30

Foreign country (if the mailing address is outside the U.S.)

Foreign postal code

31

JAPANXXXXXXXXXXXXXXX

8888888

32

33

Ohio Residency Status ? Check applicable box

34 35

Full-year

X resident

Part-year

X resident

X NInodnicraetseidsetnatte XX

Filing Status ? Check one (as reported on federal income tax return,

with limited exceptions ? see instructions)

X Single, head of household or qualifying widow(er)

36

Check applicable box for spouse (only if married filing jointly)

37

38

Full-year

X resident

Part-year

X resident

X NInodnicraetseidsetnatte XX

X Married filing jointly X Married filing separately

Yes No

39 40 41 42

Ohio Political Party Fund

Yes No

Do you want $1 to go to this fund? ............................................ X X

If joint return, does your spouse want $1 to go to this fund?..... X X

X X Did you file the federal exNteenwsi!onD4o8n6o8t? p..l.a..c..e....s..p..a..c..e..s....b..e..-......... X X Is someone else claimingitswyoeouennolywr yhaooulserpdsaopcloleaurbsneeutm(wifbejeoerinns.tdTreohtelularrern) as Yes No

a dependent? If yes, entearm"0o"uonntslianned4c..e..n..t.s...fi..e..ld..s.........................

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Note: Checking "Yes" will not increase your tax or decrease your refund.

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1. Federal adjusted gross income (from the federal 1040, line 37; 1040A, line 21;

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1040EZ, line 4; 1040NR, line 36; or 1040FNoRr s-EtaZti,clitneext1u0s)e..A..r..ia..l..f.o..n..t..(.b..la..c..k...in..k..)..a..n..d...t.r.y...t.o................... 1.

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match size. For data entry fields (shown in red

for identification purposes only), use Arial font

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2a. Additions to federal adjusted gross incom(belac(ikncinluk)d.eAOll hthioe Sdacthaeednutlrey Afie, ldinsem1u0s)t..f.o.l.l.o..w................. 2a.

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2b. Deductions from federal adjusted grossginricdomlayeo(uint.clWudheenOhaiofieSldchreedfluelcetsA,alinneeg3a5ti)v.e................. 2b.

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3. Ohio adjusted gross income (line 1 plusathlmineoeau2mnato,ummniatnkauensdsliuntrheee2thnbee)rg.ea..t.iis.v..en..o.s..igs..pn..a...cN..e.e.b.v.ee..rt.w.h..ea.e.r.dn................... 3.

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4. Personal and dependent exemption dedcuocdteioan n(iefgcalatiivmeisniggnd.ependent(s), include Schedule J) ... 4.

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5. Ohio income tax base (line 3 minus line 4; if less than -0-, enter -0-) ........................................... 5.

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6. Taxable business income (include Ohio Schedule IT BUS, line 13).............................................. 6.

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7. Line 5 minus2liDneb6ar(ciof dleessretqhuairned-0. -D, eenletteer t-h0i-s)............................................................................... 7.

54

box with text and replace it with

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the 2D barcode.

88888888888 00

88888888888 00 88888888888 00 88888888888 00

88888 00 88888888888 00

888888888 00 88888888888 00

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Target marks or registration marks

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Include your mfeudsetrmael ainscuorem6emtmaxXre6tmurmn. The

58 59

Do not write in this area; for department use only.

if line 1 of thisforuertutarrngeist m-0a-roksr noer greagtiivsetr.ation marks on every page must follow

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/ / grid layout.

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Postmark date

Code

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2016 IT 1040 ? page 1 of 2

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85

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3

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2016 Ohio IT 1040

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7

Rev. 9/16

8

SSN 888 88 8888

Individual Income Tax Return

9

7a. Amount from line 7 on page 1 ..................................................................................................................7a.

88888888888 00

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8a. Nonbusiness income tax liability on line 7a (see instructions for tax tables)............................................8a.

888888888 00

11

8b. Business income tax liability (include Ohio Schedule IT BUS, line 14) ................................................... 8b.

