12/15/16

2D Schema, Test 

Scenarios and Instructions 

2016 Ohio IT 
                                   1040, 

Schedules & SD100

                     Important Note

 This document contains the schema, test scenarios and instructions 
needed  to  assist  vendors  with  the  development  of  the  IT  1040, 
Schedule  A,  Business  Income  Schedule,  Schedule  of  Credits, 
Schedule J and SD100.

                     Ohio Department of Taxation

                     4485 Northland Ridge Blvd.

                     Columbus, OH 43229

                     tax.ohio.gov

              2016 Ohio IT 1040, Associated Schedules and SD100 

                                 2D Barcode Instructions 

  General Information 
            • The Ohio 1040, associated schedules and SD100 must be enabled for 2D Barcode decoding
            • A form enabled for 2D Barcode should not allow users or practitioners the option to turn off/on
              the 2D Barcode function
            • The minimum error correction code level is 4
            • Products must not print a 2D barcode prior to being approved in Ohio

  2D Barcode Size and Placement on the Form 
            • 2D Barcode must be placed on each page of form in the designated area indicated in the grid
              layout 
            • The maximum size of the 2D Barcode is 3.5 inches wide by 1 inch in height and must fit within the
              designated space in the grid layout 
            • 2D Barcode must not be bigger than the allocated area

  2D Barcode Layout 
            • Each field in the barcode is delimited by a single carriage return
              o <CR> equals single carriage return character
              o This separates each piece of data so it may be identified and processed.
            • Data included in the 2D Barcode can be broken down into three general sections

       Header 
              Header Version Number 
                •    Static for all Barcodes, value is T1
              Developer Code 
                •    A four-digit vendor code identifying the software developer whose application produced
                     the Barcode 
              Jurisdiction 
                •    Static for all Barcodes, value is OH
              Description 
                •    A four-digit form identifier, specific to each form
              Spec Version 
                •    A one-digit specification version control number starting with the number zero
                •    This number identifies the version of the specifications used to produce the form Barcode
              Form Version 
                •    A one-digit form version control number starting with the number one (1)
                •    This number will only be incremented when there are changes made that would affect
                     the content of the Barcode
              Date Generated 
                •    Included on page 1 only
                •    Indicates date return was generated from the product
Page 1 of 3 
12 15/ /16 

Form Specific Data – Please see encoding schemas for form specific data 
              • All fields on forms are required and must be included in the 2D Barcode
              • Fields with values are represented by the data followed by a carriage return
              • Fields with no values are represented by a carriage return only; this results in two adjacent
                carriage returns
              • The 2D barcode on page 1 of the 1040 also includes data for the Schedule J
              • The Business Income Schedule has 18 entity lines. Generate duplicate copies of page 2 to
                accommodate any additional entities, however omit the 1D and 2D barcodes from the
                duplicate pages if possible.
              • The Schedule J has 15 dependent lines. Generate duplicate copies of page 2 to accommodate
                any additional dependents, however omit the 1D and 2D barcodes from the duplicate pages if
                possible.

Trailer 
              • The last field in the Barcode data stream is the trailer
              • The trailer is used to indicate the end of data has been reached
              • A static string of *EOD* is used as the trailer value

Examples of 2D Barcode data streams 
              Header Version Number         T1<CR> 
              Developer Code                1111<CR> 
              Jurisdiction                  OH<CR> 
              Description                   1600<CR> 
              Spec Version                  0<CR> 
              Form Version                  1<CR> 
              Date Generated                011516<CR> 
              Line Item Specific Data       IN<CR>  
              Line Item Specific Data       IT40<CR> 
              Line Item Specific Data       0<CR> 
              Trailer                       *EOD* <CR>

Submission Process 
            • The deadline for submitting test packets is December 16,2016
            • Test packets may be submitted by email to Forms@tax.state.oh.us
            • The email subject line must include the vendor number, product name, tax year and form number
              in that order  e.g. 12_ABCTax_ 16_1040
            • Submissions must include
              • Ohio form STF- Approval Request for Scannable Tax Forms
              • One (1) full field sample in a PDF format
              • Sixteen (16) test scenarios provided by the Ohio Department of Taxation
                •     Each test scenario must be in a separate PDF using the following naming convention:
                      vendor number, product name, tax year, form number, test number
                      e.g.12_ABCTax_16_1040_Test 1
            • An emailed confirmation is sent to the vendor indicating the packet was received
            • Submissions found to be missing any of the items above are rejected
Page 2 of 3 
12/15/16 

Testing Process 

            • Testing of packets commences on December 12, 2016
            • Test packets are reviewed in two (2) content areas- Printed Forms and 2D Barcode Data
            • A submission is approved in its entirety once all sample documents pass in both areas

Printed forms 
               • Vendor full field matches template provided in the specifications
               • All fields are present, are formatted properly and align with grid layout
               • Test scenarios contain values specified by Ohio Department of Taxation

2D Barcode Data 
               • Barcodes read as valid
               • All test scenarios can be decoded
               • 2D Barcode data matches data on printed forms

Notifications 
            • Communications from the Ohio Department of Taxation regarding submissions are sent from
              Forms@tax.state.oh.us  to the vendor email address(es) on file for the product 
            • Vendor contact information is compiled from STF- Approval Request for Scannable Tax Forms but
              may also be submitted by email to the address above. 
            • If unapproved forms are released in software packages, vendors must include a visual indicator
              signifying the return cannot be filed. 
            • If unapproved forms are released in software packages, vendors must ensure that taxpayers
              cannot print returns containing 2D barcodes. 
            • An emailed confirmation is sent to the vendor indicating the packet was approved, at which point
              the product is authorized to print with a 2D barcode. 
            • An emailed confirmation is sent to the vendor for packets that are rejected
               • Feedback is provided regarding the errors found
               • Resubmit packets must include all test scenarios and the full field return
               • After the third submission of test materials, the department cannot guarantee timeliness
                 of the review
            • If a tax form changes before January 1, 2017 vendors will be notified and required to submit
              revised test packets.

Page 3 of 3 
12/15/16 

                                                 2016 Ohio 1040, Associated Schedules and SD100 Scenarios
                                                        Testing Information for Paper Returns ONLY 
                                                   If any questions, please e-mail Forms@tax.state.oh.us

       Note:  If there are any limitations to your software that will not allow you to follow the tests, please indicate what these are on a separate sheet of paper. 
Important Notes 
• The two-digit vendor number is used for the "XX" in the SSN field
• Vendors must submit a full field version and all test scenarios. 
• Please proof the static text and test the 1D barcodes prior to submission
• Data values on the printed form and in the 2D barcode must match each scenario
• For the Date Generated field (new for 2016) use date the scenario was created by your staff

Updates for Tax Year 2016
Personal and Dependent Exemption amounts are indexed for tax year 2016.  If Ohio Adjusted Gross Income is: 
•  Less than or equal to $40,000, the exemption amount is $2250.
•  Greater than $40,000 but less than or equal to $80,000, the exemption amount is $2,000.
•  Greater than $80,000, the exemption amount is $1,750.
IT 1040
Donation for Ohio History Connection is changing names to Ohio History Fund.
Ohio Schedule A
Line Removed - Lump Sum Distribution add-back  
New Line – Amounts contributed to a STABLE account, Ohio’s ABLE plan, (deduction)
Ohio Schedule of Credits 
•  Name Change: Ohio Political Contribution credit is changing names to Campaign Contribution Credit.
•  Line Removed: Credit for Certified Ethanol Plant Investments
•  Line Removed: Manufacturing Equipment Grant
•  New Line: Credit for Technology Investment Credit Carryforward
•  New Line: Venture Capital Credit 
•  The refundable credit section will have individual elements for each credit
Ohio Schedule IT BUS
•  Guaranteed Payments line item added as a separate entry after Schedule E, Supplemental Income and Loss.
•  The business income deduction is limited to $250,000 for a taxpayer with a filing status of single or married filing jointly and 
  $125,000 for a taxpayer with a filing status of married filing separately. 
•  Taxable business income is calculated at a rate of 3% (.03).
•  Calculations changed to reflect the fact that the deduction is no longer limited to 75% of the $250,000/$125,000
School District Income Tax Rates -  New and Changed
•  Ledgemont LSD #2805, merged into Berkshire LSD #2801 on 7/1/ 2015.
•  Northeastern LSD #1203 has a rate of 1.00%.
•  Zane Trace LSD #7107 has a rate of .75%
•  Edon-Northwest LSD #8603 has a rate of 1.00%
•  Kenton CSD #3303 has a rate change of 1.00%
•  Danville LSD #4202 has a rate change of 1.50%

                                                                               2016
                                         IT 1040 2D BARCODE AND SCHEDULE A SCHEMA
Sl. No Page                Field name\Line Item      Max Chars                                                         Field Format
1      N/A    header_version_number                  2         Always T1 
2      N/A    developer_code                         4         Vendor’s NACTP code 
3      N/A    jurisdiction                           2         Always: OH 
4      N/A    description                            4         form code: 1600
5      N/A    spec version                           1         At this time: 0 
6      N/A    form version                           1         At this time: 1 
7      N/A    Date_Generated                         6         Numeric; MMDDYY Format
8      Page 1 year                                   4         2016
9      Page 1 amended_return                         1         Numeric; 1 = Amended, 0 = Original
10     Page 1 NOL_Carryback                          1         Alpha,  Y or N, Uppercase
11     Page 1 taxpayer_ssn                           9         Numeric
12     Page 1 taxpayer_deceased                      1         1 = Yes,  0= No
13     Page 1 spouse_ssn                             9         Numeric 
14     Page 1 spouse_deceased                        1         1 = Yes,  0= No
15     Page 1 taxpayer_school-district-number        4         Numeric
16     Page 1 taxpayer_firstname                     15        Alpha
17     Page 1 taxpayer_middle_initial                1         Alpha
18     Page 1 taxpayer_lastname                      22        Alpha
19     Page 1 spouse_firstname                       15        Alpha
20     Page 1 spouse_middle_initial                  1         Alpha
21     Page 1 spouse_lastname                        22        Alpha
22     Page 1 taxpayer_address                       35        Alpha-Numeric
23     Page 1 taxpayer_city                          20        Alpha
24     Page 1 taxpayer_state                         2         Alpha
25     Page 1 taxpayer_zip                           5         Numeric
26     Page 1 taxpayer_Ohio_county                   4         Alpha, First 4 characters of county name, Uppercase
27     Page 1 home_address                           24        Alpha-Numeric
28     Page 1 home_zip                               5         Numeric
29     Page 1 home_Ohio_county                       4         Alpha, First 4 characters of county name, Uppercase
30     Page 1 foreign_country                        20        Alpha, First 20 characters of foreign country, Uppercase
31     Page 1 foreign_postal_code                    7         Alpha-Numeric
32     Page 1 primary_residency_status               1         Numeric, Resident = 1, Part-year Resident=2, Non-Resident=3
33     Page 1 primary_nonresident_state              2         Alpha
34     Page 1 spouse_residency_status                1         Numeric, Resident = 1, Part-year Resident=2, Non-Resident=3, Only use if married filing jointly return
35     Page 1 spouse_nonresident_state               2         Alpha
36     Page 1 taxpayer_fund_contribution             1         Alpha , Y or N , Uppercase
37     Page 1 spouse_fund_contribution               1         Alpha , Y or N , Uppercase
38     Page 1 filing_status                          1         Numeric : Single=1, Jointly=2, or Separately=3
39     Page 1 Extension 4868 Filed                   1         Alpha , Y or N , Uppercase
40     Page 1 being_claimed_as_dependent             1         Alpha , Y or N , Uppercase
41     Page 1 negative_indicator_for_line_item_one   1         Numeric : 1 for negative , 0 for non-negative
42     Page 1 Line  Item 1                           11        Numeric: Send Dollars Only; If negative amount use negative indicator field.  DO NOT PUT NEGATIVE SIGN IN THIS FIELD
43     Page 1 Line Item 2a                           11        Numeric; Send Dollars Only
44     Page 1 Line Item 2b                           11        Numeric; Send Dollars Only
45     Page 1 negative_indicator_for_line_item_three 1         Numeric ;1 for negative , 0 for non-negative
46     Page 1 Line Item 3                            11        Numeric; Send Dollars Only  DO NOT PUT NEGATIVE SIGN IN THIS FIELD
47     Page 1 Line Item  4                           5         Numeric; Send Dollars Only
48     Page 1 Line Item 5                            11        Numeric; Send Dollars Only
49     Page 1 Line Item 6                            9         Numeric; Send Dollars Only
50     Page 1  Line Item 7                           11        Numeric; Send Dollars Only
51     Page 2 Line Item 7a                           11        Numeric; Send Dollars Only
52     Page 2 Line Item 8a                           9         Numeric; Send Dollars Only
53     Page 2 Line Item 8b                           7         Numeric; Send Dollars Only
54     Page 2 Line Item 8c                           9         Numeric; Send Dollars Only
55     Page 2 Line Item 9                            9         Numeric; Send Dollars Only
56     Page 2 Line Item 10                           9         Numeric; Send Dollars Only
57     Page 2 Line Item 11                           9         Numeric; Send Dollars Only
58     Page 2 Sales/Use Tax Indicator                1         Alpha , Y or N , Uppercase
59     Page 2 Line Item 12                           9         Numeric; Send Dollars Only
60     Page 2 Line Item 13                           9         Numeric; Send Dollars Only
61     Page 2 Line Item 14                           9         Numeric; Send Dollars Only

12/15/2016                                                                                                                                                           Page 1 of 2

                                                                             2016
                                           IT 1040 2D BARCODE AND SCHEDULE A SCHEMA
Sl. No Page           Field name\Line Item            Max Chars                                              Field Format
62     Page 2 Line Item 15                            9         Numeric; Send Dollars Only
63     Page 2 Line Item 16                            9         Numeric; Send Dollars Only
64     Page 2 Line Item 17 - Amended Only             9         Numeric; Send Dollars Only
65     Page 2 Line Item 18                            9         Numeric; Send Dollars Only
66     Page 2 Line Item 19 - Amended Only             9         Numeric; Send Dollars Only
67     Page 2 negative_indicator_for_line_item_twenty 1         Numeric : 1 for negative , 0 for non-negative
68     Page 2 Line Item 20                            9         Numeric; Send Dollars Only DO NOT PUT NEGATIVE SIGN IN THIS FIELD
69     Page 2 Line Item 21                            9         Numeric; Send Dollars Only
70     Page 2 Line Item 22                            9         Numeric; Send Dollars Only
71     Page 2 Line Item 23                            9         Numeric; Send Dollars Only
72     Page 2 Line Item 24                            9         Numeric; Send Dollars Only
73     Page 2 Line Item 25 - Original Only            9         Numeric; Send Dollars Only
74     Page 2 Line Item 26a                           4         Numeric; Send Dollars Only
75     Page 2 Line Item 26b                           4         Numeric; Send Dollars Only
76     Page 2 Line Item 26c                           4         Numeric; Send Dollars Only
77     Page 2 Line Item 26d                           4         Numeric; Send Dollars Only
78     Page 2 Line Item 26e                           4         Numeric; Send Dollars Only
79     Page 2 Line Item 26f                           4         Numeric; Send Dollars Only
80     Page 2 Line Item 26g                           9         Numeric; Send Dollars Only
81     Page 2 Line Item 27                            9         Numeric; Send Dollars Only
82     Page 3 Sch-A_Line 1                            9         Numeric - Send Dollars Only
83     Page 3 Sch-A_Line 2                            9         Numeric - Send Dollars Only
84     Page 3 Sch-A_Line 3                            6         Numeric - Send Dollars Only
85     Page 3 Sch-A_Line 4                            9         Numeric - Send Dollars Only
86     Page 3 Sch-A_Line 5                            9         Numeric - Send Dollars Only
87     Page 3 Sch-A_Line 6                            9         Numeric - Send Dollars Only
88     Page 3 Sch-A_Line 7                            9         Numeric - Send Dollars Only
89     Page 3 Sch-A_Line 8                            9         Numeric - Send Dollars Only
90     Page 3 Sch-A_Line 9                            9         Numeric - Send Dollars Only
91     Page 3 Sch-A_Line 10                           11        Numeric - Send Dollars Only
92     Page 3 Sch-A_Line 11                           6         Numeric - Send Dollars Only
93     Page 3 Sch-A_Line 12                           9         Numeric - Send Dollars Only
94     Page 3 Sch-A_Line 13                           9         Numeric - Send Dollars Only
95     Page 3 Sch-A_Line 14                           9         Numeric - Send Dollars Only
96     Page 3 Sch-A_Line 15                           9         Numeric - Send Dollars Only
97     Page 3 Sch-A_Line 16                           9         Numeric - Send Dollars Only
98     Page 3 Sch-A_Line 17                           9         Numeric - Send Dollars Only
99     Page 3 Sch-A_Line 18                           9         Numeric - Send Dollars Only
100    Page 3 Sch-A_Line 19                           9         Numeric - Send Dollars Only
101    Page 3 Sch-A_Line 20                           9         Numeric - Send Dollars Only
102    Page 3 Sch-A_Line 21                           9         Numeric - Send Dollars Only
103    Page 3 Sch-A_Line 22                           9         Numeric - Send Dollars Only
104    Page 4 Sch-A_Line 23                           9         Numeric - Send Dollars Only
105    Page 4 Sch-A_Line 24                           9         Numeric - Send Dollars Only
106    Page 4 Sch-A_Line 25                           9         Numeric - Send Dollars Only
107    Page 4 Sch-A_Line 26                           9         Numeric - Send Dollars Only
108    Page 4 Sch-A_Line 27                           9         Numeric - Send Dollars Only
109    Page 4 Sch-A_Line 28                           9         Numeric - Send Dollars Only
110    Page 4 Sch-A_Line 29                           6         Numeric - Send Dollars Only
111    Page 4 Sch-A_Line 30                           6         Numeric - Send Dollars Only
112    Page 4 Sch-A_Line 31                           9         Numeric - Send Dollars Only
113    Page 4 Sch-A_Line 32                           9         Numeric - Send Dollars Only
114    Page 4 Sch-A_Line 33                           9         Numeric - Send Dollars Only
115    Page 4 Sch-A_Line 34                           5         Numeric - Send Dollars Only
116    Page 4 Sch-A_Line 35                           11        Numeric - Send Dollars Only
117    N/A    trailer                                 5         Always *EOD* 
                              Total Bytes/Characters  886
              General Fields
              Demographic Fields
              Line Item Fields

12/15/2016                                                                                                                       Page 2 of 2

                                                     2016 
                      OHIO BUSINESS INCOME SCHEDULE 2D BARCODE SCHEMA

Sl. No Page                Field name\Line item      Max chars                       Field Format
1      N/A    header_version_number                  2         Always T1
2      N/A    developer_code                         4         Vendor’s NACTP Code
3      N/A    jurisdiction                           2         Always OH
4      N/A    description                            4         Form Code 1626
5      N/A    spec version                           1         At this time 0
6      N/A    form version                           1         At this time 1
7      N/A    Date_Generated                         6         Numeric; MMDDYY Format
8      Page 1 year                                   4         2016
9      Page 1 Pri_SSN                                9         Numeric
10     Page 1 Earned Income TaxPayer                 1         Numeric; 1 for Primary, 2 for Spouse, 3 for Both
11     Page 1 Line 1                                 9         Numeric
12     Page 1 negative_indicator_for_line_item_two   1         Numeric; 1 for negative , 0 for non-negative
13     Page 1 Line 2                                 9         Numeric; DO NOT PUT NEGATIVE SIGN IN THIS FIELD
14     Page 1 negative_indicator_for_line_item_three 1         Numeric; 1 for negative , 0 for non-negative
15     Page 1 Line 3                                 9         Numeric; DO NOT PUT NEGATIVE SIGN IN THIS FIELD
16     Page 1 negative_indicator_for_line_item_four  1         Numeric; 1 for negative , 0 for non-negative
17     Page 1 Line 4                                 9         Numeric; DO NOT PUT NEGATIVE SIGN IN THIS FIELD
18     Page 1 Line 5                                 9         Numeric
19     Page 1 negative_indicator_for_line_item_six   1         Numeric; 1 for negative , 0 for non-negative
20     Page 1 Line 6                                 9         Numeric; DO NOT PUT NEGATIVE SIGN IN THIS FIELD
21     Page 1 negative_indicator_for_line_item_seven 1         Numeric; 1 for negative , 0 for non-negative
22     Page 1 Line 7                                 9         Numeric; DO NOT PUT NEGATIVE SIGN IN THIS FIELD
23     Page 1 negative_indicator_for_line_item_eight 1         Numeric; 1 for negative , 0 for non-negative
24     Page 1 Line 8                                 9         Numeric; DO NOT PUT NEGATIVE SIGN IN THIS FIELD
25     Page 1 negative_indicator_for_line_item_nine  1         Numeric; 1 for negative , 0 for non-negative
26     Page 1 Line 9                                 9         Numeric; DO NOT PUT NEGATIVE SIGN IN THIS FIELD
27     Page 1 Line 10                                6         Numeric
28     Page 1 Line 11                                6         Numeric
29     Page 1 Line 12                                9         Numeric
30     Page 1 Line 13                                9         Numeric
31     Page 1 Line 14                                7         Numeric
32     Page 2 Pri_SSN                                9         Numeric
33     Page 2 Ent1_Name                              20        Alpha
34     Page 2 Ent1_FEIN                              9         Numeric
35     Page 2 Ent1_Percentage                        5         Numeric; Do Not Include Decimal Point
36     Page 2 Ent2_Name                              20        Alpha
37     Page 2 Ent2_FEIN                              9         Numeric
38     Page 2 Ent2_Percentage                        5         Numeric; Do Not Include Decimal Point
39     Page 2 Ent3_Name                              20        Alpha
40     Page 2 Ent3_FEIN                              9         Numeric
41     Page 2 Ent3_Percentage                        5         Numeric; Do Not Include Decimal Point
42     Page 2 Ent4_Name                              20        Alpha
43     Page 2 Ent4_FEIN                              9         Numeric
44     Page 2 Ent4_Percentage                        5         Numeric; Do Not Include Decimal Point
45     Page 2 Ent5_Name                              20        Alpha
46     Page 2 Ent5_FEIN                              9         Numeric

12/15/2016                                                                                                     Page 1 of 2

              2016 OHIO BUSINESS INCOME SCHEDULE - 2D BARCODE SCHEMA

Sl. No Page              Field name\Line item         Max chars              Field Format
47     Page 2 Ent5_Percentage                         5         Numeric; Do Not Include Decimal Point
48     Page 2 Ent6_Name                               20        Alpha
49     Page 2 Ent6_FEIN                               9         Numeric
50     Page 2 Ent6_Percentage                         5         Numeric; Do Not Include Decimal Point
51     Page 2 Ent7_Name                               20        Alpha
52     Page 2 Ent7_FEIN                               9         Numeric
53     Page 2 Ent7_Percentage                         5         Numeric; Do Not Include Decimal Point
54     Page 2 Ent8_Name                               20        Alpha
55     Page 2 Ent8_FEIN                               9         Numeric
56     Page 2 Ent8_Percentage                         5         Numeric; Do Not Include Decimal Point
57     Page 2 Ent9_Name                               20        Alpha
58     Page 2 Ent9_FEIN                               9         Numeric
59     Page 2 Ent9_Percentage                         5         Numeric; Do Not Include Decimal Point
60     Page 2 Ent10_Name                              20        Alpha
61     Page 2 Ent10_FEIN                              9         Numeric
62     Page 2 Ent10_Percentage                        5         Numeric; Do Not Include Decimal Point
63     Page 2 Ent11_Name                              20        Alpha
64     Page 2 Ent11_FEIN                              9         Numeric
65     Page 2 Ent11_Percentage                        5         Numeric; Do Not Include Decimal Point
66     Page 2 Ent12_Name                              20        Alpha
67     Page 2 Ent12_FEIN                              9         Numeric
68     Page 2 Ent12_Percentage                        5         Numeric; Do Not Include Decimal Point
69     Page 2 Ent13_Name                              20        Alpha
70     Page 2 Ent13_FEIN                              9         Numeric
71     Page 2 Ent13_Percentage                        5         Numeric; Do Not Include Decimal Point
72     Page 2 Ent14_Name                              20        Alpha
73     Page 2 Ent14_FEIN                              9         Numeric
74     Page 2 Ent14_Percentage                        5         Numeric; Do Not Include Decimal Point
75     Page 2 Ent15_Name                              20        Alpha
76     Page 2 Ent15_FEIN                              9         Numeric
77     Page 2 Ent15_Percentage                        5         Numeric; Do Not Include Decimal Point
78     Page 2 Ent16_Name                              20        Alpha
79     Page 2 Ent16_FEIN                              9         Numeric
80     Page 2 Ent16_Percentage                        5         Numeric; Do Not Include Decimal Point
81     Page 2 Ent17_Name                              20        Alpha
82     Page 2 Ent17_FEIN                              9         Numeric
83     Page 2 Ent17_Percentage                        5         Numeric; Do Not Include Decimal Point
84     Page 2 Ent18_Name                              20        Alpha
85     Page 2 Ent18_FEIN                              9         Numeric
86     Page 2 Ent18_Percentage                        5         Numeric; Do Not Include Decimal Point
87     N/A    trailer                                 5         Always *EOD* 
                               Total Bytes/Characters 785

                                              General Fields

                                              Entity Fields

                                              Line Item Fields

12/15/2016                                                                                           Page 2 of 2

                                        2016 
                  SCHEDULE OF CREDITS 2D BARCODE SCHEMA

Sl. No     Page           Field name\Line item Max Chars               Field Format
1          N/A    header_version_number        2         Always T1
2          N/A    developer_code               4         Vendor’s NACTP Code
3          N/A    jurisdiction                 2         Always OH
4          N/A    description                  4         Form Code 1628
5          N/A    spec version                 1         At this time 0
6          N/A    form version                 1         At this time 1
7          N/A    Date_Generated               6         Numeric; MMDDYY Format
8          Page 1 year                         4         2016
9          Page 1 Primary SSN                  9         Numeric
10         Page 1 Line 1                       9         Numeric - Send Dollars Only
11         Page 1 Line 2                       3         Numeric - Send Dollars Only
12         Page 1 Line 3                       6         Numeric - Send Dollars Only
13         Page 1 Line 4                       2         Numeric - Send Dollars Only
14         Page 1 Line 5                       4         Numeric - Send Dollars Only
15         Page 1 Line 6                       4         Numeric - Send Dollars Only
16         Page 1 Line 7                       2         Numeric - Send Dollars Only
17         Page 1 Line 8                       4         Numeric - Send Dollars Only
18         Page 1 Line 9                       3         Numeric - Send Dollars Only
19         Page 1 Line 10                      3         Numeric - Send Dollars Only
20         Page 1 Line 11                      9         Numeric - Send Dollars Only
21         Page 1 Line 12                      9         Numeric - Send Dollars Only
22         Page 1 Line 13                      3         Numeric - Send Dollars Only
23         Page 1 Line 14                      3         Numeric - Send Dollars Only
24         Page 1 Line 15                      5         Numeric - Send Dollars Only
25         Page 1 Line 16                      7         Numeric - Send Dollars Only
26         Page 1 Line 17                      7         Numeric - Send Dollars Only
27         Page 1 Line 18                      7         Numeric - Send Dollars Only
28         Page 1 Line 19                      7         Numeric - Send Dollars Only
29         Page 1 Line 20                      7         Numeric - Send Dollars Only
30         Page 1 Line 21                      7         Numeric - Send Dollars Only
31         Page 1 Line 22                      7         Numeric - Send Dollars Only
32         Page 1 Line 23                      7         Numeric - Send Dollars Only
33         Page 1 Line 24                      7         Numeric - Send Dollars Only
34         Page 1 Line 25                      9         Numeric - Send Dollars Only
35         Page 2 Primary SSN                  9         Numeric
36         Page 2 From Date of Non-Res         6         Numeric - MMDDYY
37         Page 2 To Date of Non-Res           6         Numeric - MMDDYY
38         Page 2 State of Residency           2         Alpha

12/15/2016                                                                          Page 1 of 2

                          2016 SCHEDULE OF CREDITS
                          2D BARCODE SCHEMA

Sl. No     Page           Field name\Line item   Max Chars                    Field Format
39         Page 2 Line 26                        9               Numeric - Send Dollars Only
40         Page 2 Line 27                        9               Numeric - Send Dollars Only
41         Page 2 Line 28                        9               Numeric - Send Dollars Only
42         Page 2 Line 29                        9               Numeric - Send Dollars Only
43         Page 2 Line 30                        9               Numeric - Send Dollars Only
44         Page 2 Line 31                        9               Numeric - Send Dollars Only
45         Page 2 Line 32                        9               Numeric - Send Dollars Only
46         Page 2 Line 33                        9               Numeric - Send Dollars Only
47         Page 2 Line 34                        9               Numeric - Send Dollars Only
48         Page 2 Line 35                        8               Numeric - Send Dollars Only
49         Page 2 Line 36                        8               Numeric - Send Dollars Only
50         Page 2 Line 37                        8               Numeric - Send Dollars Only
51         Page 2 Line 38                        8               Numeric - Send Dollars Only
52         Page 2 Line 39                        8               Numeric - Send Dollars Only
53         Page 2 Line 40                        8               Numeric - Send Dollars Only
54         Page 2 Line 41                        9               Numeric - Send Dollars Only
55         N/A    trailer                        5               Always *EOD* 
                          Total Bytes/Characters 340

                                                 General Fields

                                                 Line Item Fields

12/15/2016                                                                                  Page 2 of 2

                                                    2016
                                 SCHEDULE J 2D BARCODE SCHEMA

Sl. No     Page                Field name\Line Item     Max Chars                 Field Format
1          N/A    header_version_number                 2         Always T1 
2          N/A    developer_code                        4         Vendor’s NACTP code 
3          N/A    jurisdiction                          2         Always: OH 
4          N/A    description                           4         form code: 1623
5          N/A    spec version                          1         At this time: 0 
6          N/A    form version                          1         At this time: 1 
7          N/A    Date_Generated                        6         Numeric; MMDDYY Format
8          Page 1 year                                  4         2016
9          Page 1 taxpayer_ssn                          9         Numeric
10         Page 1 Dep1_SSN                              9         Numeric
11         Page 1 Dep1_BD                               8         Numeric; MMDDCCYY Format
12         Page 1 Dep1_Relation                         15        Alpha
13         Page 1 Dep1_First_Name                       15        Alpha
14         Page 1 Dep1_Mid_Initial                      1         Alpha
15         Page 1 Dep1_Last_Name                        20        Alpha
16         Page 1 Dep2_SSN                              9         Numeric
17         Page 1 Dep2_BD                               8         Numeric; MMDDCCYY Format
18         Page 1 Dep2_Relation                         15        Alpha
19         Page 1 Dep2_First_Name                       15        Alpha
20         Page 1 Dep2_Mid_Initial                      1         Alpha
21         Page 1 Dep2_Last_Name                        20        Alpha
22         Page 1 Dep3_SSN                              9         Numeric
23         Page 1 Dep3_BD                               8         Numeric; MMDDCCYY Format
24         Page 1 Dep3_Relation                         15        Alpha
25         Page 1 Dep3_First_Name                       15        Alpha
26         Page 1 Dep3_Mid_Initial                      1         Alpha
27         Page 1 Dep3_Last_Name                        20        Alpha
28         Page 1 Dep4_SSN                              9         Numeric
29         Page 1 Dep4_BD                               8         Numeric; MMDDCCYY Format
30         Page 1 Dep4_Relation                         15        Alpha
31         Page 1 Dep4_First_Name                       15        Alpha
32         Page 1 Dep4_Mid_Initial                      1         Alpha
33         Page 1 Dep4_Last_Name                        20        Alpha
34         Page 1 Dep5_SSN                              9         Numeric
35         Page 1 Dep5_BD                               8         Numeric; MMDDCCYY Format
36         Page 1 Dep5_Relation                         15        Alpha
37         Page 1 Dep5_First_Name                       15        Alpha

12/15/2016                                                                                    Page 1 of 3

                                                2016
                                    Schedule J 2D Barcode Schema

Sl. No     Page            Field name\Line Item     Max Chars          Field Format

38         Page 1 Dep5_Mid_Initial                  1           Alpha
39         Page 1 Dep5_Last_Name                    20          Alpha
40         Page 1 Dep6_SSN                          9           Numeric
41         Page 1 Dep6_BD                           8           Numeric; MMDDCCYY Format
42         Page 1 Dep6_Relation                     15          Alpha
43         Page 1 Dep6_First_Name                   15          Alpha
44         Page 1 Dep6_Mid_Initial                  1           Alpha
45         Page 1 Dep6_Last_Name                    20          Alpha
46         Page 1 Dep7_SSN                          9           Numeric
47         Page 1 Dep7_BD                           8           Numeric; MMDDCCYY Format
48         Page 1 Dep7_Relation                     15          Alpha
49         Page 1 Dep7_First_Name                   15          Alpha
50         Page 1 Dep7_Mid_Initial                  1           Alpha
51         Page 1 Dep7_Last_Name                    20          Alpha
52         Page 2 taxpayer_ssn                      9           Numeric
53         Page 2 Dep8_SSN                          9           Numeric
54         Page 2 Dep8_BD                           8           Numeric; MMDDCCYY Format
55         Page 2 Dep8_Relation                     15          Alpha
56         Page 2 Dep8_First_Name                   15          Alpha
57         Page 2 Dep8_Mid_Initial                  1           Alpha
58         Page 2 Dep8_Last_Name                    20          Alpha
59         Page 2 Dep9_SSN                          9           Numeric
60         Page 2 Dep9_BD                           8           Numeric; MMDDCCYY Format
61         Page 2 Dep9_Relation                     15          Alpha
62         Page 2 Dep9_First_Name                   15          Alpha
63         Page 2 Dep9_Mid_Initial                  1           Alpha
64         Page 2 Dep9_Last_Name                    20          Alpha
65         Page 2 Dep10_SSN                         9           Numeric
66         Page 2 Dep10_BD                          8           Numeric; MMDDCCYY Format
67         Page 2 Dep10_Relation                    15          Alpha
68         Page 2 Dep10_First_Name                  15          Alpha
69         Page 2 Dep10_Mid_Initial                 1           Alpha
70         Page 2 Dep10_Last_Name                   20          Alpha
71         Page 2 Dep11_SSN                         9           Numeric
72         Page 2 Dep11_BD                          8           Numeric; MMDDCCYY Format
73         Page 2 Dep11_Relation                    15          Alpha
74         Page 2 Dep11_First_Name                  15          Alpha

12/15/2016                                                                              Page 2 of 3

                                                2016
                                    Schedule J 2D Barcode Schema

Sl. No     Page            Field name\Line Item            Max Chars                 Field Format

75         Page 2 Dep11_Mid_Initial                        1            Alpha
76         Page 2 Dep11_Last_Name                          20           Alpha
77         Page 2 Dep12_SSN                                9            Numeric
78         Page 2 Dep12_BD                                 8            Numeric; MMDDCCYY Format
79         Page 2 Dep12_Relation                           15           Alpha
80         Page 2 Dep12_First_Name                         15           Alpha
81         Page 2 Dep12_Mid_Initial                        1            Alpha
82         Page 2 Dep12_Last_Name                          20           Alpha
83         Page 2 Dep13_SSN                                9            Numeric
84         Page 2 Dep13_BD                                 8            Numeric; MMDDCCYY Format
85         Page 2 Dep13_Relation                           15           Alpha
86         Page 2 Dep13_First_Name                         15           Alpha
87         Page 2 Dep13_Mid_Initial                        1            Alpha
88         Page 2 Dep13_Last_Name                          20           Alpha
89         Page 2 Dep14_SSN                                9            Numeric
90         Page 2 Dep14_BD                                 8            Numeric; MMDDCCYY Format
91         Page 2 Dep14_Relation                           15           Alpha
92         Page 2 Dep14_First_Name                         15           Alpha
93         Page 2 Dep14_Mid_Initial                        1            Alpha
94         Page 2 Dep14_Last_Name                          20           Alpha
95         Page 2 Dep15_SSN                                9            Numeric
96         Page 2 Dep15_BD                                 8            Numeric; MMDDCCYY Format
97         Page 2 Dep15_Relation                           15           Alpha
98         Page 2 Dep15_First_Name                         15           Alpha
99         Page 2 Dep15_Mid_Initial                        1            Alpha
100        Page 2 Dep15_Last_Name                          20           Alpha
101        N/A    trailer                                  5            Always *EOD* 
                                    Total Bytes/Characters 1067

                                                           Entity Fields

                                                           General Fields

12/15/2016                                                                                       Page 3 of 3

                                                                 2016
                                                       SD100 2D BARCODE SCHEMA
Sl. No Page                 Field name\Line Item       Max Chars                                                 Field Format
1      N/A    header_version_number                    2         Always T1
2      N/A    developer_code                           4         Vendor’s NACTP code
3      N/A    jurisdiction                             2         Always: OH
4      N/A    description                              4         Form code: 1602
5      N/A    spec_version                             1         At this time: 0
6      N/A    form_version                             1         At this time: 1
7      N/A    Date_Generated                           6         Numeric; MMDDYY Format
8      Page 1 year                                     4         2016
9      Page 1 amended_return                           1         Numeric; 1 = Amended, 0 = Original
10     Page 1 NOL_Carryback                            1         Alpha,  Y or N, Uppercase
11     Page 1 taxpayer_ssn                             9         Numeric
12     Page 1 taxpayer_deceased                        1         Numeric; 1 = Yes, 0 = No
13     Page 1 spouse_ssn                               9         Numeric
14     Page 1 spouse_deceased                          1         Numeric; 1 = Yes, 0 = No
15     Page 1 school_district_number                   4         Numeric; Must be valid School District (see tax instructions booklet for complete list)
16     Page 1 taxpayer_firstname                       15        Alpha
17     Page 1 taxpayer_middle_initial                  1         Alpha
18     Page 1 taxpayer_lastname                        22        Alpha
19     Page 1 spouse_firstname                         15        Alpha
20     Page 1 spouse_middle_initial                    1         Alpha
21     Page 1 spouse_lastname                          22        Alpha
22     Page 1 taxpayer_address                         35        Alpha-Numeric
23     Page 1 taxpayer_city                            20        Alpha
24     Page 1 taxpayer_state                           2         Alpha
25     Page 1 taxpayer_zip                             5         Numeric
26     Page 1 taxpayer_Ohio_county                     4         Alpha ; First 4 characters of county name ; Uppercase
27     Page 1 home_address                             24        Alpha-Numeric
28     Page 1 home_zip                                 5         Numeric
29     Page 1 home_Ohio_county                         4         Alpha ; First 4 characters of county name ; Uppercase
30     Page 1 foreign_country                          20        Alpha ; First 20 characters of foreign country ; Uppercase
31     Page 1 foreign_postalcode                       7         Alpha Numeric
32     Page 1 primary_school_district_residency_status 1         Numeric ; Resident = 1, Part-year Resident=2, Non-Resident=3 
33     Page 1 primary_non_residency_from_date          6         Numeric; Format MMDDYY
34     Page 1 primary_non_residency_to_date            6         Numeric; Format MMDDYY
35     Page 1 spouse_school_district_residency_status  1         Numeric ; Resident = 1, Part-year Resident=2, Non-Resident=3 ; Only use if married filing jointly return
36     Page 1 spouse_non_residency_from_date           6         Numeric; Format MMDDYY
37     Page 1 spouse_non_residency_to_date             6         Numeric; Format MMDDYY
38     Page 1 filing_status                            1         Numeric; 1 = Single; 2 = Jointly; 3 = Separately
39     Page 1 Line Item One                            9         Numeric; Send Dollars Only
40     Page 1 Line Item Two                            8         Numeric; Send Dollars Only
41     Page 1 Line Item Three                          2         Numeric; Send Dollars Only
42     Page 1 Line item Four                           6         Numeric (see tax instructions booklet for school district tax rate)
43     Page 1 Line Item Five                           6         Numeric; Send Dollars Only
44     Page1  Line Item Six                            6         Numeric; Send Dollars Only
45     Page2  Line Item Six(a)                         6         Numeric; Send Dollars Only
46     Page 2 Line Item Seven                          6         Numeric; Send Dollars Only
47     Page 2 Line Item Eight                          6         Numeric; Send Dollars Only
48     Page 2 Line Item Nine                           6         Numeric; Send Dollars Only
49     Page 2 Line Item 10                             6         Numeric; Send Dollars Only
50     Page 2 Line Item 11                             6         Numeric; Send Dollars Only
51     Page 2 negative_indicator_for_line_item_12      1         Numeric; 1 for negative , 0 for Positive
52     Page 2 Line Item 12                             6         Numeric; Send Dollars Only; Numeric;  DO NOT PUT NEGATIVE SIGN IN THIS FIELD
53     Page 2 Line Item 13                             7         Numeric; Send Dollars Only
54     Page 2 Line Item 14                             7         Numeric; Send Dollars Only
55     Page 2 Line Item 15                             8         Numeric; Send Dollars Only
56     Page 2 Line Item 16                             7         Numeric; Send Dollars Only
57     Page 2 Line Item 17                             7         Numeric; Send Dollars Only