8888888 00

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8c. Income tax liability before credits (line 8a plus line 8b)........................................................................... 8c.

888888888 00

13

9. Ohio nonrefundable credits (include Ohio Schedule of Credits, line 34).................................................. 9.

888888888 00

14

10. Tax liability after nonrefundable credits (line 8c minus line 9; if less than -0-, enter -0-) ..........................10.

888888888 00

15

11. Interest penalty on underpayment of estimated tax (include Ohio IT/SD 2210)....................................... 11.

888888888 00

16

17

12. Sales and use tax due on Internet, mail order or other out-of-state purchases (see instructions). If you certify that no sales or use tax is due, check the box to the right ........................................

X ...12.

18

13. Total Ohio tax liability before withholding or estimated payments (add lines 10, 11 and 12) ................13.

888888888 00 888888888 00

19

14. Ohio income tax withheld (W-2, box 17; W-2G, box 15; 1099-R, box 12). Include W-2(s), W-2G(s) and

20

1099-R(s) with the return..........................................................................................................................14.

888888888 00

21

15. Estimated and extension payments made (2016 Ohio IT 1040ES and/or IT 40P) and credit

22

carryforward from previous year return ......................................................................................................15.

888888888 00

23

24

16. Refundable credits (include Ohio Schedule of Credits, line 41) ...............................................................16.

25

17. Amended return only ? amount previously paid with original/amended return......................................17.

888888888 00 888888888 00

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27

18. Total Ohio tax payments (add lines 14, 15, 16 and 17) .........................................................................18.

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19. Amended return only ? overpayment previously requested on original/amended return ......................19.

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888888888 00 888888888 00

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20. Line 18 minus line 19 ...............................................................................................................................20.

888888888 00

31

32

33

If line 20 is MORE THAN line 13, skip to line 24. OTHERWISE, continue to line 21.

34

35

21. Tax liability (line 13 minus line 20)............................................................................................................21.

36

22. Interest and penalty due on late filing or late payment of tax (see instructions)...........................................................22.

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23. TOTAL AMOUNT DUE (line 21 plus line 22). Include Ohio IT 40P (if original return) or IT 40XP

38

(if amended return) and make check payable to "Ohio Treasurer of State"........AMOUNT DUE23.

39

40

24. Overpayment (line 20 minus line 13)........................................................................................................24.

41

25. Original return only ? amount of line 24 to be credited toward 2017 income tax liability .........................25.

42

43

26. Amount of line 24 to be donated:

a. Wildlife species

b. Military injury relief

c. Ohio History Fund

44

45

8888 00

8888 00

8888 00

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47

d. State nature preserves e. Breast / cervical cancer f. Wishes for Sick Children

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8888 00

8888 00

8888 00

Total.......26g.

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50

27. YOUR REFUND (line 24 minus lines 25 and 26g) ...................................................YOUR REFUND27.

51

888888888 00 888888888 00 888888888 00 888888888 00 888888888 00

888888888 00 888888888 00

52

53

Sign Here (required): I have read this return. Under penalties of perjury, I declare that, to If your refund is $1.00 or less, no refund will be issued.

54

the best of my knowledge and belief, the return and all enclosures are true, correct and complete. If you owe $1.00 or less, no payment is necessary.

55

56

Your signature

57

Spouse's signature (see instructions)

58

Date (MM/DD/YY) Phone number

NO Payment Included ? Mail to: Ohio Department of Taxation P.O. Box 2679 Columbus, OH 43270-2679

Payment Included ? Mail to:

59

Preparer's printed name (see Instructions) PTIN

Phone number

60

Do you authorize your preparer to contact us regarding this return? X Yes X No

Ohio Department of Taxation P.O. Box 2057

Columbus, OH 43270-2057

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2016 IT 1040 ? page 2 of 2

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66

Grid layout

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85

2

3

4

Do not use staples. Use only black ink and UPPERCASE letters.

5

2016 Ohio IT 1040

6

7

Rev. 9/16

Individual Income Tax Return

8

88 88 88

Note: This form encompasses the IT 1040, IT 1040EZ and amended IT 1040X.

9

10

Is this an amended return? X Yes X No If yes, include Ohio IT RE (do not include a copy of the previously filed return)

11

12

Is this a Net Operating Loss (NOL) carryback? X Yes X No If yes, include Schedule IT NOL

13

Taxpayer's SSN (required)

If deceased Spouse's SSN (if filing jointly)

If deceased Enter school district # for

14

888 88 8888

X

888 88 8888

X

this return (see instructions).

15

check box

check box SD# 8888

16

First name

M.I. Last name

17

JOHNXXXXXXXXXXX

Q PUBL I CXXXXXXXXXXXXXX

18

19

Spouse's first name (only if married filing jointly)

M.I. Last name

20

JANEXXXXXXXXXXX

Q PUBL I CXXXXXXXXXXXXXX

21

Mailing address (for faster processing, use a street address)

22

23

8888 CHERRY LANEXXXXXXXXXXXXXXXXXXX

24

City

25

State ZIP code

Ohio county (first four letters)

26

CITYXXXXXXXXXXXXXXXX

OH 88888

PICK

27

Home address (if different from mailing address) ? do NOT include city or state

ZIP code

Ohio county (first four letters)

28

8888 BERRY AVEXXXXXXXXXX

88888

FRAN

29

30

Foreign country (if the mailing address is outside the U.S.)

Foreign postal code

31

JAPANXXXXXXXXXXXXXXX

8888888

32

33

Ohio Residency Status ? Check applicable box

34 35

Full-year

X resident

Part-year

X resident

X NInodnicraetseidsetnatte XX

Filing Status ? Check one (as reported on federal income tax return,

with limited exceptions ? see instructions)

X Single, head of household or qualifying widow(er)

36

Check applicable box for spouse (only if married filing jointly)

37

38

Full-year

X resident

Part-year

X resident

X NInodnicraetseidsetnatte XX

X Married filing jointly X Married filing separately

Yes No

39 40 41

Ohio Political Party Fund

Yes No

Do you want $1 to go to this fund? ............................................ X X

Did you file the federal extension 4868? ......................................

Is someone else claiming you or your spouse (if joint return) as a dependent? If yes, enter "0" on line 4 ........................................

XX

Yes No

XX

42

If joint return, does your spouse want $1 to go to this fund?..... X X

43

Note: Checking "Yes" will not increase your tax or decrease your refund.

44

1. Federal adjusted gross income (from the federal 1040, line 37; 1040A, line 21;

45

1040EZ, line 4; 1040NR, line 36; or 1040NR-EZ, line 10)................................................................. 1.

46

47

2a. Additions to federal adjusted gross income (include Ohio Schedule A, line 10) ......................... 2a.

48

2b. Deductions from federal adjusted gross income (include Ohio Schedule A, line 35) .................. 2b.

49

3. Ohio adjusted gross income (line 1 plus line 2a minus line 2b) .................................................... 3.

50

4. Personal and dependent exemption deduction (if claiming dependent(s), include Schedule J) ... 4.

51

5. Ohio income tax base (line 3 minus line 4; if less than -0-, enter -0-) ........................................... 5.

52

6. Taxable business income (include Ohio Schedule IT BUS, line 13).............................................. 6.

53

7. Line 5 minus line 6 (if less than -0-, enter -0-)............................................................................... 7.

54

88888888888 00

88888888888 00 88888888888 00 88888888888 00

88888 00 88888888888 00

888888888 00 88888888888 00

55

56

57

Include your federal income tax return

58

Do not write in this area; for department use only.

if line 1 of this return is -0- or negative.

59

60

//

61

Postmark date

Code

62

63

2016 IT 1040 ? page 1 of 2

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85

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3

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2016 Ohio IT 1040

6

7

Rev. 9/16

8

SSN 888 88 8888

Individual Income Tax Return

9

7a. Amount from line 7 on page 1 ..................................................................................................................7a.

88888888888 00

10

8a. Nonbusiness income tax liability on line 7a (see instructions for tax tables)............................................8a.