12/15/2016                                                                                                                                              Page 1 of 2

                                                                  2016
                                                  SD100 2D BARCODE SCHEMA
Sl. No Page                Field name\Line Item   Max Chars                                             Field Format
58     Page 2 Line Item 18                        7             Numeric; Send Dollars Only
59     Page 2 negative_indicator_for_line_item_19 1             Numeric; 1 for negative , 0 for Positive
60     Page 2 Line Item 19                        9             Numeric; Send Dollars Only; Numeric;  DO NOT PUT NEGATIVE SIGN IN THIS FIELD
61     Page 2 Line Item 20                        6             Numeric; Send Dollars Only
62     Page 2 negative_indicator_for_line_item_21 1             Numeric; 1 for negative , 0 for Positive
63     Page 2 Line Item 21                        9             Numeric; Send Dollars Only; Numeric;  DO NOT PUT NEGATIVE SIGN IN THIS FIELD
64     Page 2 Line Item 22                        9             Numeric; Send Dollars Only
65     Page 2 Line Item 23                        9             Numeric; Send Dollars Only
66     Page 2 Line Item 24                        9             Numeric; Send Dollars Only
67     Page 2 negative_indicator_for_line_item_25 1             Numeric; 1 for negative , 0 for Negative
68     Page 2 Line Item 25                        9             Numeric; Send Dollars Only; Numeric;  DO NOT PUT NEGATIVE SIGN IN THIS FIELD
69     Page 2 Line Item 26                        6             Numeric; Send Dollars Only
70     Page 2 Line Item 27                        9             Numeric; Send Dollars Only
71     N/A    trailer                             5             Always *EOD*
                           Total Bytes/Characters 485

                                                  General Fields

                                                  Demographic Fields

                                                  Line Item Fields

12/15/2016                                                                                                                                  Page 2 of 2

Ohio Test #1                                                                IT1040 with SD100
Taxpayer Information                                    Description
                     Primary Social Security Number                   XX0007601
                     Primary First Name                               IMA
                     Primary Last Name                                BUCKEYE
                     Date of Birth - Primary                          1/1/1956
                     Occupation - Primary                             Clerk
                     Foreign Address Line 1                           1099 NUTT ST APT 2A
                     Foreign City                                     VICTORIA
                     Foreign State                                    BRITISH COLUMBIA
                     Foreign Country                                  CA
                     Foreign Postal Code                              V8X 3X4
                     Ohio County                                      FRANKLIN
                     County Code (Ohio Public School District Number) 9999

                     Address Line 1                                   123 BUCKEYE WAY
                     City                                             GIBSONBURG
                     State                                            OH
                     Zip Code                                         43431
                                             Income Statements
             W-2 #1
                     Employers Identification Number                  11-3456789
                     Employer's Name                                  LOAFER'S SANDWICH SHOPPE
                     Foreign Address Line 1                           14A LOAFERS LANE
                     Foreign City                                     VICTORIA
                     Foreign State                                    BRITISH COLUMBIA
                     Foreign Country                                  CA
                     Foreign Postal Code                              V8X 3X4
                     Employee's Social Security Number                400-00-7601
                     Employee's Name                                  IMA BUCKEYE
                     Foreign Address Line 1                           1099 NUTT ST APT 2A
                     Foreign City                                     VICTORIA
                     Foreign State                                    BRITISH COLUMBIA
                     Foreign Country                                  CA
                     Foreign Postal Code                              V8X 3X4
                     Box 1 Wages, Tips, etc                           $12,420.00
                     Box 2 Federal Income Tax Withheld                $300.00
                     Box 3 Social Security Wages                      $12,420.00
                     Box 4 Social Security Tax Withheld               $770.00
                     Box 5 Medicare Wages and Tips                    $12,420.00
                     Box 6 Medicare Withheld                          $180.00
                     Box 15 State                                     OH
                     State ID Number                                  51-345678
                     State Wages                                      $12,420.00
                     State Income Tax Withheld                        $70.00
                     Local Wages                                      $12,420.00
                     Local Income Tax Withheld                        $248.00
                     Name of Locality                                 TIPP CITY
                     School District Wages                            $12,420.00
                     School District Tax Withheld                     $31.00
                     School District #                                8706

                                                                                  1-1

Ohio Test #1
Federal Return Information                                           1040                                            Description
                           Filing Status                                                                   Married Filing Separately
                           Exemptions, Self                                                                1
                           Line 7 Total Wages                                                              $12,420.00
                           Line 10 Taxable Refunds, credits or offsets of state and local income taxes     $3,000.00
                           Line 12 Business loss Schedule C                                                -$2,500.00
                           Schedule SE Section A line 2                                                    -$2,500.00
                           Line 37 Adjusted Gross Income                                                   $12,920.00
State Return Information                                    Description
                           Is this an amended return?                                                      No
                           Paid Preparer's PTIN                                                            P24682468
                           Paid Preparer's Firm ID Number                                                  987654321
                           Paid Preparer's Business Name                                                   TAX INC
                           Paid Preparer's name                                                            CARL BROWN
                           Preparer's US Address                                                           123 MAIN ST
                           City                                                                            TIPP CITY
                           State                                                                           OH
                           ZIP Code                                                                        45371
                           Paid Preparer's Phone Number                                                    614-554-6789
                           Paid Preparer's Email Address                                                   CARLBROWN@TAXINC.COM
                           Filing Status                                                                   Married Filing Separately
                           Ohio Residency Status (Primary)                                                 Full-Year Nonresident
                           Country of Residency for Nonresident Primary Taxpayer                           Canada (CA)
                           Ohio Political Party Fund Contribution - Primary                                No
                           Is someone else claiming you or your spouse (if joint return) as a dependent?   No
                           Enter the number of dependents                                                  0
                           Eligible for JFC?                                                               No
                           Certain Income Earned by Military Nonresidents and Civilian Nonresident Spouses $12,420.00
                           Donation From Taxpayer - Wildlife species                                       $15.00
                           Donation From Taxpayer - Military Injury Relief Fund                            $10.00
                           Donation From Taxpayer - State nature preserves                                 $5.00
                           Donation From Taxpayer - Wishes for sick children                               $10.00
                           Preparer Authorization Check Box                                                Yes
                           Perjury Statement Acceptance                                                    Yes
                           Taxpayer's Phone Number                                                         614-554-1234
                           Taxpayer's E-mail Address                                                       BUCKEYE@OHIO.GOV
SD Return Information
                           Are you Filing the Ohio School District Income Tax Return Electronically        Yes
                           What is the school district number for which you are filing the SD 100?         8706
                           School District Residency (Primary Taxpayer)                                    Full-Year Nonresident
                           Tax Type                                                                        Earned Income Only

                                                                                                                              1-2

Ohio Test #1
            OH Line #                                           Line Item                                      Amount
            1         Federal Adjusted Gross Income                                                                  $12,920.00
            2a        Additions to federal adjusted gross income                                                     $0.00
            2b        Deductions from federal adjusted gross income                                                  $15,420.00
            3         Ohio Adjusted Gross Income (OAGI)                                                              ($2,500.00)
            4         Personal and dependent exemption deduction                                                     $2,250.00
            5         Ohio income tax base                                                                           $0.00
            6         Taxable business income (Ohio IT BUS, line 13)                                                 $0.00
            7         Line 5 minus line 6 (if less than 0, enter 0)                                                  $0.00
            7a        Amount from line 7 on page 1                                                                   $0.00
            8a        Nonbusiness income tax liability                                                               $0.00
            8b        Business income tax liability (Ohio IT BUS, line 14)                                           $0.00
            8c        Income tax liability before credits (line 8a plus 8b)                                          $0.00
            9         Ohio nonrefundable credits                                                                     $108.00
            10        Tax liability after nonrefundable credits                                                      $0.00
            11        Interest penalty on underpayment of estimated tax                                              $0.00
            12        Sales and use tax due on Internet, mail order or other out-of-state purchases                  $0.00
            13        Total Ohio tax liability before withholding or estimated payments                              $0.00
            14        Ohio income tax withheld                                                                       $70.00
                      Add the Ohio estimated & extension payments & credit carryforward from previous year 
            15        return                                                                                         $0.00
            16        Refundable credits                                                                             $0.00
            17        Amended return only - amount previously paid with original/amended return                      $0.00
            18        Total Ohio Tax Payments                                                                        $70.00
            19        Amended return only - overpayment previously received on original/amended return               $0.00
            20        Line 18 minus line 19                                                                          $70.00
            21        Tax liability                                                                                  $0.00
            22        Interest and penalty due on late filing or payment of tax                                      $0.00
            23        Total Amount Due                                                                               $0.00
            24        Overpayment                                                                                    $70.00
            25        Original return only - amount of line 24 to be credited toward 2016 income tax liability       $0.00
            26a       Amount of line 24 to be donated - Wildlife species                                             $15.00
            26b       Amount of line 24 to be donated - Military injury relief                                       $10.00
            26c       Amount of line 24 to be donated - Ohio History Fund                                            $0.00
            26d       Amount of line 24 to be donated - State nature preserves                                       $5.00
            26e       Amount of line 24 to be donated - Breast/cervical cancer                                       $0.00
            26f       Amount of line 24 to be donated - Wishes for sick children                                     $10.00
            26g       Total                                                                                          $40.00
            27        Your Refund                                                                                    $30.00

                                                                                                                1-3

Ohio Test #1
Schedule A     Additions
            1  Non-Ohio state or local government interest and dividends                                         $0.00
            2  Certain Ohio pass-through entity and financial institutions taxes paid                            $0.00
               Reimbursement of college tutition expenses and fees deducted in any previous year(s) and 
            3  noneducation expenditures from a college savings account                                          $0.00
            4  Losses from sale or disposition of Ohio public obligations                                        $0.00
            5  Nonmedical withdrawals from a medical savings account                                             $0.00
               Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if 
            6  the reimbursement is not in federal adjusted gross income                                         $0.00
            7  Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense                 $0.00
            8  Federal interest and dividends subject to state taxation                                          $0.00
            9  Miscellaneous federal income tax additions                                                        $0.00
            10 Total additions                                                                                   $0.00
Schedule A     Deductions
            11 Business income deduction (attach Ohio Schedule IT BUS, line 11)                                  $0.00
            12 Employee compensation earned in Ohio by full-year residents of neighboring states                 $0.00
            13 State or municipal income tax overpayments shown on IRS form 1040, line 10                    $3,000.00
            14 Qualifying Social Security benefits and certain railroad retirement benefits                      $0.00
               Interest income from Ohio public obligations and from Ohio purchase obligations; gains from 
               the sale or disposition of Ohio public obligations; public service payments received from the 
            15 state of Ohio or income from a transfer agreement                                                 $0.00
            16 Amounts contributed to an individual development account                                          $0.00
            17 Amounts contributed to STABLE account; Ohio's ABLE plan
            18 Federal interest and dividends exempt from state taxation                                         $0.00
            19 Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense                 $0.00
               Refund or reimbursements shown on IRS form 1040, line 21 for itemized deductions claimed 
            20 on a prior year federal income tax return                                                         $0.00
            21 Repayment of income reported in a prior year                                                      $0.00
            22 Wage expense not deducted due to claiming the federal work opportunity credit                     $0.00
            23 Miscellaneous federal income tax  deductions                                                      $0.00
            24 Military pay for Ohio residents received while the military member was stationed outside Ohio     $0.00
            25 Certain income earned by military nonresidents and civilian nonresident spouses               $12,420.00
            26 Uniformed services retirement income                                                              $0.00
            27 Military injury relief fund                                                                       $0.00
            28 Certain Ohio National Guard reimbursements and benefits                                           $0.00
            29 Ohio 529 contributions, tuition credit purchases                                                  $0.00
            30 Pell/Ohio College Opportunity taxable grant amounts used to pay room and board                    $0.00
            31 Disability and survivorship benefits (do not include pension continuation benefits)               $0.00
               Unreimbursed long-term care insurance premiums, unsubsidized health care insurance 
            32 premiums and excess health care expenses                                                          $0.00
               Funds deposited into, and earnings of, a medical savings account for eligible health care 
            33 expenses                                                                                          $0.00
            34 Qualified organ donor expenses                                                                    $0.00
            35 Total deductions                                                                              $15,420.00

                                                                                                              1-4

Ohio Test #1
Schedule of Credits    Nonrefundable credits
                    1  Total tax liability (From IT1040 8c)                                                              $0.00
                    2  Retirement Income Credit                                                                          $0.00
                    3  Lump sum retirement credit                                                                        $0.00
                    4  Senior citizen credit                                                                             $0.00
                    5  Lump sum distribution credit                                                                      $0.00
                    6  Child care and dependent care credit                                                              $0.00
                       If Ohio form IT 1040, line 5 is $10,000 or less, enter $88; otherwise, enter -0- (low income 
                    7  credit)                                                                                           $88.00
                    8  Displaced worker training credit                                                                  $0.00
                       Campaign contribution credit for Ohio statewide office or General 
                    9  Assembly                                                                                          $0.00
                    10 Income-based exemption credit                                                                     $20.00
                    11 Total (add lines 2 through 10)                                                                    $108.00
                    12 Tax less credits (line 1 minus line 11; if less than -0-, enter -0-)                              $0.00
                    13 Joint filing credit                                                                               $0.00
                    14 Earned income credit                                                                              $0.00
                    15 Ohio adoption credit                                                                              $0.00
                    16 Job retention credit, nonrefundable portion                                                       $0.00
                    17 Credit for eligible new employees in an enterprise zone                                           $0.00
                    18 Credit for purchases of grape production property                                                 $0.00
                    19 Credit for investing in an Ohio small business                                                    $0.00
                    20 Technology investment credit carryforward                                                         $0.00
                    21 Enterprise zone day care and training credits                                                     $0.00
                    22 Research and development credit                                                                   $0.00
                    23 Ohio historic preservation credit, nonrefundable carryforward portion                             $0.00
                    24 Total (add lines 13 through 23)                                                                   $0.00
                    25 Tax less additional credits (line 12 minus line 24; if less than -0-, enter -0-)                  $0.00
                       Nonresident Credit
                    26 Enter the portion of OAGI that was not earned or received in Ohio                                 $0.00
                    27 Enter the OAGI                                                                                    $0.00
                       Line 26/27 _____* Multiply this factor by the amount on line 25 to calculate your nonresident 
                    28 credit                                                                                            $0.00
                       Resident Credit
                    29 Enter the portion of OAGI subjected to tax by other states or DC while an OH resident             $0.00
                    30 Enter OAGI                                                                                        $0.00
                    31 Divide line 29 by line 30 ____*Multiply this factor by the amount on line 25                      $0.00
                    32 Enter the 2016 income tax, less all credits other than w/h and est tax pmts and CCFs              $0.00
                    33 Enter the smaller of line 31 or line 32. This is your Ohio resident tax credit.                   $0.00
                    34 Total nonrefundable credits                                                                       $108.00
                       Refundable Credits
                    35 Historic preservation credit                                                                      $0.00
                    36 Business jobs credit                                                                              $0.00
                    37 Pass-through entity credit                                                                        $0.00
                    38 Motion picture production credit                                                                  $0.00
                    39 Financial Institutions Tax (FIT) credit                                                           $0.00
                    40 Venture Capital credit                                                                            $0.00
                    41 Total refundable credits                                                                          $0.00

                                                                                                                      1-5

Ohio Test #1
Schedule IT BUS
                                                      Part 1
               1                                      Sch B - Interest and Ordinary Dividends                                                        $0.00
               2                                      Sch C - Profit or Loss From Business (Sole Proprietership)                                     $0.00
               3                                      Sch D - Capital Gains and Losses                                                               $0.00
               4                                      Sch E - Supplemental Income and Loss                                                           $0.00
                                                      Guranteed payments, compensation and/or wages from each pass-through entity in which 
               5                                      you have at least a 20% direct or indirect ownership interest                                  $0.00
               6                                      Sch F - Profit or Loss From Farming                                                            $0.00
                                                      Other items of income and gain separately stated on federal Schedule K-1, federal 4787 
                                                      gains and/or losses reported on federal 4787 and miscellaneous federal income tax 
               7                                      adjustments, if any                                                                            $0.00
               8                                      Total of business income                                                                       $0.00
                                                      Part 2
                                                      All business income. Enter here & on  IT 1040, line 6. If 0 or negative, stop here & don't 
               9                                      complete Part 3.                                                                               $0.00
               10                                     Enter $250,000 if single or MFJ, enter $125,000 if MFS                                         $0.00
               11                                     Lesser of line  9or line 10. Enter here and on Ohio Schedule A, line 11                        $0.00
                                                      Part 3
               12                                     Line  9minus line 1 1(if less than -0-, enter -0-)                                             $0.00
               13                                     Taxable Business Income                                                                        $0.00
               14                                     Business income tax liability. Enter here and on Ohio IT 1040, line 8b.                        $0.00
School District Return Information (Nonresident #8706)
               1                                      School district taxable income:  Traditional or Earned Income tax base                         $0.00
               2                                      School District Tax .____ times line 1.                                                        $0.00
               3                                      Senior Citizen Credit                                                                          $0.00
               4                                      School District Income Tax liability                                                           $0.00
               5                                      Interest penalty on underpayment of estimated tax                                              $0.00
               6                                      Total school district income tax liability (line 4 plus line 5)                                $0.00
               6a                                     Amount from line 6, page 1                                                                     $0.00
               7                                      School district income tax withheld                                                            $31.00
               8                                      SD100ES & SD40P, Extension Payments and Credit carryforward from previous year return          $0.00
               9                                      Amended return only - amount previously paid with original/amended return                      $0.00
               10                                     Total school district income tax payments (add lines 7, 8 and 9)                               $31.00
               11                                     Amended return only - overpayment previously received on original/amended return               $0.00
               12                                     Total Payments less overpayment previously received on original/amended return                 $31.00
               13                                     Tax Liability                                                                                  $0.00
               14                                     Interest and penalty due on late filing or payment of tax                                      $0.00
               15                                     Total Amount Due                                                                               $0.00
               16                                     Overpayment                                                                                    $31.00
               17                                     Original return only - amount of line 16 to be credited toward 2016 income tax liability       $0.00
               18                                     Your Refund                                                                                    $31.00
School District Schedule A "Traditional" Tax Base School District Amounts
               19                                     Ohio income tax base reported on line 5 of Ohio IT 1040                                        $0.00
               20                                     Business income deduction add-back                                                             $0.00
               21                                     Total Traditional Tax Base School District Income (Line 19 + Line 20)                          $0.00
               22                                     Amount of traditional tax base school district income that you earned while not a resident     $0.00
               23                                     School District Taxable Income (Enter here and on line 1)                                      $0.00
School District Schedule B "Earned Income Only" Tax Base School District Amounts
               24                                     Wages and other compensation as described in the instructions                                  $0.00
               25                                     Net Earnings from Self Employment                                                          ($2,500.00)
               26                                     Depreciation Expense Adjustments                                                               $0.00
               27                                     School District Taxable Income (Enter here and on line 1)                                      $0.00

                                                                                                                                                  1-6

Ohio Test #1
What is Tested?
IT1040WithSD100
Paid Preparer
Preparer Contact - Authorized
MFS status
Ohio W-2
Foreign Address
IT1040 
Nonresident
[$0 - $5,250] tax bracket
Sch. A - State/municipal income tax overpayments
Sch. A -Income earned by civilian nonresident spouse
Schedule of Credits - Low income credit 
Donations

SD100
Nonresident 
Earned income only school district

                                                     1-7

Ohio Test #2                                                              IT1040 with two SD100s
Taxpayer Information                                    Description
                     Primary Social Security Number                   XX0-00-7602
                     Primary First Name                               HOSS
                     Primary Last Name                                SHOE
                     Date of Birth - Primary                          01/01/1960
                     Date of Death - Primary                          10/15/2016
                     Occupation - Primary                             CONSULTANT
                     "In Care of" Addressee                           JOHN DOE
                     Address Line 1                                   8484 ½ SOLE AVE
                     City                                             SPRINGFIELD
                     State                                            OH
                     Zip Code                                         45502
                     Ohio County                                      CLARK
                     County Code (Ohio Public School District Number) 1203
                                             Income Statements
             W-2 #1
                     Employers Identification Number                  13-9876543
                     Employer's Name                                  SWEET AROMA HEALTH AND 
                                                                      BEAUTY AIDES
                     Employer's Address                               7 FRAGRANT WAY
                     Employer's City                                  RISINGSUN
                     Employer's State                                 Ohio
                     Employer's Zip Code                              43457
                     Employee's Social Security Number                400-00-7602
                     Employee's Name                                  HOSS SHOE
                     Employee's Address                               8484 ½ SOLE AVE
                     Employee's City                                  SPRINGFIELD
                     Employee's State                                 OH
                     Employee's Zip Code                              45502
                     Box 1 Wages, Tips, etc                           $12,500.00
                     Box 2 Federal Income Tax Withheld                $75.00
                     Box 3 Social Security Wages                      $12,500.00
                     Box 4 Social Security Tax Withheld               $775.00
                     Box 5 Medicare Wages and Tips                    $12,500.00
                     Box 6 Medicare Withheld                          $181.00
                     Box 15 State                                     OH
                     State ID Number                                  52-456789
                     State Wages                                      $12,500.00
                     State Income Tax Withheld                        $75.00
                     Local Wages                                      $12,500.00
                     Local Income Tax Withheld                        $188.00
                     Name of Locality                                 FREMONT
                     School District Wages                            $12,500.00
                     School District Tax Withheld                     $125.00
                     School District #                                3303

                                                                                      2-1

Ohio Test #2
Federal Return Information      1040                                  Description
                                     Filing Status                                                                 Single
                                     Exemptions, Self                                                              1
                                     Line 7 Total Wages                                                            $12,500.00
                                     Line 37 Adjusted Gross Income                                                 $12,500.00
                                     Federal Earned Income Credit                                                  $180.00
                                     Qualifying Children for Earned Income Credit                                  0
State Return Information                                              Description
                                     Is this an amended return?                                                    No
                                     NonPaid Preparer's name                                                       HANNAH GREEN
                                     NonPaid Preparer's phone number                                               419-554-3456
                                     NonPaid Preparer's Email Address                                              HANNAH@GREENCO.COM
                                     NonPaid Preparer's PTIN                                                       P97533579
                                     NonPaid Preparer's US Address                                                 45 W 2ND ST
                                     City                                                                          MINSTER
                                     State                                                                         OH
                                     ZIPCode                                                                       45865
                                     Filing Status                                                                 Single
                                     Ohio Residency Status (Primary)                                               Full-Year Resident
                                     Ohio Political Party Fund Contribution - Primary                              No
                                     Is someone else claiming you or your spouse (if joint return) as a dependent? No
                                     Enter the number of dependents                                                0
                                     Eligible for JFC?                                                             No
                                     Preparer Authorization Check Box                                              Yes
                                     Perjury Statement Acceptance                                                  Yes
                                     Taxpayer's Phone Number                                                       419-554-1234
                                     Taxpayer's E-mail Address                                                     SHOE@SHOE.COM
SD Return Information (SD #1203)
                                     Are you Filing the Ohio School District Income Tax Return Electronically      Yes
                                     What is the school district number for which you are filing the SD 100?       1203
                                     School District Residency (Primary Taxpayer)                                  Full-Year Resident
                                     Tax Type                                                                      Earned Income Only
SD Return Information (SD #3303)
                                     Are you Filing the Ohio School District Income Tax Return Electronically      Yes
                                     What is the school district number for which you are filing the SD 100?       3303
                                     School District Residency (Primary Taxpayer)                                  Full-Year Nonresident
                                     Tax Type                                                                      Traditional

                                                                                                                                         2-2

Ohio Test #2
            OH Line #                                     Line Item                                      Amount
            1   Federal Adjusted Gross Income                                                                  $12,500.00
            2a  Additions to federal adjusted gross income                                                     $0.00
            2b  Deductions from federal adjusted gross income                                                  $0.00
            3   Ohio Adjusted Gross Income (OAGI)                                                              $12,500.00
            4   Personal and dependent exemption deduction                                                     $2,250.00
            5   Ohio income tax base                                                                           $10,250.00
            6   Taxable business income (Ohio IT BUS, line 13)                                                 $0.00
            7   Line 5 minus line 6 (if less than 0, enter 0)                                                  $10,250.00
            7a  Amount from line 7 on page 1                                                                   $10,250.00
            8a  Nonbusiness income tax liability                                                               $75.00
            8b  Business income tax liability (Ohio IT BUS, line 14)                                           $0.00
            8c  Tax liability (line 8a plus 8b)                                                                $75.00
            9   Ohio nonrefundable credits                                                                     $38.00
            10  Tax liability after nonrefundable credits                                                      $37.00
            11  Interest penalty on underpayment of estimated tax                                              $0.00
            12  Sales and use tax due on Internet, mail order or other out-of-state purchases                  $0.00
            13  Total Ohio tax liability before withholding or estimated payments                              $37.00
            14  Ohio income tax withheld                                                                       $75.00
                Add the Ohio estimated & extension payments & credit carryforward from previous year 
            15  return                                                                                         $0.00
            16  Refundable credits                                                                             $0.00
            17  Amended return only - amount previously paid with original/amended return                      $0.00
            18  Total Ohio Tax Payments                                                                        $75.00
            19  Amended return only - overpayment previously received on original/amended return               $0.00
            20  Line 18 minus line 19                                                                          $75.00
            21  Tax liability                                                                                  $0.00
            22  Interest and penalty due on late filing or payment of tax                                      $0.00
            23  Total Amount Due                                                                               $0.00
            24  Overpayment                                                                                    $38.00
            25  Original return only - amount of line 24 to be credited toward 2016 income tax liability       $0.00
            26a Amount of line 24 to be donated - Military injury relief                                       $0.00
            26b Amount of line 24 to be donated - Ohio History Fund                                            $0.00
            26c Amount of line 24 to be donated - State nature preserves                                       $0.00
            26d Amount of line 24 to be donated - Breast/cervical cancer                                       $0.00
            26e Amount of line 24 to be donated - Wishes for sick children                                     $0.00
            26f Amount of line 24 to be donated - Wildlife species                                             $0.00
            26g Total                                                                                          $0.00
            27  Your Refund                                                                                    $38.00

                                                                                                                2-3

Ohio Test #2
Schedule A     Additions
            1  Non-Ohio state or local government interest and dividends                                     $0.00
            2  Certain Ohio pass-through entity and financial institutions taxes paid                        $0.00
               Reimbursement of college tutition expenses and fees deducted in any previous year(s) and 
            3  noneducation expenditures from a college savings account                                      $0.00
            4  Losses from sale or disposition of Ohio public obligations                                    $0.00
            5  Nonmedical withdrawals from a medical savings account                                         $0.00
               Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if 
            6  the reimbursement is not in federal adjusted gross income                                     $0.00
            7  Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense             $0.00
            8  Federal interest and dividends subject to state taxation                                      $0.00
            9  Miscellaneous federal income tax additions                                                    $0.00
            10 Total additions                                                                               $0.00
Schedule A     Deductions
            11 Business income deduction (attach Ohio Schedule IT BUS, line 11)                              $0.00
            12 Employee compensation earned in Ohio by residents of neighboring states                       $0.00
            13 State or municipal income tax overpayments shown on IRS form 1040, line 10                    $0.00
            14 Qualifying Social Security benefits and certain railroad retirement benefits                  $0.00
               Interest income from Ohio public obligations and from Ohio purchase obligations; gains from 
               the sale or disposition of Ohio public obligations; public service payments received from the 
            15 state of Ohio or income from a transfer agreement                                             $0.00
            16 Amounts contributed to an individual development account                                      $0.00
            17 Amounts contributed to STABLE account; Ohio's ABLE plan
            18 Federal interest and dividends exempt from state taxation                                     $0.00
            19 Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense             $0.00
               Refund or reimbursements shown on IRS form 1040, line 21 for itemized deductions claimed 
            20 on a prior year federal income tax return                                                     $0.00
            21 Repayment of income reported in a prior year                                                  $0.00
            22 Wage expense not deducted due to claiming the federal work opportunity credit                 $0.00
            23 Miscellaneous federal income tax  deductions                                                  $0.00
            24 Military pay for Ohio residents received while the military member was stationed outside Ohio $0.00
            25 Certain income earned by military nonresidents and civilian nonresident spouses               $0.00
            26 Uniformed services retirement income                                                          $0.00
            27 Military injury relief fund                                                                   $0.00
            28 Certain Ohio National Guard reimbursements and benefits                                       $0.00
            29 Ohio 529 contributions, tuition credit purchases                                              $0.00
            30 Pell/Ohio College Opportunity taxable grant amounts used to pay room and board                $0.00
            31 Disability and survivorship benefits (do not include pension continuation benefits)           $0.00
               Unreimbursed long-term care insurance premiums, unsubsidized health care insurance 
            32 premiums and excess health care expenses                                                      $0.00
               Funds deposited into, and earnings of, a medical savings account for eligible health care 
            33 expenses                                                                                      $0.00
            34 Qualified organ donor expenses                                                                $0.00
            35 Total deductions                                                                              $0.00

                                                                                                              2-4

Ohio Test #2
Schedule of Credits    Nonrefundable credits
                    1  Total tax liability (From IT1040 8c)                                                              $75.00
                    2  Retirement Income Credit                                                                          $0.00
                    3  Lump sum retirement credit                                                                        $0.00
                    4  Senior citizen credit                                                                             $0.00
                    5  Lump sum distribution credit                                                                      $0.00
                    6  Child care and dependent care credit                                                              $0.00
                    7  If Ohio form IT 1040, line 5 is $10,000 or less, enter $88; otherwise, enter -0- (low income cred $0.00
                    8  Displaced worker training credit                                                                  $0.00
                       Campaign contribution credit for Ohio statewide office or General 
                    9  Assembly                                                                                          $0.00
                    10 Income-based exemption credit                                                                     $20.00
                    11 Total (add lines 2 through 10)                                                                    $20.00
                    12 Tax less credits (line 1 minus line 11; if less than -0-, enter -0-)                              $55.00
                    13 Joint filing credit                                                                               $0.00
                    14 Earned income credit                                                                              $18.00
                    15 Ohio adoption credit                                                                              $0.00
                    16 Job retention credit, nonrefundable portion                                                       $0.00
                    17 Credit for eligible new employees in an enterprise zone                                           $0.00
                    18 Credit for purchases of grape production property                                                 $0.00
                    19 Credit for investing in an Ohio small business                                                    $0.00
                    20 Technology investment credit carryforward                                                         $0.00
                    21 Enterprise zone day care and training credits                                                     $0.00
                    22 Research and development credit                                                                   $0.00
                    23 Ohio historic preservation credit, nonrefundable carryforward portion                             $0.00
                    24 Total (add lines 13 through 23)                                                                   $18.00
                    25 Tax less additional credits (line 12 minus line 24; if less than -0-, enter -0-)                  $37.00
                       Nonresident Credit
                    26 Enter the portion of OAGI that was not earned or received in Ohio                                 $0.00
                    27 Enter the OAGI                                                                                    $0.00
                       Line 26/27 _____* Multiply this factor by the amount on line 25 to calculate your nonresident 
                    28 credit                                                                                            $0.00
                       Resident Credit
                    29 Enter the portion of OAGI subjected to tax by other states or DC while an OH resident             $0.00
                    30 Enter OAGI                                                                                        $0.00
                    31 Divide line 29 by line 30 ____*Multiply this factor by the amount on line 25                      $0.00
                    32 Enter the 2016 income tax, less all credits other than w/h and est tax pmts and CCFs              $0.00
                    33 Enter the smaller of line 31 or line 32. This is your Ohio resident tax credit.                   $0.00
                    34 Total nonrefundable credits                                                                       $38.00
                       Refundable Credits
                    35 Historic preservation credit                                                                      $0.00
                    36 Business jobs credit                                                                              $0.00
                    37 Pass-through entity credit                                                                        $0.00
                    38 Motion picture production credit                                                                  $0.00
                    39 Financial Institutions Tax (FIT) credit                                                           $0.00
                    40 Venture Capital credit                                                                            $0.00
                    41 Total refundable credits                                                                          $0.00

                                                                                                                          2-5

Ohio Test #2
Sch IT BUS
                                                   Part 1
            1                                      Sch B - Interest and Ordinary Dividends                                                    $0.00
            2                                      Sch C - Profit or Loss From Business (Sole Proprietership)                                 $0.00
            3                                      Sch D - Capital Gains and Losses                                                           $0.00
            4                                      Sch E - Supplemental Income and Loss                                                       $0.00
                                                   Guranteed payments, compensation and/or wages from each pass-through entity in which 
            5                                      you have at least a 20% direct or indirect ownership interest                              $0.00
            6                                      Sch F - Profit or Loss From Farming                                                        $0.00
                                                   Other items of income and gain separately stated on federal Schedule K-1, federal 4787 
                                                   gains and/or losses reported on federal 4787 and miscellaneous federal income tax 
            7                                      adjustments, if any                                                                        $0.00
            8                                      Total of business income                                                                   $0.00
                                                   Part 2
                                                   All business income. Enter here & on  IT 1040, line 6. If 0 or negative, stop here & don't 
            9                                      complete Part 3.                                                                           $0.00
            10                                     Enter $250,000 if single or MFJ, enter $125,000 if MFS                                     $0.00
            11                                     Lesser of line  9or line 10. Enter here and on Ohio Schedule A, line 11                    $0.00
                                                   Part 3
            12                                     Line  9minus line 1 1(if less than -0-, enter -0-)                                         $0.00
            13                                     Taxable Business Income                                                                    $0.00
            14                                     Business income tax liability. Enter here and on Ohio IT 1040, line 8b.                    $0.00
School District Return Information (Resident #1203)
            1                                      School district taxable income:  Traditional or Earned Income tax base                     $12,500.00
            2                                      School District Tax .____ times line 1.                                                    $125.00
            3                                      Senior Citizen Credit                                                                      $0.00
            4                                      School District Income Tax liability                                                       $125.00
            5                                      Interest Penalty on Underpayment of School District Estimated Tax                          $0.00
            6                                      Total school district income tax liability (line 4 plus line 5)                            $125.00
            6a                                     Amount from line 6                                                                         $125.00
            7                                      School district income tax withheld                                                        $0.00
            8                                      SD100ES & SD40P, Extension Payments and Credit Carryforward from previous year return      $0.00
            9                                      Amended return only - amount previously paid with original/amended return                  $0.00
            10                                     Total school district income tax payments (add lines 7, 8 and 9)                           $0.00
            11                                     Amended return only - overpayment previously received on original/amended return           $0.00
            12                                     Total Payments less overpayment previously received on original/amended return             $0.00
            13                                     Tax Liability                                                                              $125.00
            14                                     Interest and penalty due on late filing or payment of tax                                  $0.00
            15                                     Total Amount Due                                                                           $125.00
            16                                     Overpayment                                                                                $0.00
            17                                     Original return only - amount of line 16 to be credited toward 2016 income tax liability   $0.00
            18                                     Your Refund                                                                                $0.00
School District Schedule A "Traditional" Tax Base School District Amounts
            19                                     Ohio income tax base reported on line 5 of Ohio IT 1040                                    $0.00
            20                                     Business income deduction add-back                                                         $0.00
            21                                     Total Traditional Tax Base School District Income (Line 19 + Line 20)                      $0.00
            22                                     Amount of traditional tax base school district income that you earned while not a resident $0.00
            23                                     School District Taxable Income (Enter here and on line 1)                                  $0.00

                                                                                                                                               2-6

Ohio Test #2
School District Schedule B "Earned Income Only" Tax Base School District Amounts
                                                   24 Wages and other compensation as described in the instructions                              $12,500.00
                                                   25 Net Earnings from Self Employment                                                          $0.00
                                                   26 Depreciation Expense Adjustments                                                           $0.00
                                                   27 School District Taxable Income (Enter here and on line 1)                                  $12,500.00

School District Return Information (Non-resident #3303)
                                                   1  School district taxable income:  Traditional or Earned Income tax base                     $0.00
                                                   2  School District Tax .____ times line 1.                                                    $0.00
                                                   3  Senior Citizen Credit                                                                      $0.00
                                                   4  School District Income Tax liability                                                       $0.00
                                                   5  Interest Penalty on Underpayment of School District Estimated Tax                          $0.00
                                                   6  Total school district income tax liability (line 4 plus line 5)                            $0.00
                                                   6a Amount from line 6                                                                         $0.00
                                                   7  School district income tax withheld                                                        $125.00
                                                   8  SD100ES & SD40P, Extension Payments and Credit Carryforward from previous year return      $0.00
                                                   9  Amended return only - amount previously paid with original/amended return                  $0.00
                                                   10 Total school district income tax payments (add lines 7, 8 and 9)                           $125.00
                                                   11 Amended return only - overpayment previously received on original/amended return           $0.00
                                                   12 Total Payments less overpayment previously received on original/amended return             $125.00
                                                   13 Tax Liability                                                                              $0.00
                                                   14 Interest and penalty due on late filing or payment of tax                                  $0.00
                                                   15 Total Amount Due                                                                           $0.00
                                                   16 Overpayment                                                                                $125.00
                                                   17 Original return only - amount of line 16 to be credited toward 2016 income tax liability   $0.00
                                                   18 Your Refund                                                                                $125.00
School District Schedule A "Traditional" Tax Base School District Amounts
                                                   19 Ohio income tax base reported on line 5 of Ohio IT 1040                                    $10,250.00
                                                   20 Business income deduction add-back                                                         $0.00
                                                   21 Total Traditional Tax Base School District Income (Line 19 + Line 20)                      $10,250.00
                                                   22 Amount of traditional tax base school district income that you earned while not a resident $10,250.00
                                                   23 School District Taxable Income (Enter here and on line 1)                                  $0.00
School District Schedule B "Earned Income Only" Tax Base School District Amounts
                                                   24 Wages and other compensation as described in the instructions                              $0.00
                                                   25 Net Earnings from Self Employment                                                          $0.00
                                                   26 Depreciation Expense Adjustments                                                           $0.00
                                                   27 School District Taxable Income (Enter here and on line 1)                                  $0.00
Ohio Test #2
                  What is Tested?
IT1040WithSD100
Non-paid Preparer
Preparer Contact - Authorized
Single status
Ohio W-2
Deceased primary taxpayer

IT1040
Full year resident
[$5,250 - $10,500] tax bracket
Earned Income Credit - 0 qualifying children 

SD100
Multiple SD100 returns
Traditional school district - Full year nonresident
(Taxpayer lived in SD 1203; employer withheld for 
wrong school district)
Earned Income only school dist.- Full year resident

                                                                                                                                                  2-7

Ohio Test #3                                                               IT1040 with SD100
Taxpayer Information                                    Description
                     Primary Social Security Number                   XX0-00-7603
                     Primary First Name                               NADA
                     Primary Last Name                                WOLVERINE
                     Date of Birth - Primary                          8/13/1995
                     Occupation - Primary                             Gamer
                     Spouse's Social Security Number                  XX0-00-7653
                     spouse First Name                                NORA
                     Spouse Last Name                                 BADGER
                     Date of Birth - Spouse                           02/02/1996
                     Date of Death - Spouse                           10/15/2016
                     Occupation - Spouse                              Window Washer
                     Address Line 1                                   75 S ANIMAL DR
                     City                                             EDON
                     State                                            OH
                     Zip Code                                         43518
                     Ohio County                                      WILLIAMS
                     County Code (Ohio Public School District Number) 8603
                                             Income Statements
             W-2 #1
                     Employers Identification Number                  14-3456789
                     Employer's Name                                  GMRZ INC
                     Employer's Address                               25 SOUTH BLVD
                     Employer's City                                  DETROIT
                     Employer's State                                 MI
                     Employer's Zip Code                              48201
                     Employee's Social Security Number                400-00-7603
                     Employee's Name                                  NADA WOLVERINE
                     Employee's Address                               75 S ANIMAL DR
                     Employee's City                                  EDON
                     Employee's State                                 OH
                     Employee's Zip Code                              43518
                     Box 1 Wages, Tips, etc                           $23,450.00
                     Box 2 Federal Income Tax Withheld                $300.00
                     Box 3 Social Security Wages                      $23,450.00
                     Box 4 Social Security Tax Withheld               $1,454.00
                     Box 5 Medicare Wages and Tips                    $23,450.00
                     Box 6 Medicare Withheld                          $340.00
                     Box 15 State                                     OH
                     State ID Number                                  51-567890
                     State Wages                                      $23,450.00
                     State Income Tax Withheld                        $122.00
                     Local Wages                                      $23,450.00
                     Local Income Tax Withheld                        $293.00
                     Name of Locality                                 SPENCERVILLE