888888888 00

11

8b. Business income tax liability (include Ohio Schedule IT BUS, line 14) ................................................... 8b.

8888888 00

12

8c. Income tax liability before credits (line 8a plus line 8b)........................................................................... 8c.

888888888 00

13

9. Ohio nonrefundable credits (include Ohio Schedule of Credits, line 34).................................................. 9.

888888888 00

14

10. Tax liability after nonrefundable credits (line 8c minus line 9; if less than -0-, enter -0-) ..........................10.

888888888 00

15

11. Interest penalty on underpayment of estimated tax (include Ohio IT/SD 2210)....................................... 11.

888888888 00

16

17

12. Sales and use tax due on Internet, mail order or other out-of-state purchases (see instructions). If you certify that no sales or use tax is due, check the box to the right ........................................

X ...12.

18

13. Total Ohio tax liability before withholding or estimated payments (add lines 10, 11 and 12) ................13.

888888888 00 888888888 00

19

14. Ohio income tax withheld (W-2, box 17; W-2G, box 15; 1099-R, box 12). Include W-2(s), W-2G(s) and

20

1099-R(s) with the return..........................................................................................................................14.

888888888 00

21

15. Estimated and extension payments made (2016 Ohio IT 1040ES and/or IT 40P) and credit

22

carryforward from previous year return ......................................................................................................15.

888888888 00

23

24

16. Refundable credits (include Ohio Schedule of Credits, line 41) ...............................................................16.

25

17. Amended return only ? amount previously paid with original/amended return......................................17.

888888888 00 888888888 00

26

27

18. Total Ohio tax payments (add lines 14, 15, 16 and 17) .........................................................................18.

28

19. Amended return only ? overpayment previously requested on original/amended return ......................19.

29

888888888 00 888888888 00

30

20. Line 18 minus line 19 ...............................................................................................................................20.

888888888 00

31

32

33

If line 20 is MORE THAN line 13, skip to line 24. OTHERWISE, continue to line 21.

34

35

21. Tax liability (line 13 minus line 20)............................................................................................................21.

36

22. Interest and penalty due on late filing or late payment of tax (see instructions)...........................................................22.

37

23. TOTAL AMOUNT DUE (line 21 plus line 22). Include Ohio IT 40P (if original return) or IT 40XP

38

(if amended return) and make check payable to "Ohio Treasurer of State"........AMOUNT DUE23.

39

40

24. Overpayment (line 20 minus line 13)........................................................................................................24.

41

25. Original return only ? amount of line 24 to be credited toward 2017 income tax liability .........................25.

42

43

26. Amount of line 24 to be donated:

a. Wildlife species

b. Military injury relief

c. Ohio History Fund

44

45

8888 00

8888 00

8888 00

46

47

d. State nature preserves e. Breast / cervical cancer f. Wishes for Sick Children

48

8888 00

8888 00

8888 00

Total.......26g.

49

50

27. YOUR REFUND (line 24 minus lines 25 and 26g) ...................................................YOUR REFUND27.

51

888888888 00 888888888 00 888888888 00 888888888 00 888888888 00

888888888 00 888888888 00

52

53

Sign Here (required): I have read this return. Under penalties of perjury, I declare that, to If your refund is $1.00 or less, no refund will be issued.

54

the best of my knowledge and belief, the return and all enclosures are true, correct and complete. If you owe $1.00 or less, no payment is necessary.

55

56

Your signature

57

Spouse's signature (see instructions)

58

Date (MM/DD/YY) Phone number

NO Payment Included ? Mail to: Ohio Department of Taxation P.O. Box 2679 Columbus, OH 43270-2679

Payment Included ? Mail to:

59

Preparer's printed name (see Instructions) PTIN

Phone number

60

Do you authorize your preparer to contact us regarding this return? X Yes X No

Ohio Department of Taxation P.O. Box 2057

Columbus, OH 43270-2057

61

62

63

2016 IT 1040 ? page 2 of 2

64

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66

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