                                                                                     3-1

Ohio Test #3
W-2 #2 (added 10/31/2016)
                         Employers Identification Number                                      14-3456789
                         Employer's Name                                                      GMRZ INC
                         Employer's Address                                                   25 SOUTH BLVD
                         Employer's City                                                      DETROIT
                         Employer's State                                                     MI
                         Employer's Zip Code                                                  48201
                         Employee's Social Security Number                                    400-00-7653
                         Employee's Name                                                      NORA BADGER
                         Employee's Address                                                   75 S ANIMAL DR
                         Employee's City                                                      EDON
                         Employee's State                                                     OH
                         Employee's Zip Code                                                  43518
                         Box 1 Wages, Tips, etc                                               $500.00
                         Box 2 Federal Income Tax Withheld                                    $40.00
                         Box 3 Social Security Wages                                          $500.00
                         Box 4 Social Security Tax Withheld                                   $31.00
                         Box 5 Medicare Wages and Tips                                        $500.00
                         Box 6 Medicare Withheld                                              $7.00
                         Box 15 State                                                         OH
                         State ID Number                                                      51-567890
                         State Wages                                                          $500.00
                         State Income Tax Withheld                                            $10.00
                         Local Wages                                                          $500.00
                         Local Income Tax Withheld                                            $5.00
                         Name of Locality                                                     SPENCERVILLE
            1099-K
                         Filer Name                                                           DRIVE INC.
                         Filer Address                                                        25 SOUTH BLVD
                         Filer City                                                           SAN FRANCISCO
                         Filer State                                                          CA
                         Filer Zip Code                                                       94103
                         Filer Identification Number                                          14-2333444
                         Payment Settlement Entity (PSE)                                      X
                         Payment Card                                                         X
                         Individual Payee's Social Security Number                            400-00-7653
                         Individual Payee's Name                                              NORA BADGER
                         Payee Address                                                        75 S ANIMAL DR
                         Payee City                                                           EDON
                         Payee State                                                          OH
                         Payee Zip Code                                                       43518
                         Box 1a Gross amount of payment card/third party network transactions $500.00
                         Box 3 Number of payment transactions                                 10
                         Box 5c March                                                         $500.00
                         State Tax Withheld                                                   $5.00
                         State abbreviation code                                              OH
                         State ID Number                                                      51-555222
                         State Wages                                                          $500.00

                                                                                                             3-2

Ohio Test #3
            1099-OID
                                Payer's Name                                                                  FIRST BANK
                                Payer's US Address                                                            500 MONEY LN
                                Payer's City                                                                  BASCOM
                                Payer's State                                                                 OH
                                Payer's Zip Code                                                              44809
                                Payer's Federal Identification Number                                         16-3456789
                                Recipient's Identification Number                                             400-00-7653
                                Recipient's Name                                                              NORA BADGER
                                Recipient's US Address                                                        75 S ANIMAL DR
                                Recipient's City                                                              EDON
                                Recipient's State                                                             OH
                                Recipient's Zip Code                                                          43518
                                Box 1 Original Issue Discount                                                 $1,500
                                Federal Income Tax Withheld                                                   $100
                                Box 12 State Tax Withheld                                                     $52
                                Box 10 State                                                                  OH
                                Box 11 State Identification no                                                51-789012
                                State Distribution Amount                                                     $1,500
Federal Return Information 1040                                       Description
                                Filing Status                                                                 Married Filing Jointly
                                Exemptions, Self, Spouse                                                      2
                                Line 7 Total Wages                                                            $23,950.00
                                Line 8a Taxable Interest                                                      $1,500.00
                                Line 10 Taxable Refunds, credits or offsets of state and local income taxes   $125.00
                                Line 12 Business loss Schedule C (1099-K income is included in loss)          -$10,125.00
                                Schedule SE Section A line 2                                                  -$10,125.00
                                Line 37 Adjusted Gross Income                                                 $15,450.00
State Return Information                                              Description
                                Is this an amended return?                                                    No
                                Self-Prepared                                                                 X
                                Filing Status                                                                 Married Filing Jointly
                                Ohio Residency Status (Primary)                                               Full-Year Resident
                                Ohio Residency Status (Spouse)                                                Full-Year Resident
                                Ohio Political Party Fund Contribution - Primary                              No
                                Ohio Political Party Fund Contribution - Spouse                               Yes
                                Is someone else claiming you or your spouse (if joint return) as a dependent? No
                                Enter the number of dependents                                                0
                                Eligible for JFC?                                                             Yes
                                Amount Credited to Next Year's Tax Liability                                  $5.00
                                Donation From Taxpayer - Ohio History Fund                                    $5.00
                                Preparer Authorization Check Box                                              No
                                Perjury Statement Acceptance                                                  x
                                Taxpayer's Phone Number                                                       330-554-1234
                                Taxpayer's E-mail Address                                                     WOLVERINE@HOTMAIL.COM

                                                                                                                                     3-3

Ohio Test #3
             Worksheets           Unpaid Ohio Use Tax
                        a.        Did you make any out of state purchases                                                  Yes
                        b.        Did the retailer charge you any sales tax                                                No
                        c.        Amount of Purchases that you did not pay sales tax                                       $100.00
                        d.        County sales tax rate                                                                    7.25%
SD Return Information
                                  Are you Filing the Ohio School District Income Tax Return Electronically                 Yes
                                  What is the school district number for which you are filing the SD 100?                  8603
                                  School District Residency (Primary)                                                      Full-Year Resident
                                  School District Residency (Spouse)                                                       Full-Year Resident
                                  Tax Type                                                                                 Earned Income Only
                                  Interest and Penalty on Late-paid and/or Late-filed Return                               $50.00
                                  Net Earnings from Self Employment                                                        ($10,125.00)
                        OH Line #                                           Line Item                                      Amount
                        1         Federal Adjusted Gross Income                                                                              $15,450.00
                        2a        Additions to federal adjusted gross income                                                                 $0.00
                        2b        Deductions from federal adjusted gross income                                                              $125.00
                        3         Ohio Adjusted Gross Income (OAGI)                                                                          $15,325.00
                        4         Personal and dependent exemption deduction                                                                 $4,500.00
                        5         Ohio income tax base                                                                                       $10,825.00
                        6         Taxable business income (Ohio IT BUS, line 13)                                                             $0.00
                        7         Line 5 minus line 6 (if less than 0, enter 0)                                                              $10,825.00
                        7a        Amount from line 7 on page 1                                                                               $10,825.00
                        8a        Nonbusiness income tax liability                                                                           $84.00
                        8b        Business income tax liability (Ohio IT BUS, line 14)                                                       $0.00
                        8c        Tax liability (line 8a plus 8b)                                                                            $84.00
                        9         Ohio nonrefundable credits                                                                                 $49.00
                        10        Tax liability after nonrefundable credits                                                                  $35.00
                        11        Interest penalty on underpayment of estimated tax                                                          $0.00
                        12        Sales and use tax due on Internet, mail order or other out-of-state purchases                              $7.00
                        13        Total Ohio tax liability before withholding or estimated payments                                          $42.00
                        14        Ohio income tax withheld                                                                                   $189.00
                                  Add the Ohio estimated & extension payments & credit carryforward from previous year 
                        15        return                                                                                                     $0.00
                        16        Refundable credits                                                                                         $0.00
                        17        Amended return only - amount previously paid with original/amended return                                  $0.00
                        18        Total Ohio Tax Payments                                                                                    $189.00
                        19        Amended return only - overpayment previously received on original/amended return                           $0.00
                        20        Line 18 minus line 19                                                                                      $189.00
                        21        Tax liability                                                                                              $0.00
                        22        Interest and penalty due on late filing or payment of tax                                                  $0.00
                        23        Total Amount Due                                                                                           $0.00
                        24        Overpayment                                                                                                $147.00
                        25        Original return only - amount of line 24 to be credited toward 2016 income tax liability                   $5.00
                        26a       Amount of line 24 to be donated - Military injury relief                                                   $0.00
                        26b       Amount of line 24 to be donated - Ohio History Fund                                                        $5.00
                        26c       Amount of line 24 to be donated - State nature preserves                                                   $0.00
                        26d       Amount of line 24 to be donated - Breast/cervical cancer                                                   $0.00
                        26e       Amount of line 24 to be donated - Wishes for sick children                                                 $0.00
                        26f       Amount of line 24 to be donated - Wildlife species                                                         $0.00
                        26g       Total                                                                                                      $5.00
                        27        Your Refund                                                                                                $137.00

                                                                                                                                              3-4

Ohio Test #3
Schedule A     Additions
            1  Non-Ohio state or local government interest and dividends                                     $0.00
            2  Certain Ohio pass-through entity and financial institutions taxes paid                        $0.00
               Reimbursement of college tutition expenses and fees deducted in any previous year(s) and 
            3  noneducation expenditures from a college savings account                                      $0.00
            4  Losses from sale or disposition of Ohio public obligations                                    $0.00
            5  Nonmedical withdrawals from a medical savings account                                         $0.00
               Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if 
            6  the reimbursement is not in federal adjusted gross income                                     $0.00
            7  Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense             $0.00
            8  Federal interest and dividends subject to state taxation                                      $0.00
            9  Miscellaneous federal income tax additions                                                    $0.00
            10 Total additions                                                                               $0.00
Schedule A     Deductions
            11 Business income deduction (attach Ohio Schedule IT BUS, line 11)                              $0.00
            12 Employee compensation earned in Ohio by residents of neighboring states                       $0.00
            13 State or municipal income tax overpayments shown on IRS form 1040, line 10                    $125.00
            14 Qualifying Social Security benefits and certain railroad retirement benefits                  $0.00
               Interest income from Ohio public obligations and from Ohio purchase obligations; gains from 
               the sale or disposition of Ohio public obligations; public service payments received from the 
            15 state of Ohio or income from a transfer agreement                                             $0.00
            16 Amounts contributed to an individual development account                                      $0.00
            17 Amounts contributed to STABLE account; Ohio's ABLE plan
            18 Federal interest and dividends exempt from state taxation                                     $0.00
            19 Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense             $0.00
               Refund or reimbursements shown on IRS form 1040, line 21 for itemized deductions 
            20 claimed on a prior year federal income tax return                                             $0.00
            21 Repayment of income reported in a prior year                                                  $0.00
            22 Wage expense not deducted due to claiming the federal work opportunity credit                 $0.00
            23 Miscellaneous federal income tax  deductions                                                  $0.00
               Military pay for Ohio residents received while the military member was stationed outside 
            24 Ohio                                                                                          $0.00
            25 Certain income earned by military nonresidents and civilian nonresident spouses               $0.00
            26 Uniformed services retirement income                                                          $0.00
            27 Military injury relief fund                                                                   $0.00
            28 Certain Ohio National Guard reimbursements and benefits                                       $0.00
            29 Ohio 529 contributions, tuition credit purchases                                              $0.00
            30 Pell/Ohio College Opportunity taxable grant amounts used to pay room and board                $0.00
            31 Disability and survivorship benefits (do not include pension continuation benefits)           $0.00
               Unreimbursed long-term care insurance premiums, unsubsidized health care insurance 
            32 premiums and excess health care expenses                                                      $0.00
               Funds deposited into, and earnings of, a medical savings account for eligible health care 
            33 expenses                                                                                      $0.00
            34 Qualified organ donor expenses                                                                $0.00
            35 Total deductions                                                                              $125.00

                                                                                                              3-5

Ohio Test #3
Schedule of Credits    Nonrefundable credits
                    1  Total tax liability (From IT1040 8c)                                                             $84.00
                    2  Retirement Income Credit                                                                         $0.00
                    3  Lump sum retirement credit                                                                       $0.00
                    4  Senior citizen credit                                                                            $0.00
                    5  Lump sum distribution credit                                                                     $0.00
                    6  Child care and dependent care credit                                                             $0.00
                    7  If Ohio form IT 1040, line 5 is $10,000 or less, enter $88; otherwise, enter -0- (low income cre $0.00
                    8  Displaced worker training credit                                                                 $0.00
                       Campaign contribution credit for Ohio statewide office or General 
                    9  Assembly                                                                                         $0.00
                    10 Income-based exemption credit                                                                    $40.00
                    11 Total (add lines 2 through 10)                                                                   $40.00
                    12 Tax less credits (line 1 minus line 11; if less than -0-, enter -0-)                             $44.00
                    13 Joint filing credit                                                                              $9.00
                    14 Earned income credit                                                                             $0.00
                    15 Ohio adoption credit                                                                             $0.00
                    16 Job retention credit, nonrefundable portion                                                      $0.00
                    17 Credit for eligible new employees in an enterprise zone                                          $0.00
                    18 Credit for purchases of grape production property                                                $0.00
                    19 Credit for investing in an Ohio small business                                                   $0.00
                    20 Technology investment credit carryforward                                                        $0.00
                    21 Enterprise zone day care and training credits                                                    $0.00
                    22 Research and development credit                                                                  $0.00
                    23 Ohio historic preservation credit, nonrefundable carryforward portion                            $0.00
                    24 Total (add lines 13 through 23)                                                                  $9.00
                    25 Tax less additional credits (line 12 minus line 24; if less than -0-, enter -0-)                 $35.00
                       Nonresident Credit
                    26 Enter the portion of OAGI that was not earned or received in Ohio                                $0.00
                    27 Enter the OAGI                                                                                   $0.00
                       Line 26/27 _____* Multiply this factor by the amount on line 25 to calculate your nonresident 
                    28 credit                                                                                           $0.00
                       Resident Credit
                    29 Enter the portion of OAGI subjected to tax by other states or DC while an OH resident            $0.00
                    30 Enter OAGI                                                                                       $0.00
                    31 Divide line 29 by line 30 ____*Multiply this factor by the amount on line 25                     $0.00
                    32 Enter the 2016 income tax, less all credits other than w/h and est tax pmts and CCFs             $0.00
                    33 Enter the smaller of line 31 or line 32. This is your Ohio resident tax credit.                  $0.00
                    34 Total nonrefundable credits                                                                      $49.00
                       Refundable Credits
                    35 Historic preservation credit                                                                     $0.00
                    36 Business jobs credit                                                                             $0.00
                    37 Pass-through entity credit                                                                       $0.00
                    38 Motion picture production credit                                                                 $0.00
                    39 Financial Institutions Tax (FIT) credit                                                          $0.00
                    40 Venture Capital credit                                                                           $0.00
                    41 Total refundable credits                                                                         $0.00

                                                                                                                         3-6

Ohio Test #3
Sch IT BUS
                                                   Part 1
            1                                      Sch B - Interest and Ordinary Dividends                                                    $0.00
            2                                      Sch C - Profit or Loss From Business (Sole Proprietership)                                 $0.00
            3                                      Sch D - Capital Gains and Losses                                                           $0.00
            4                                      Sch E - Supplemental Income and Loss                                                       $0.00
                                                   Guranteed payments, compensation and/or wages from each pass-through entity in which 
            5                                      you have at least a 20% direct or indirect ownership interest                              $0.00
            6                                      Sch F - Profit or Loss From Farming                                                        $0.00
                                                   Other items of income and gain separately stated on federal Schedule K-1, federal 4787 
                                                   gains and/or losses reported on federal 4787 and miscellaneous federal income tax 
            7                                      adjustments, if any                                                                        $0.00
            8                                      Total of business income                                                                   $0.00
                                                   Part 2
                                                   All business income. Enter here & on  IT 1040, line 6. If 0 or negative, stop here & don't 
            9                                      complete Part 3.                                                                           $0.00
            10                                     Enter $250,000 if single or MFJ, enter $125,000 if MFS                                     $0.00
            11                                     Lesser of line  9or line 10. Enter here and on Ohio Schedule A, line 11                    $0.00
                                                   Part 3
            12                                     Line  9minus line 1 1(if less than -0-, enter -0-)                                         $0.00
            13                                     Taxable Business Income                                                                    $0.00
            14                                     Business income tax liability. Enter here and on Ohio IT 1040, line 8b.                    $0.00
School District Return Information (Resident #8603)
            1                                      School district taxable income:  Traditional or Earned Income tax base                     $13,825.00
            2                                      School District Tax .____ times line 1.                                                    $138.00
            3                                      Senior Citizen Credit                                                                      $0.00
            4                                      School District Income Tax liability                                                       $138.00
            5                                      Interest Penalty on Underpayment of School District Estimated Tax                          $0.00
            6                                      Total school district income tax liability (line 4 plus line 5)                            $138.00
            6a                                     Amount from line 6                                                                         $138.00
            7                                      School district income tax withheld                                                        $0.00
            8                                      SD100ES & SD40P, Extension Payments and Credit carryforward from previous year return      $0.00
            9                                      Amended return only - amount previously paid with original/amended return                  $0.00
            10                                     Total school district income tax payments (add lines 7, 8 and 9)                           $0.00
            11                                     Amended return only - overpayment previously received on original/amended return           $0.00
            12                                     Total Payments less overpayment previously received on original/amended return             $0.00
            13                                     Tax Liability                                                                              $138.00
            14                                     Interest and penalty due on late filing or payment of tax                                  $50.00
            15                                     Total Amount Due                                                                           $188.00
            16                                     Overpayment                                                                                $0.00
            17                                     Original return only - amount of line 16 to be credited toward 2016 income tax liability   $0.00
            18                                     Your Refund                                                                                $0.00

                                                                                                                                               3-7

Ohio Test #3
School District Schedule A "Traditional" Tax Base School District Amounts
                                  19                       Ohio income tax base reported on line 5 of Ohio IT 1040                                    $0.00
                                  20                       Business income deduction add-back                                                         $0.00
                                  21                       Total Traditional Tax Base School District Income (Line 19 + Line 20)                      $0.00
                                  22                       Amount of traditional tax base school district income that you earned while not a resident $0.00
                                  23                       School District Taxable Income (Enter here and on line 1)                                  $0.00
School District Schedule B "Earned Income Only" Tax Base School District Amounts
                                  24                       Wages and other compensation as described in the instructions                              $23,950.00
                                  25                       Net Earnings from Self Employment                                                          ($10,125.00)
                                  26                       Depreciation Expense Adjustments                                                           $0.00
                                  27                       School District Taxable Income (Enter here and on line 1)                                  $13,825.00
Ohio Test #3
What is Tested?
IT1040WithSD100
Self-Prepared
MFJ status
Deceased spouse
Ohio W-2
1099-K
1099-OID

IT1040
Full year resident
[$10,500 - $15,800] tax bracket
20% joint filing credit
Use tax
Sch. A - State/municipal income tax overpayments
Donation 
Refund/credit carryforward split 

SD100
Earned income only school district
Interest & Penalty - do not calculate interest for testing 
purposes
Tax due

                                                                                                                                                       3-8

Ohio Test #4                                                                IT1040 with SD100
Taxpayer Information                                    Description
                     Primary Social Security Number                   XX0-00-7604
                     Primary First Name                               EMMA
                     Primary Last Name                                CHAMP
                     Date of Birth - Primary                          5/20/1960
                     Occupation - Primary                             RETIRED ARMY
                     Spouse's Social Security Number                  XX0-00-7654
                     Spouse First Name                                WILL
                     Spouse Middle Initial                            B
                     Spouse Last Name                                 CHAMP
                     Date of Birth - Spouse                           2/21/1963
                     Occupation - Spouse                              MEDICAL ASSISTANT
                     Address Line 1                                   123 TROPHY LN
                     City                                             PAINESVILLE
                     State                                            OH
                     Zip Code                                         44077
                     Ohio County                                      LOGAN
                     County Code (Ohio Public School District Number) 4604
                                             Income Statements
             W-2 #1
                     Employers Identification Number                  31-9876543
                     Employer's Name                                  NATIONAL GUARD
                     Employer's Address                               25 S BUNKER DR
                     Employer's City                                  SOLON
                     Employer's State                                 OH
                     Employer's Zip Code                              44139
                     Employee's Social Security Number                400-00-7604
                     Employee's Name                                  EMMA CHAMP
                     Employee's Address                               123 TROPHY LN
                     Employee's City                                  PAINESVILLE
                     Employee's State                                 OH
                     Employee's Zip Code                              44077
                     Box 1 Wages, Tips, etc                           $5,600.00
                     Box 2 Federal Income Tax Withheld                $50.00
                     Box 3 Social Security Wages                      $5,600.00
                     Box 4 Social Security Tax Withheld               $347.00
                     Box 5 Medicare Wages and Tips                    $5,600.00
                     Box 6 Medicare Withheld                          $81.00
                     Box 15 State                                     OH
                     State ID Number                                  52-890123
                     State Wages                                      $5,600.00
                     State Income Tax Withheld                        $36.00
                     Local Wages                                      $5,600.00
                     Local Income Tax Withheld                        $100.00
                     Name of Locality                                 ANSONIA

                                                                                        4-1

Ohio Test #4
            W-2 #2
                  Employers Identification Number    38-3838196
                  Employer's Name                    DOCTORS AND ASSOCIATES
                  Employer's Address                 75 LIBERTY ST
                  Employer's City                    OBERLIN
                  Employer's State                   OH
                  Employer's Zip Code                44074
                  Employee's Social Security Number  400-00-7654
                  Employee's Name                    WILL B CHAMP
                  Employee's Address                 123 TROPHY LN
                  Employee's City                    PAINESVILLE
                  Employee's State                   OH
                  Employee's Zip Code                44077
                  Box 1 Wages, Tips, etc             $10,777.00
                  Box 2 Federal Income Tax Withheld  $64.00
                  Box 3 Social Security Wages        $10,777.00
                  Box 4 Social Security Tax Withheld $668.00
                  Box 5 Medicare Wages and Tips      $10,777.00
                  Box 6 Medicare Withheld            $156.00
                  Box 15 State                       OH
                  State ID Number                    51-901234
                  State Wages                        $10,777.00
                  State Income Tax Withheld          $488.00
                  Local Wages                        $10,777.00
                  Local Income Tax Withheld          $189.00
                  Name of Locality                   ANSONIA
                  School District Wages              $10,777.00
                  School District Tax Withheld       $189.00
                  School District #                  4604

            W-2 #3
                  Employers Identification Number    20-9876543
                  Employer's Name                    LITTLE LULU'S CAFÉ
                  Employer's Address                 6 S HIGH ST
                  Employer's City                    TULSA
                  Employer's State                   OK
                  Employer's Zip Code                74103
                  Employee's Social Security Number  400-00-7654
                  Employee's Name                    WILL B CHAMP
                  Employee's Address                 123 TROPHY LN
                  Employee's City                    PAINESVILLE
                  Employee's State                   OH
                  Employee's Zip Code                44077
                  Box 1 Wages, Tips, etc             $6,000.00
                  Box 2 Federal Income Tax Withheld  $300.00
                  Box 3 Social Security Wages        $6,000.00
                  Box 4 Social Security Tax Withheld $372.00
                  Box 5 Medicare Wages and Tips      $6,000.00
                  Box 6 Medicare Withheld            $87.00
                  Box 15 State                       SC
                  State ID Number                    118A46C
                  State Wages                        $6,000.00
                  State Income Tax Withheld          $150.00
                  Local Wages                        $6,000.00
                  Local Income Tax Withheld          $75.00
                  Name of Locality                   SPRINGVILLE

                                                                        4-2

Ohio Test #4
            1099R #1
                    Payer's Identification Number      20-3456789
                    Payer's Name                       US ARMY
                    Payer's Address                    100 N BUNKER DR
                    Payer's City                       SOLON
                    Payer's State                      OHIO
                    Payer's Zip Code                   44139
                    Recipient's Social Security Number 400-00-7604
                    Recipient's Name                   EMMA CHAMP
                    Recipient's Address                123 TROPHY LN
                    Recipient's City                   PAINESVILLE
                    Recipient's State                  OH
                    Recipient's Zip Code               44077
                    Gross Distribution Amount          $2,100.00
                    Taxable Amount                     $2,100.00
                    Distribution Code                  7
                    Box 15 State                       OH
                    State Payer ID                     51-123456
                    State Distribution                 $2,100.00
                    State Income Tax Withheld          $17.00
            1099R #2
                    Payer's Identification Number      21-9876543
                    Payer's Name                       SUNSET INC
                    Payer's Address                    98 N OBERLIN DR
                    Payer's City                       OBERLIN
                    Payer's State                      OH
                    Payer's Zip Code                   44074
                    Recipient's Social Security Number 400-00-7654
                    Recipient's Name                   WILL B CHAMP
                    Recipient's Address                123 TROPHY LN
                    Recipient's City                   PAINESVILLE
                    Recipient's State                  OH
                    Recipient's Zip Code               44077
                    Gross Distribution Amount          $5,900.00
                    Taxable Amount                     $5,900.00
                    Distribution Code                  7
                    Box 15 State                       OH
                    State Payer ID                     52-234567
                    State Distribution                 $5,900.00
                    State Income Tax Withheld          $160.00

                                                                       4-3

Ohio Test #4
Federal Return Information 1040                                        Description
                                Filing Status                                                                            Married Filing Jointly
                                Exemptions, Self, Spouse                                                                 2
                                Line 7 Total Wages  (Includes $400 of the taxable portion of a Pell Grant and $500 for   $23,277.00
                                Military Injury Relief Fund)
                                Line 16b Pensions and Annuities                                                          $8,000.00
                                Line 37 Adjusted Gross Income                                                            $31,277.00
State Return Information                                               Description
                                Is this an amended return?                                                               No
                                Paid Preparer's PTIN                                                                     P13579135
                                Paid Preparer's Firm ID Number                                                           123456789
                                Paid Preparer's Business Name                                                            WE FILE TAXES
                                Paid Preparer's name                                                                     JAKE HOWARD
                                Preparer's US Address                                                                    500 NORTH ST
                                City                                                                                     ANSONIA
                                State                                                                                    OH
                                ZIP Code                                                                                 45303
                                Paid Preparer's Phone Number                                                             937-554-6789
                                Paid Preparer's Email Address                                                            JAKEH@WEFILETAXES.COM
                                Filing Status                                                                            Married Filing Jointly
                                Ohio Residency Status (Primary)                                                          Full-Year Resident
                                Ohio Residency Status (Spouse)                                                           Full-Year Resident
                                Ohio Political Party Fund Contribution - Primary                                         No
                                Ohio Political Party Fund Contribution - Spouse                                          No
                                Is someone else claiming you or your spouse (if joint return) as a dependent?            No
                                Enter the number of dependents                                                           0
                                Military pay for Ohio Residents Stationed Outside Ohio                                   $5,600.00
                                Uniformed Services Retirement and Military Injury Relief Fund                            $2,100.00
                                Military Injury Relief Fund                                                              $500.00
                                Ohio National Guard Reimbursements and Benefits                                          $279.00
                                Eligible for Retirement Income Credit?                                                   Yes
                                Eligible for JFC?                                                                        No
                                Enter the Portion of Line 3 Subjected to tax by Other States or the District of Columbia $6,000.00
                                While an Ohio Resident
                                2016 income tax less all credits other than withholding and estimated payment and 
                                overpayment credit carryforward from previous year paid to the other state(s) or the District  $150.00
                                of Columbia
                                Amount Credited to Next Year's Tax Liability                                             $500.00
                                Taxpayer's E-mail Address                                                                EMMA@EMMA.NET
                                Taxpayer's Phone Number                                                                  937-554-2345
                                Perjury Statement Acceptance                                                             Yes
                                Preparer Authorization Check Box                                                         No
            Worksheets          Pell Grant Worksheet
                                Line 1 Amount of Pell Grant                                                              $5,000.00
                                Line 2 Portion used to pay qualified expenses                                            $4,600.00
                                Line 4 Portion of line 3 reported as a taxable amount on IRS form 1040                   $400.00
                                Line 5 Portion of line 4 applied to room and board expenses                              $400.00
SD Return Information
                                Are you Filing the Ohio School District Income Tax Return Electronically                 Yes
                                What is the school district number for which you are filing the SD 100?                  4604
                                School District Residency (Primary)                                                      Full-Year Resident
                                School District Residency (Spouse)                                                       Full-Year Resident
                                Tax Type                                                                                 Traditional
                                SD100ES & SD40P, Extension Payments and Credit Carryover                                 $50.00

                                                                                                                                                4-4

Ohio Test #4
            OH Line #                                           Line Item                                      Amount
            1         Federal Adjusted Gross Income                                                                  $31,277.00
            2a        Additions to federal adjusted gross income                                                     $0.00
            2b        Deductions from federal adjusted gross income                                                  $8,879.00
            3         Ohio Adjusted Gross Income (OAGI)                                                              $22,398.00
            4         Personal and dependent exemption deduction                                                     $4,500.00
            5         Ohio income tax base                                                                           $17,898.00
            6         Taxable business income (Ohio IT BUS, line 13)                                                 $0.00
            7         Line 5 minus line 6 (if less than 0, enter 0)                                                  $17,898.00
            7a        Amount from line 7 on page 1                                                                   $17,898.00
            8a        Nonbusiness income tax liability                                                               $235.00
            8b        Business income tax liability (Ohio IT BUS, line 14)                                           $0.00
            8c        Tax liability (line 8a plus 8b)                                                                $235.00
            9         Ohio nonrefundable credits                                                                     $187.00
            10        Tax liability after nonrefundable credits                                                      $48.00
            11        Interest penalty on underpayment of estimated tax                                              $0.00
            12        Sales and use tax due on Internet, mail order or other out-of-state purchases                  $0.00
            13        Total Ohio tax liability before withholding or estimated payments                              $48.00
            14        Ohio income tax withheld                                                                       $701.00
            15        Add the Ohio estimated & extension payments & credit carryforward from previous year retur     $0.00
            16        Refundable credits                                                                             $0.00
            17        Amended return only - amount previously paid with original/amended return                      $0.00
            18        Total Ohio Tax Payments                                                                        $701.00
            19        Amended return only - overpayment previously received on original/amended return               $0.00
            20        Line 18 minus line 19                                                                          $701.00
            21        Tax liability                                                                                  $0.00
            22        Interest and penalty due on late filing or payment of tax                                      $0.00
            23        Total Amount Due                                                                               $0.00
            24        Overpayment                                                                                    $653.00
            25        Original return only - amount of line 24 to be credited toward 2016 income tax liability       $500.00
            26a       Amount of line 24 to be donated - Military injury relief                                       $0.00
            26b       Amount of line 24 to be donated - Ohio History Fund                                            $0.00
            26c       Amount of line 24 to be donated - State nature preserves                                       $0.00
            26d       Amount of line 24 to be donated - Breast/cervical cancer                                       $0.00
            26e       Amount of line 24 to be donated - Wishes for sick children                                     $0.00
            26f       Amount of line 24 to be donated - Wildlife species                                             $0.00
            26g       Total                                                                                          $0.00
            27        Your Refund                                                                                    $153.00

                                                                                                                      4-5

Ohio Test #4
Schedule A     Additions
            1  Non-Ohio state or local government interest and dividends                                 $0.00
            2  Certain Ohio pass-through entity and financial institutions taxes paid                    $0.00
               Reimbursement of college tutition expenses and fees deducted in any previous year(s) and 
            3  noneducation expenditures from a college savings account                                  $0.00
            4  Losses from sale or disposition of Ohio public obligations                                $0.00
            5  Nonmedical withdrawals from a medical savings account                                     $0.00
               Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if 
            6  the reimbursement is not in federal adjusted gross income                                 $0.00
            7  Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense         $0.00
            8  Federal interest and dividends subject to state taxation                                  $0.00
            9  Miscellaneous federal income tax additions                                                $0.00
            10 Total additions                                                                           $0.00
Schedule A     Deductions
            11 Business income deduction (attach Ohio Schedule IT BUS, line 11)                          $0.00
            12 Employee compensation earned in Ohio by residents of neighboring states                   $0.00
            13 State or municipal income tax overpayments shown on IRS form 1040, line 10                $0.00
            14 Qualifying Social Security benefits and certain railroad retirement benefits              $0.00
               Interest income from Ohio public obligations and from Ohio purchase obligations; gains 
               from the sale or disposition of Ohio public obligations; public service payments received 
            15 from the state of Ohio or income from a transfer agreement                                $0.00
            16 Amounts contributed to an individual development account                                  $0.00
            17 Amounts contributed to STABLE account; Ohio's ABLE plan
            18 Federal interest and dividends exempt from state taxation                                 $0.00
            19 Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense         $0.00
               Refund or reimbursements shown on IRS form 1040, line 21 for itemized deductions 
            20 claimed on a prior year federal income tax return                                         $0.00
            21 Repayment of income reported in a prior year                                              $0.00
            22 Wage expense not deducted due to claiming the federal work opportunity credit             $0.00
            23 Miscellaneous federal income tax deductions                                               $0.00
               Military pay for Ohio residents received while the military member was stationed outside 
            24 Ohio                                                                                      $5,600.00
            25 Certain income earned by military nonresidents and civilian nonresident spouses           $0.00
            26 Uniformed services retirement income                                                      $2,100.00
            27 Military injury relief fund                                                               $500.00
            28 Certain Ohio National Guard reimbursements and benefits                                   $279.00
            29 Ohio 529 contributions, tuition credit purchases                                          $0.00
            30 Pell/Ohio College Opportunity taxable grant amounts used to pay room and board            $400.00
            31 Disability and survivorship benefits (do not include pension continuation benefits)       $0.00
               Unreimbursed long-term care insurance premiums, unsubsidized health care insurance 
            32 premiums and excess health care expenses                                                  $0.00
               Funds deposited into, and earnings of, a medical savings account for eligible health care 
            33 expenses                                                                                  $0.00
            34 Qualified organ donor expenses                                                            $0.00
            35 Total deductions                                                                          $8,879.00

                                                                                                          4-6

Ohio Test #4
Schedule of Credits    Nonrefundable credits
                    1  Total tax liability (From IT1040 8c)                                                             $235.00
                    2  Retirement Income Credit                                                                         $130.00
                    3  Lump sum retirement credit                                                                       $0.00
                    4  Senior citizen credit                                                                            $0.00
                    5  Lump sum distribution credit                                                                     $0.00
                    6  Child care and dependent care credit                                                             $0.00
                    7  If Ohio form IT 1040, line 5 is $10,000 or less, enter $88; otherwise, enter -0- (low income cre $0.00
                    8  Displaced worker training credit                                                                 $0.00
                       Campaign contribution credit for Ohio statewide office or General 
                    9  Assembly                                                                                         $0.00
                    10 Income-based exemption credit                                                                    $40.00
                    11 Total (add lines 2 through 10)                                                                   $170.00
                    12 Tax less credits (line 1 minus line 11; if less than -0-, enter -0-)                             $65.00
                    13 Joint filing credit                                                                              $0.00
                    14 Earned income credit                                                                             $0.00
                    15 Ohio adoption credit                                                                             $0.00
                    16 Job retention credit, nonrefundable portion                                                      $0.00
                    17 Credit for eligible new employees in an enterprise zone                                          $0.00
                    18 Credit for purchases of grape production property                                                $0.00
                    19 Credit for investing in an Ohio small business                                                   $0.00
                    20 Technology investment credit carryforward                                                        $0.00
                    21 Enterprise zone day care and training credits                                                    $0.00
                    22 Research and development credit                                                                  $0.00
                    23 Ohio historic preservation credit, nonrefundable carryforward portion                            $0.00
                    24 Total (add lines 13 through 23)                                                                  $0.00
                    25 Tax less additional credits (line 12 minus line 24; if less than -0-, enter -0-)                 $65.00
                       Nonresident Credit
                    26 Enter the portion of OAGI that was not earned or received in Ohio                                $0.00
                    27 Enter the OAGI                                                                                   $0.00
                       Line 26/27 _____* Multiply this factor by the amount on line 25 to calculate your nonresident 
                    28 credit                                                                                           $0.00
                       Resident Credit
                    29 Enter the portion of OAGI subjected to tax by other states or DC while an OH resident            $6,000.00
                    30 Enter OAGI                                                                                       $22,398.00
                    31 Divide line 29 by line 30 ____*Multiply this factor by the amount on line 25                     $17.00
                    32 Enter the 2016 income tax, less all credits other than w/h and est tax pmts and CCFs             $150.00
                    33 Enter the smaller of line 31 or line 32. This is your Ohio resident tax credit.                  $17.00
                    34 Total nonrefundable credits                                                                      $187.00
                       Refundable Credits
                    35 Historic preservation credit                                                                     $0.00
                    36 Business jobs credit                                                                             $0.00
                    37 Pass-through entity credit                                                                       $0.00
                    38 Motion picture production credit                                                                 $0.00
                    39 Financial Institutions Tax (FIT) credit                                                          $0.00
                    40 Venture Capital credit                                                                           $0.00
                    41 Total refundable credits                                                                         $0.00

                                                                                                                         4-7

Ohio Test #4
Sch IT BUS
                                                   Part 1
            1                                      Sch B - Interest and Ordinary Dividends                                                    $0.00
            2                                      Sch C - Profit or Loss From Business (Sole Proprietership)                                 $0.00
            3                                      Sch D - Capital Gains and Losses                                                           $0.00
            4                                      Sch E - Supplemental Income and Loss                                                       $0.00
                                                   Guranteed payments, compensation and/or wages from each pass-through entity in which 
            5                                      you have at least a 20% direct or indirect ownership interest                              $0.00
            6                                      Sch F - Profit or Loss From Farming                                                        $0.00
                                                   Other items of income and gain separately stated on federal Schedule K-1, federal 4787 
                                                   gains and/or losses reported on federal 4787 and miscellaneous federal income tax 
            7                                      adjustments, if any                                                                        $0.00
            8                                      Total of business income                                                                   $0.00
                                                   Part 2
                                                   All business income. Enter here & on  IT 1040, line 6. If 0 or negative, stop here & don't 
            9                                      complete Part 3.                                                                           $0.00
            10                                     Enter $250,000 if single or MFJ, enter $125,000 if MFS                                     $0.00
            11                                     Lesser of line  9or line 10. Enter here and on Ohio Schedule A, line 11                    $0.00
                                                   Part 3
            12                                     Line  9minus line 1 1(if less than -0-, enter -0-)                                         $0.00
            13                                     Taxable Business Income                                                                    $0.00
            14                                     Business income tax liability. Enter here and on Ohio IT 1040, line 8b.                    $0.00
School District Return Information (Resident #4604)
            1                                      School district taxable income:  Traditional or Earned Income tax base                     $17,898.00
            2                                      School District Tax .____ times line 1.                                                    $313.00
            3                                      Senior Citizen Credit                                                                      $0.00
            4                                      School District Income Tax liability                                                       $313.00
            5                                      Interest Penalty on Underpayment of School District Estimated Tax                          $0.00
            6                                      Total school district income tax liability (line 4 plus line 5)                            $313.00
            6a                                     Amount from line 6                                                                         $313.00
            7                                      School district income tax withheld                                                        $189.00
            8                                      SD100ES & SD40P, Extension Payments and Credit carryforward from previous year return      $50.00
            9                                      Amended return only - amount previously paid with original/amended return                  $0.00
            10                                     Total school district income tax payments (add lines 7, 8 and 9)                           $239.00
            11                                     Amended return only - overpayment previously received on original/amended return           $0.00
            12                                     Total Payments less overpayment previously received on original/amended return             $239.00
            13                                     Tax Liability                                                                              $74.00
            14                                     Interest and penalty due on late filing or payment of tax                                  $0.00
            15                                     Total Amount Due                                                                           $74.00
            16                                     Overpayment                                                                                $0.00
            17                                     Original return only - amount of line 16 to be credited toward 2016 income tax liability   $0.00
            18                                     Your Refund                                                                                $0.00

                                                                                                                                               4-8

Ohio Test #4
School District Schedule A "Traditional" Tax Base School District Amounts
                                            19    Ohio income tax base reported on line 5 of Ohio IT 1040                                    $17,898.00
                                            20    Business income deduction add-back                                                         $0.00
                                            21    Total Traditional Tax Base School District Income (Line 19 + Line 20)                      $17,898.00
                                            22    Amount of traditional tax base school district income that you earned while not a resident $0.00
                                            23    School District Taxable Income (Enter here and on line 1)                                  $17,898.00
School District Schedule B "Earned Income Only" Tax Base School District Amounts
                                            24    Wages and other compensation as described in the instructions                              $0.00
                                            25    Net Earnings from Self Employment                                                          $0.00
                                            26    Depreciation Expense Adjustments                                                           $0.00
                                            27    School District Taxable Income (Enter here and on line 1)                                  $0.00
What is Tested?
IT1040WithSD100
Paid Preparer
Preparer Contact - Declined
MFJ status
Ohio W-2; Ohio 1099-R; Non-Ohio W-2

IT1040 
Full year resident
[$15,800 - $21,100] tax bracket
Sch. A Military pay outside Ohio  
Sch. A Uniformed services retirement income 
Sch. A Military injury relief fund 
Sch. A Ohio Nat Guard reimbursement/benefit 
Sch. A Pell/Ohio college opportunity taxable grant
Sch of Credits - Retirement income credit 
Sch of Credits - Ohio resident credit 
Refund/credit carryforward split

SD100
Traditional school district 
Full year resident
School district installment payments 
Tax due

                                                                                                                                              4-9

Ohio Test #5                                                                IT1040 with SD100
Taxpayer Information                                    Description
                     Primary Social Security Number                   XX0-00-7605
                     Primary First Name                               JAMES
                     Primary Middle Initial                           T 
                     Primary Last Name                                PRIDE
                     Date of Birth - Primary                          6/30/1979
                     Occupation - Primary                             COOK
                     Spouse's Social Security Number                  XX0-00-7655
                     Spouse First Name                                AUTUMN
                     Spouse Middle Initial                            C 
                     Spouse Last Name                                 PRIDE
                     Date of Birth - Spouse                           8/8/1987
                     Occupation - Spouse                              COOK
                     Address Line 1                                   78 PUMPKIN DR
                     City                                             CHILLICOTHE
                     State                                            OH
                     Zip Code                                         45601
                     Ohio County                                      ROSS
                     County Code (Ohio Public School District Number) 7107
                                             Income Statements
             W-2 #1
                     Employers Identification Number                  22-3456789
                     Employer's Name                                  PRIDE CONSTRUCTION
                     Employer's Address                               30 NORTH AVE
                     Employer's City                                  CIRCLEVILLE
                     Employer's State                                 OH
                     Employer's Zip Code                              43113
                     Employee's Social Security Number                400-00-7605
                     Employee's Name                                  JAMES T PRIDE
                     Employee's Address                               78 PUMPKIN DR
                     Employee's City                                  CHILLICOTHE
                     Employee's State                                 OH
                     Employee's Zip Code                              45601
                     Box 1 Wages, Tips, etc                           $21,720.00
                     Box 2 Federal Income Tax Withheld                $2,072.00
                     Box 3 Social Security Wages                      $21,720.00
                     Box 4 Social Security Tax Withheld               $1,347.00
                     Box 5 Medicare Wages and Tips                    $21,720.00
                     Box 6 Medicare Withheld                          $315.00
                     Box 15 State                                     OH
                     State ID Number                                  51-876543
                     State Wages                                      $16,720.00
                     State Income Tax Withheld                        $40.00
                     Local Wages                                      $16,720.00
                     Local Income Tax Withheld                        $197.00
                     Name of Locality                                 CIRCLEVILLE
                     Local Wages                                      $5,000.00
                     Local Income Tax Withheld                        $125.00
                     Name of Locality                                 COLUMBUS
                     School District Wages                            $11,405.00
                     School District Tax Withheld                     $0.00
                     School District #                                7107

                                                                                              5-1

Ohio Test #5
            W-2 #2
                  Employers Identification Number    23-9876543
                  Employer's Name                    BUCKEYE CANDY
                  Employer's Address                 270 STRING ST
                  Employer's City                    CIRCLEVILLE
                  Employer's State                   OH
                  Employer's Zip Code                43113
                  Employee's Social Security Number  400-00-7655
                  Employee's Name                    AUTUMN C PRIDE
                  Employee's Address                 78 PUMPKIN DR
                  Employee's City                    CHILLICOTHE
                  Employee's State                   OH
                  Employee's Zip Code                45601
                  Box 1 Wages, Tips, etc             $16,280.00
                  Box 2 Federal Income Tax Withheld  $1,309.00
                  Box 3 Social Security Wages        $16,280.00
                  Box 4 Social Security Tax Withheld $1,009.00
                  Box 5 Medicare Wages and Tips      $16,280.00
                  Box 6 Medicare Withheld            $236.00
                  Box 15 State                       OH
                  State ID Number                    52-765432
                  State Wages                        $16,280.00
                  State Income Tax Withheld          $37.00
                  Local Wages                        $16,280.00
                  Local Income Tax Withheld          $204.00
                  Name of Locality                   CIRCLEVILLE
                  School District Wages              $8,995.00
                  School District Tax Withheld       $0.00
                  School District #                  7107
Ohio Test #5
            W-2 #3
                  Employers Identification Number    24-3456789
                  Employer's Name                    BUCK'S PRIDE
                  Employer's Address                 15 S MAIN ST
                  Employer's City                    CIRCLEVILLE
                  Employer's State                   OH
                  Employer's Zip Code                43113
                  Employee's Social Security Number  400-00-7655
                  Employee's Name                    AUTUMN C PRIDE
                  Employee's Address                 78 PUMPKIN DR
                  Employee's City                    CHILLICOTHE
                  Employee's State                   OH
                  Employee's Zip Code                45601
                  Box 1 Wages, Tips, etc             $25,000.00
                  Box 2 Federal Income Tax Withheld  $2,400.00
                  Box 3 Social Security Wages        $25,000.00
                  Box 4 Social Security Tax Withheld $1,550.00
                  Box 5 Medicare Wages and Tips      $25,000.00
                  Box 6 Medicare Withheld            $363.00
                  Box 15 State                       OH
                  State ID Number                    51-654321
                  State Wages                        $25,000.00
                  State Income Tax Withheld          $100.00
                  Local Wages                        $25,000.00
                  Local Income Tax Withheld          $250.00
                  Name of Locality                   CIRCLEVILLE
                  School District Wages              $25,000.00
                  School District Tax Withheld       $0.00
                  School District #                  7107

                                                                    5-2

Ohio Test #5
            1099-G
                    Payer's Name                          STATE OF OHIO
                    Payer's US Address                    1030 E BROAD ST
                    Payer's City                          COLUMBUS
                    Payer's State                         OH
                    Payer's Zip Code                      43229
                    Payer's Federal Identification Number 35-9876543
                    Recipient's SSN                       400-00-7655
                    Recipient's Name                      AUTUMN C PRIDE
                    Recipient's Address                   78 PUMPKIN DR
                    Recipient's City                      CHILLICOTHE
                    Recipient's State                     OH
                    Recipient's Zip Code                  45601
                    Box 1 Unemployment compensation       $5,000.00 
                    Federal Income Tax Withheld           $500.00 
                    Box 11 State income tax withheld      $16.00 
                    Box 10a State                         OH
                    Box 10b State identification no.      51-234999
                    State Distribution Amount             $5,000.00 
            1099-INT
                    Payer's Identification Number         25-9876543
                    Payer's Name                          INVESTMENT LTD
                    Payer's Address                       123 MAIN ST
                    Payer's City                          SOLON
                    Payer's State                         OHIO
                    Payer's Zip Code                      44139
                    Recipient's Social Security Number    400-00-7605
                    Recipient's Name                      JAMES T PRIDE
                    Recipient's Address                   78 PUMPKIN DR
                    Recipient's City                      CHILLICOTHE
                    Recipient's State                     OH
                    Recipient's Zip Code                  45601
                    Interest Income                       $1,000.00 
                    Box 13 State income tax withheld      $10.00 
                    Box 11 State                          OH
                    Box 12 State identification no.       51-237777
                    Interest Income                       $1,000.00 

                                                                          5-3

Ohio Test #5
Federal Return Information 1040                                                   Description
                                            Filing Status                                                         Married Filing Jointly
                                            Exemptions, Self, spouse , 2 children                                 4
                                            Dependent 1 SSN                                                       400-00-7680
                                            Dependent 1 Date of Birth                                             12/14/2010
                                            Dependent 1 First Name                                                DAUGHTER
                                            Dependent 1 Middle Initial                                            J
                                            Dependent 1 Last Name                                                 PRIDE
                                            Dependent 1 Relationship                                              DAUGHTER
                                            Dependent 2 SSN                                                       400-00-7681
                                            Dependent 2 Date of Birth                                             2/15/2013
                                            Dependent 2 First Name                                                SON 
                                            Dependent 2 Last Name                                                 PRIDE
                                            Dependent 2 Relationship                                              SON 
                                            Line 7 Total Wages                                                    $63,000.00
                                            Line 8a Taxable Interest                                              $2,500.00
                                            Line 12 Business Loss Schedule C                                      -$31,000.00
                                            Schedule SE Section A line 2                                          -$31,000.00
                                            Line 19 Unemployment compensation                                     $5,000.00
                                            Line 21 Other Income (Refund or Reimbursement for itemized deduction) $250.00
                                            Line 37 Adjusted Gross Income                                         $39,750.00
Federal Schedule A
                                            Repayment of income Reported in a prior year                          $750.00
Federal Schedule B
                                            Interest - H bond                                                     $1,500.00
                                            Interest -  Interest from Ohio Public Obligations                     $1,000.00
Form 2441  - Child & Dependent Care Expenses
                           Part 1
                                            a Providers Name                                                      CARING PLACE
                                            b Address                                                             16 STRAIGHT ST
                                                                                                                  CIRCLEVILLE, OH 43113
                                            c. Identifying Number                                                 32-4567893
                                            d. Amount Paid                                                        $3,110.00
                           Part 2
                                            a. Qualifying Person's Name                                           DAUGHTER J PRIDE
                                            b. Qualifying Person's SSN                                            400-00-7680
                                            c. Qualified Expenses                                                 $1,555.00
                                            a. Qualifying Person's Name                                           SON PRIDE
                                            b. Qualifying Person's SSN                                            400-00-7681
                                            c. Qualified Expenses                                                 $1,555.00
                                            Line 6                                                                $3,110.00
                                            Line 9                                                                $684.00

                                                                                                                                         5-4

Ohio Test #5
State Return Information                                     Description
                         Is this an amended return?                                                               No
                         Self-Prepared                                                                            x
                         Filing Status                                                                            Married Filing Jointly
                         Ohio Residency Status (Primary)                                                          Full-Year Resident
                         Ohio Residency Status (Spouse)                                                           Full-Year Resident
                         Ohio Political Party Fund Contribution - Primary                                         Yes
                         Ohio Political Party Fund Contribution - Spouse                                          No
                         Did you file the federal extension 4868?                                                 No
                         Is someone else claiming you or your spouse (if joint return) as a dependent?            No
                         Enter the number of dependents                                                           2
                         Losses from the Sale or disposition of Ohio Public Obligations                           $1,950.00
                         Non-Medical Withdrawals from a Medical Savings Account                                   $4,863.00
                         Add back 5/6ths of the Depreciation Expense Adjustment for IRC Section 168 (k) 179 Bonus $1,000.00
                         Depreciation
                         Interest income from Ohio public obligations and from Ohio purchase obligations          $1,000.00
                         Amounts Contributed to an Individual Development Account                                 $300.00
                         Amounts contributed to STABLE account; Ohio's ABLE plan                                  $1,000.00
                         Federal Interest and Dividends Exempt from State Taxation                                $1,500.00
                         Adjustment for IRC section 168 (k) 179 Depreciation Expense                              $400.00
                         Refund or Reimbursements of Prior Year Federal Itemized Deductions                       $250.00
                         Repayment of income Reported in a prior year                                             $750.00
                         Wage/Salary Expense not Deducted Due to the Work Opportunity Tax Credits                 $350.00
                         Contributions to a College Advantage 529 Savings Account and/or purchases of tuition     $2,800.00
                         credits
                         Qualified Organ Donor Expenses                                                           $250.00
                         Eligible for JFC?                                                                        Yes
                         Taxpayer's E-mail Address                                                                PRIDE@GMAIL.COM
                         Taxpayer's Phone Number                                                                  937-554-3456
                         Perjury Statement Acceptance                                                             Yes
                         Preparer Authorization Check Box                                                         No
            Worksheets   Child and Dependent Care Worksheet
                         Line 9 Federal Form 2441                                                                 $684.00
            Worksheets   Medical Savings Account Worksheet
                         Line 1 Amount you contributed during 2016                                                $4,636.00
                         Line 2 Amount your spouse contributed during 2016                                        $501.00
                         Line 5 2016 withdrawals from the account for nonmedical purposes                         $10,000.00
SD Return Information
                         Are you Filing the Ohio School District Income Tax Return Electronically                 Yes
                         What is the school district number for which you are filing the SD 100?                  7107
                         School District Residency (Primary)                                                      Part-Year Resident
                         School District Residency (Spouse)                                                       Part-Year Resident
                         School District Non-Residency Begin Date                                                 01/01/2016
                         School District Non-Residency End Date                                                   04/30/2016
                         Tax Type                                                                                 Earned Income Only

                                                                                                                                         5-5

Ohio Test #5
            OH Line #                                           Line Item                                      Amount
            1         Federal Adjusted Gross Income                                                                  $39,750.00
            2a        Additions to federal adjusted gross income                                                     $7,813.00
            2b        Deductions from federal adjusted gross income                                                  $8,350.00
            3         Ohio Adjusted Gross Income (OAGI)                                                              $38,963.00
            4         Personal and dependent exemption deduction                                                     $9,000.00
            5         Ohio income tax base                                                                           $29,963.00
            6         Taxable business income (Ohio IT BUS, line 13)                                                     $0.00
            7         Line 5 minus line 6 (if less than 0, enter 0)                                                  $29,963.00
            7a        Amount from line 7 on page 1                                                                   $29,963.00
            8a        Nonbusiness income tax liability                                                               $577.00
            8b        Business income tax liability (Ohio IT BUS, line 14)                                               $0.00
            8c        Tax liability (line 8a plus 8b)                                                                $577.00
            9         Ohio nonrefundable credits                                                                     $300.00
            10        Tax liability after nonrefundable credits                                                      $277.00
            11        Interest penalty on underpayment of estimated tax                                                  $0.00
            12        Sales and use tax due on Internet, mail order or other out-of-state purchases                      $0.00
            13        Total Ohio tax liability before withholding or estimated payments                              $277.00
            14        Ohio income tax withheld                                                                       $203.00
            15        Add the Ohio estimated & extension payments & credit carryforward from previous year return        $0.00
            16        Refundable credits                                                                                 $0.00
            17        Amended return only - amount previously paid with original/amended return                          $0.00
            18        Total Ohio Tax Payments                                                                        $203.00
            19        Amended return only - overpayment previously received on original/amended return                   $0.00
            20        Line 18 minus line 19                                                                          $203.00
            21        Tax liability                                                                                      $74.00
            22        Interest and penalty due on late filing or payment of tax                                          $0.00
            23        Total Amount Due                                                                                   $74.00
            24        Overpayment                                                                                        $0.00
            25        Original return only - amount of line 24 to be credited toward 2016 income tax liability           $0.00
            26a       Amount of line 24 to be donated - Military injury relief                                           $0.00
            26b       Amount of line 24 to be donated - Ohio History Fund                                                $0.00
            26c       Amount of line 24 to be donated - State nature preserves                                           $0.00
            26d       Amount of line 24 to be donated - Breast/cervical cancer                                           $0.00
            26e       Amount of line 24 to be donated - Wishes for sick children                                         $0.00
            26f       Amount of line 24 to be donated - Wildlife species                                                 $0.00
            26g       Total                                                                                              $0.00
            27        Your Refund                                                                                        $0.00

                                                                                                                          5-6

Ohio Test #5
Schedule A     Additions
            1  Non-Ohio state or local government interest and dividends                                      $0.00
            2  Certain Ohio pass-through entity and financial institutions taxes paid                         $0.00
               Reimbursement of college tutition expenses and fees deducted in any previous year(s) and 
            3  noneducation expenditures from a college savings account                                       $0.00
            4  Losses from sale or disposition of Ohio public obligations                                    $1,950.00
            5  Nonmedical withdrawals from a medical savings account                                         $4,863.00
               Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if 
            6  the reimbursement is not in federal adjusted gross income                                      $0.00
            7  Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense             $1,000.00
            8  Federal interest and dividends subject to state taxation                                       $0.00
            9  Miscellaneous federal income tax additions                                                     $0.00
            10 Total additions                                                                               $7,813.00
Schedule A     Deductions
            11 Business income deduction (attach Ohio Schedule IT BUS, line 11)                               $0.00
            12 Employee compensation earned in Ohio by residents of neighboring states                        $0.00
            13 State or municipal income tax overpayments shown on IRS form 1040, line 10                     $0.00
            14 Qualifying Social Security benefits and certain railroad retirement benefits                   $0.00
               the sale or disposition of Ohio public obligations; public service payments received from the 
            15 state of Ohio or income from a transfer agreement                                             $1,000.00
            16 Amounts contributed to an individual development account                                      $300.00
            17 Amounts contributed to STABLE account; Ohio's ABLE plan                                       $1,000.00
            18 Federal interest and dividends exempt from state taxation                                     $1,500.00
            19 Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense             $400.00
               Refund or reimbursements shown on IRS form 1040, line 21 for itemized deductions claimed 
            20 on a prior year federal income tax return                                                     $250.00
            21 Repayment of income reported in a prior year                                                  $750.00
            22 Wage expense not deducted due to claiming the federal work opportunity credit                 $350.00
            23 Miscellaneous federal income tax deductions                                                    $0.00
            24 Military pay for Ohio residents received while the military member was stationed outside Ohio  $0.00
            25 Certain income earned by military nonresidents and civilian nonresident spouses                $0.00
            26 Uniformed services retirement income                                                           $0.00
            27 Military injury relief fund                                                                    $0.00
            28 Certain Ohio National Guard reimbursements and benefits                                        $0.00
            29 Ohio 529 contributions, tuition credit purchases                                              $2,800.00
            30 Pell/Ohio College Opportunity taxable grant amounts used to pay room and board                 $0.00
            31 Disability and survivorship benefits (do not include pension continuation benefits)            $0.00
               Unreimbursed long-term care insurance premiums, unsubsidized health care insurance 
            32 premiums and excess health care expenses                                                       $0.00
               Funds deposited into, and earnings of, a medical savings account for eligible health care 
            33 expenses                                                                                       $0.00
            34 Qualified organ donor expenses                                                                $250.00
            35 Total deductions                                                                              $8,350.00

                                                                                                               5-7

Ohio Test #5
Schedule of Credits    Nonrefundable credits
                    1  Total tax liability (From IT1040 8c)                                                             $577.00
                    2  Retirement Income Credit                                                                         $0.00
                    3  Lump sum retirement credit                                                                       $0.00
                    4  Senior citizen credit                                                                            $0.00
                    5  Lump sum distribution credit                                                                     $0.00
                    6  Child care and dependent care credit                                                             $171.00
                    7  If Ohio form IT 1040, line 5 is $10,000 or less, enter $88; otherwise, enter -0- (low income cre $0.00
                    8  Displaced worker training credit                                                                 $0.00
                       Campaign contribution credit for Ohio statewide office or General 
                    9  Assembly                                                                                         $0.00
                    10 Income-based exemption credit                                                                    $80.00
                    11 Total (add lines 2 through 10)                                                                   $251.00
                    12 Tax less credits (line 1 minus line 11; if less than -0-, enter -0-)                             $326.00
                    13 Joint filing credit                                                                              $49.00
                    14 Earned income credit                                                                             $0.00
                    15 Ohio adoption credit                                                                             $0.00
                    16 Job retention credit, nonrefundable portion                                                      $0.00
                    17 Credit for eligible new employees in an enterprise zone                                          $0.00
                    18 Credit for purchases of grape production property                                                $0.00
                    19 Credit for investing in an Ohio small business                                                   $0.00
                    20 Technology investment credit carryforward                                                        $0.00
                    21 Enterprise zone day care and training credits                                                    $0.00
                    22 Research and development credit                                                                  $0.00
                    23 Ohio historic preservation credit, nonrefundable carryforward portion                            $0.00
                    24 Total (add lines 13 through 23)                                                                  $49.00
                    25 Tax less additional credits (line 12 minus line 24; if less than -0-, enter -0-)                 $277.00
                       Nonresident Credit
                    26 Enter the portion of OAGI that was not earned or received in Ohio                                $0.00
                    27 Enter the OAGI                                                                                   $0.00
                       Line 26/27 _____* Multiply this factor by the amount on line 25 to calculate your nonresident 
                    28 credit                                                                                           $0.00
                       Resident Credit
                    29 Enter the portion of OAGI subjected to tax by other states or DC while an OH resident            $0.00
                    30 Enter OAGI                                                                                       $0.00
                    31 Divide line 29 by line 30 ____*Multiply this factor by the amount on line 25                     $0.00
                    32 Enter the 2016 income tax, less all credits other than w/h and est tax pmts and CCFs             $0.00
                    33 Enter the smaller of line 31 or line 32. This is your Ohio resident tax credit.                  $0.00
                    34 Total nonrefundable credits                                                                      $300.00
                       Refundable Credits
                    35 Historic preservation credit                                                                     $0.00
                    36 Business jobs credit                                                                             $0.00
                    37 Pass-through entity credit                                                                       $0.00
                    38 Motion picture production credit                                                                 $0.00
                    39 Financial Institutions Tax (FIT) credit                                                          $0.00
                    40 Venture Capital credit                                                                           $0.00
                    41 Total refundable credits                                                                         $0.00

                                                                                                                         5-8

Ohio Test #5
Sch IT BUS
                                      Part 1
                                   1  Sch B - Interest and Ordinary Dividends                                                    $0.00
                                   2  Sch C - Profit or Loss From Business (Sole Proprietership)                                 $0.00
                                   3  Sch D - Capital Gains and Losses                                                           $0.00
                                   4  Sch E - Supplemental Income and Loss                                                       $0.00
                                      Guranteed payments, compensation and/or wages from each pass-through entity in which 
                                   5  you have at least a 20% direct or indirect ownership interest                              $0.00
                                   6  Sch F - Profit or Loss From Farming                                                        $0.00
                                      Other items of income and gain separately stated on federal Schedule K-1, federal 4787 
                                      gains and/or losses reported on federal 4787 and miscellaneous federal income tax 
                                   7  adjustments, if any                                                                        $0.00
                                   8  Total of business income                                                                   $0.00
                                      Part 2
                                      All business income. Enter here & on  IT 1040, line 6. If 0 or negative, stop here & don't 
                                   9  complete Part 3.                                                                           $0.00
                                   10 Enter $250,000 if single or MFJ, enter $125,000 if MFS                                     $0.00
                                   11 Lesser of line  9or line 10. Enter here and on Ohio Schedule A, line 11                    $0.00
                                      Part 3
                                   12 Line  9minus line 1 1(if less than -0-, enter -0-)                                         $0.00
                                   13 Taxable Business Income                                                                    $0.00
                                   14 Business income tax liability. Enter here and on Ohio IT 1040, line 8b.                    $0.00
School District Return Information 
                                   1  School district taxable income:  Traditional or Earned Income tax base                     $0.00
                                   2  School District Tax .____ times line 1.                                                    $0.00
                                   3  Senior Citizen Credit                                                                      $0.00
                                   4  School District Income Tax liability                                                       $0.00
                                   5  Interest Penalty on Underpayment of School District Estimated Tax                          $0.00
                                   6  Total school district income tax liability (line 4 plus line 5)                            $0.00
                                   6a Amount from line 6                                                                         $0.00
                                   7  School district income tax withheld                                                        $0.00
                                   8  SD100ES & SD40P, Extension Payments and Credit carryforward from previous year return      $0.00
                                   9  Amended return only - amount previously paid with original/amended return                  $0.00
                                   10 Total school district income tax payments (add lines 7, 8 and 9)                           $0.00
                                   11 Amended return only - overpayment previously received on original/amended return           $0.00
                                   12 Total Payments less overpayment previously received on original/amended return             $0.00
                                   13 Tax Liability                                                                              $0.00
                                   14 Interest and penalty due on late filing or payment of tax                                  $0.00
                                   15 Total Amount Due                                                                           $0.00
                                   16 Overpayment                                                                                $0.00
                                   17 Original return only - amount of line 16 to be credited toward 2016 income tax liability   $0.00
                                   18 Your Refund                                                                                $0.00

                                                                                                                                  5-9

Ohio Test #5
School District Schedule A "Traditional" Tax Base School District Amounts
                                               19    Ohio income tax base reported on line 5 of Ohio IT 1040                                    $0.00
                                               20    Business income deduction add-back                                                         $0.00
                                               21    Total Traditional Tax Base School District Income (Line 19 + Line 20)                      $0.00
                                               22    Amount of traditional tax base school district income that you earned while not a resident $0.00
                                               23    School District Taxable Income (Enter here and on line 1)                                  $0.00
School District Schedule B "Earned Income Only" Tax Base School District Amounts
                                               24    Wages and other compensation as described in the instructions                              $20,400.00
                                               25    Net Earnings from Self Employment                                                          ($31,000.00)
                                               26    Depreciation Expense Adjustments                                                           $0.00
                                               27    School District Taxable Income (Enter here and on line 1)                                  $0.00
                   What is Tested?
IT1040WithSD100
Self-Prepared
Contact Preparer - Declined
MFJ status
Ohio W-2
1099-INT
1099-G

IT1040  
Full year resident
FiledFedExtForm4868
Schedule J dependents
[$21,100 - $42,100] tax bracket
15% joint filing credit
Sch. A - Losses from sale & disp of OH pub oblig. 
Sch. A - Non-medical withdrawal 
Sch. A - Adjust IRC for 168(k) and 179 depr exp 
Sch. A - Ohio oblig. int/gains & pub svc pymt 
Sch. A - Contributions to indiv. development account 
Sch. A - Contributions to STABLE account
Sch. A - Federal interest/dividends 
Sch. A - Adjustment  for depreciation expense 
Sch. A - Refund or reimbursements 
Sch. A - Repayment of income 
Sch. A - Wage expense 
Sch. A - Ohio 529 plan contributions 
Sch. A - Organ donor expense 
Sch of Credits - Child care and dependent care
MSA worksheet
Dependent care worksheet
Tax due 

SD100
Earned income only school district
Part-year resident 
School district Sch B - Negative taxable income
Zero return

                                                                                                                                                 5-10

Ohio Test #6                                                               IT1040 with SD100
Taxpayer Information                                      Description
                     Primary Social Security Number                   XX0-00-7606
                     Primary First Name                               MELVIN
                     Primary Last Name                                MERMAID
                     Date of Birth - Primary                          12/02/1947
                     Occupation - Primary                             WAITER
                     Spouse's Social Security Number                  XX0-00-7656
                     Spouse First Name                                MARTHA
                     Spouse Last Name                                 MERMAID-UNDERTHESEAS
                     Date of Birth - Spouse                           11/01/1947
                     Occupation - Spouse                              RETIRED
                     Foreign Address Line 1                           123 SLIPPERY ROCK DR UNIT 
                                                                      234567 SW
                     Foreign City                                     PUNTA GORDA 
                     Foreign Province Or State                        TOLEDO
                     Foreign Zip Code                                 AB78583
                     Foreign Country                                  BELIZE
                     Ohio County                                      KNOX
                     County Code (Ohio Public School District Number) 4202

                     Address Line 1                                   123 BUCKEYE WAY
                     City                                             COLUMBUS
                     State                                            OH
                     Zip Code                                         43201
                     US Home Address                                  25 S HIGH ST APT 1 DOWN
                     Home City                                        DANVILLE
                     Home State                                       OH
                     Home Zip Code                                    43014
                     Home County                                      KNOX
                                             Income Statements
             W-2 #1
                     Employers Identification Number                  26-3456789
                     Employer's Name                                  RONS RIB BACK ON THE 
                                                                      RIVER
                     Employer's Foreign Address                       15 RIVERFRONT RD
                     Employer's Foreign City                          PUNTA GORDA
                     Employer's Foreign Province Or State             TOLEDO
                     Employer's Foreign Country                       BELIZE
                     Employer's Foreign Postal Code                   AB78583
                     Employee's Social Security Number                400-00-7606
                     Employee's Name                                  MELVIN MERMAID
                     Employee's Foreign Address                       123 SLIPPERY ROCK DR UNIT 
                                                                      234567 SW
                     Employee's Foreign City                          PUNTA GORDA 
                     Employee's Foreign Province Or State             TOLEDO
                     Employee's Foreign Country                       BELIZE
                     Employee's Postal Code                           AB78583
                     Box 1 Wages, Tips, etc                           $18,148.00
                     Box 2 Federal Income Tax Withheld                $0.00
                     Box 3 Social Security Wages                      $0.00
                     Box 4 Social Security Tax Withheld               $0.00
                     Box 5 Medicare Wages and Tips                    $0.00
                     Box 6 Medicare Withheld                          $0.00
                     Box 15 State
                     State ID Number
                     State Wages
                     State Income Tax Withheld

                                                                                              6-1

Ohio Test #6
            1099R #1
                                Employers Identification Number                 27-9876543
                                Employer's Name                                 ASSOCIATED RETIREMENT
                                Employer's US Address                           1402 RESTFUL PLACE
                                Employer's City                                 ANSONIA
                                Employer's State                                OH 
                                Employer's Zip Code                             45303
                                Employee's Social Security Number               400-00-7656
                                Employee's Name                                 MARTHA MERMAID-
                                                                                UNDERTHESEAS
                                Employee's Foreign Address                      123 SLIPPERY ROCK DR UNIT 
                                                                                234567 SW
                                Employee's Foreign City                         PUNTA GORDA
                                Employee's Foreign Province or State            TOLEDO
                                Employee's Foreign Country                      BELIZE
                                Employee's Foreign Postal Code                  AB78583
                                Gross Distribution Amount                       $46,852.00
                                Taxable Amount                                  $46,852.00
                                Distribution Code                               7
                                Box 15 State                                    OH
                                State Payer ID                                  52-321065
                                State Distribution                              $46,852.00
                                State Income Tax Withheld                       $300.00
Federal Return Information 1040                                      Description
                                Filing Status                                   Married Filing Jointly
                                Exemptions, Self, Spouse                        2
                                Line 7 Total Wages                              $18,148.00
                                Line 16b Taxable Pensions and Annuities         $46,852.00
                                Line 12 Schedule C                              -$121,852.00
                                Line 37 Adjusted Gross Income                   -$56,852.00

                                                                                                       6-2

Ohio Test #6
State Return Information                                      Description
                         Is this an amended return?                                                                No
                         Paid Preparer's PTIN                                                                      P12457812
                         Paid Preparer's Firm ID Number                                                            123789456
                         Paid Preparer's Business Name                                                             GRAY TAXES
                         Paid Preparer's name                                                                      LYDIANN GRAY
                         Paid Preparer's Foreign Address                                                           500 MAIN ST
                         Paid Preparer's Foreign City                                                              PUNTA GORDA
                         Paid Preparer's Foreign Province or State                                                 TOLEDO
                         Paid Preparer's Foreign Country                                                           BELIZE
                         Paid Preparer's Foreign Postal Code                                                       AB78583
                         Paid Preparer's Phone Number                                                              501-7-554-5545

                         Paid Preparer's Phone Number                                                              614-554-1234
                         Paid Preparer's Email Address                                                             LGRAY@GRAYTAXES.COM
                         Filing Status                                                                             Married Filing Jointly
                         Ohio Residency Status (Primary)                                                           Full-Year Resident
                         Ohio Residency Status (Spouse)                                                            Full-Year Resident
                         Ohio Political Party Fund Contribution - Primary                                          No
                         Ohio Political Party Fund Contribution - Spouse                                           Yes
                         Is someone else claiming you or your spouse (if joint return) as a dependent?             No
                         Enter the number of dependents                                                            0
                         Non-Ohio State or Local Government Interest & Dividends                                   $100,000.00
                         Pass-Through Entity Addback and ORC section 5733.40 (A) PTE Adjustment                    $11,000.00
                         Reimbursement of College Tuition Expenses and Fees Deducted in any Previous Year(s)       $15,017.00
                         Federal interest and dividends subject to state taxation                                  $9,000.00
                         Disability and Survivorship Benefits                                                      $20,000.00
                         Funds deposited into, and earnings of, a medical savings account for eligible medical exp $3,100.00
                         Retirement Income Credit                                                                  $200.00
                         Lump Sum Distribution Credit                                                              $840.00
                         Ohio Campaign Contributions Credit                                                        $70.00
                         Eligible for JFC?                                                                         No
                         OH Estimated Tax, IT 40P Extension Payments, and Overpayments Credited to Current Tax     $2,000.00
                         Year
                         Taxpayer's E-mail Address                                                                 MERMAID@MAIL.NET
                         Perjury Statement Acceptance                                                              Yes
                         Preparer Authorization Check Box                                                          Yes

                                                                                                                                          6-3

Ohio Test #6
             Worksheets                                            Unpaid Ohio Use Tax
                        a.        Did you make any out of state purchases                                                  Yes
                        b.        Did the retailer charge you any sales tax                                                No
                        c.        Amount of Purchases that you did not pay sales tax                                       $4,286.00
                        d.        County sales tax rate                                                                    6.75%
            Worksheets                                     Medical Savings Account Worksheet
                                  Line 1 Amount you contributed during 2016                                                $2,100.00
                                  Line 2 Amount your spouse contributed during 2016                                        $1,500.00
                                  Line 5 2016 withdrawals from the account for nonmedical purposes                         $500.00
                                                        Lump Sum Distribution Credit Worksheet
                            1 Lump sum distribution recipient's age                                                        69
                            2 Life expectancy                                                                              16.8
                            3 Lump sum distribution credit  (line 2 times $50)                                             $840.00
SD Return Information
                                  Are you Filing the Ohio School District Income Tax Return Electronically                 Yes
                                  What is the school district number for which you are filing the SD 100?                  4202
                                  School District Residency (Primary)                                                      Full-Year Resident
                                  School District Residency (Spouse)                                                       Full-Year Resident
                                  Tax Type                                                                                 Traditional
                                  SD100ES & SD40P, Extension Payments and Credit Carryover                                 $769.00
                                  Amount Credited to Next Year's Tax Liability                                             $20.00
                        OH Line #                                           Line Item                                      Amount
                        1         Federal Adjusted Gross Income                                                                              ($56,852.00)
                        2a        Additions to federal adjusted gross income                                                                 $135,017.00
                        2b        Deductions from federal adjusted gross income                                                              $23,100.00
                        3         Ohio Adjusted Gross Income (OAGI)                                                                          $55,065.00
                        4         Personal and dependent exemption deduction                                                                 $4,000.00
                        5         Ohio income tax base                                                                                       $51,065.00
                        6         Taxable business income (Ohio IT BUS, line 13)                                                             $0.00
                        7         Line 5 minus line 6 (if less than 0, enter 0)                                                              $51,065.00
                        7a        Amount from line 7 on page 1                                                                               $51,065.00
                        8a        Nonbusiness income tax liability                                                                           $1,248.00
                        8b        Business income tax liability (Ohio IT BUS, line 14)                                                       $0.00
                        8c        Tax liability (line 8a plus 8b)                                                                            $1,248.00
                        9         Ohio nonrefundable credits                                                                                 $1,110.00
                        10        Tax liability after nonrefundable credits                                                                  $138.00
                        11        Interest penalty on underpayment of estimated tax                                                          $0.00
                        12        Sales and use tax due on Internet, mail order or other out-of-state purchases                              $289.00
                        13        Total Ohio tax liability before withholding or estimated payments                                          $427.00
                        14        Ohio income tax withheld                                                                                   $300.00
                                  Add the Ohio estimated & extension payments & credit carryforward from previous year 
                        15        return                                                                                                     $2,000.00
                        16        Refundable credits                                                                                         $0.00
                        17        Amended return only - amount previously paid with original/amended return                                  $0.00
                        18        Total Ohio Tax Payments                                                                                    $2,300.00
                        19        Amended return only - overpayment previously received on original/amended return                           $0.00
                        20        Line 18 minus line 19                                                                                      $2,300.00
                        21        Tax liability                                                                                              $0.00
                        22        Interest and penalty due on late filing or payment of tax                                                  $0.00
                        23        Total Amount Due                                                                                           $0.00
                        24        Overpayment                                                                                                $1,873.00
                        25        Original return only - amount of line 24 to be credited toward 2016 income tax liability                   $0.00
                        26a       Amount of line 24 to be donated - Military injury relief                                                   $0.00
                        26b       Amount of line 24 to be donated - Ohio History Fund                                                        $0.00
                        26c       Amount of line 24 to be donated - State nature preserves                                                   $0.00
                        26d       Amount of line 24 to be donated - Breast/cervical cancer                                                   $0.00
                        26e       Amount of line 24 to be donated - Wishes for sick children                                                 $0.00
                        26f       Amount of line 24 to be donated - Wildlife species                                                         $0.00
                        26g       Total                                                                                                      $0.00
                        27        Your Refund                                                                                                $1,873.00

                                                                                                                                              6-4

Ohio Test #6
Schedule A     Additions
            1  Non-Ohio state or local government interest and dividends                                     $100,000.00
            2  Certain Ohio pass-through entity and financial institutions taxes paid                        $11,000.00
               Reimbursement of college tutition expenses and fees deducted in any previous year(s) and 
            3  noneducation expenditures from a college savings account                                      $15,017.00
            4  Losses from sale or disposition of Ohio public obligations                                    $0.00
            5  Nonmedical withdrawals from a medical savings account                                         $0.00
               Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if 
            6  the reimbursement is not in federal adjusted gross income                                     $0.00
            7  Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense             $0.00
            8  Federal interest and dividends subject to state taxation                                      $9,000.00
            9  Miscellaneous federal income tax additions                                                    $0.00
            10 Total additions                                                                               $135,017.00
Schedule A     Deductions
            11 Business income deduction (attach Ohio Schedule IT BUS, line 11)                              $0.00
            12 Employee compensation earned in Ohio by residents of neighboring states                       $0.00
            13 State or municipal income tax overpayments shown on IRS form 1040, line 10                    $0.00
            14 Qualifying Social Security benefits and certain railroad retirement benefits                  $0.00
               Interest income from Ohio public obligations and from Ohio purchase obligations; gains from 
               the sale or disposition of Ohio public obligations; public service payments received from the 
            15 state of Ohio or income from a transfer agreement                                             $0.00
            16 Amounts contributed to an individual development account                                      $0.00
            17 Amounts contributed to STABLE account; Ohio's ABLE plan                                       $0.00
            18 Federal interest and dividends exempt from state taxation                                     $0.00
            19 Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense             $0.00
               Refund or reimbursements shown on IRS form 1040, line 21 for itemized deductions claimed 
            20 on a prior year federal income tax return                                                     $0.00
            21 Repayment of income reported in a prior year                                                  $0.00
            22 Wage expense not deducted due to claiming the federal work opportunity credit                 $0.00
            23 Miscellaneous federal income tax deductions                                                   $0.00
               Military pay for Ohio residents received while the military member was stationed outside 
            24 Ohio                                                                                          $0.00
            25 Certain income earned by military nonresidents and civilian nonresident spouses               $0.00
            26 Uniformed services retirement income                                                          $0.00
            27 Military injury relief fund                                                                   $0.00
            28 Certain Ohio National Guard reimbursements and benefits                                       $0.00
            29 Ohio 529 contributions, tuition credit purchases                                              $0.00
            30 Pell/Ohio College Opportunity taxable grant amounts used to pay room and board                $0.00
            31 Disability and survivorship benefits (do not include pension continuation benefits)           $20,000.00
               Unreimbursed long-term care insurance premiums, unsubsidized health care insurance 
            32 premiums and excess health care expenses                                                      $0.00
               Funds deposited into, and earnings of, a medical savings account for eligible health care 
            33 expenses                                                                                      $3,100.00
            34 Qualified organ donor expenses                                                                $0.00
            35 Total deductions                                                                              $23,100.00

                                                                                                              6-5

Ohio Test #6
Schedule of Credits    Nonrefundable credits
                    1  Total tax liability (From IT1040 8c)                                                          $1,248.00
                    2  Retirement Income Credit                                                                      $200.00
                    3  Lump sum retirement credit                                                                    $0.00
                    4  Senior citizen credit                                                                         $0.00
                    5  Lump sum distribution credit                                                                  $840.00
                    6  Child care and dependent care credit                                                          $0.00
                       If Ohio form IT 1040, line 5 is $10,000 or less, enter $88; otherwise, enter -0- (low income 
                    7  credit)                                                                                       $0.00
                    8  Displaced worker training credit                                                              $0.00
                       Campaign contribution credit for Ohio statewide office or General 
                    9  Assembly                                                                                      $70.00
                    10 Income-based exemption credit                                                                 $0.00
                    11 Total (add lines 2 through 10)                                                                $1,110.00
                    12 Tax less credits (line 1 minus line 11; if less than -0-, enter -0-)                          $138.00
                    13 Joint filing credit                                                                           $0.00
                    14 Earned income credit                                                                          $0.00
                    15 Ohio adoption credit                                                                          $0.00
                    16 Job retention credit, nonrefundable portion                                                   $0.00
                    17 Credit for eligible new employees in an enterprise zone                                       $0.00
                    18 Credit for purchases of grape production property                                             $0.00
                    19 Credit for investing in an Ohio small business                                                $0.00
                    20 Technology investment credit carryforward                                                     $0.00
                    21 Enterprise zone day care and training credits                                                 $0.00
                    22 Research and development credit                                                               $0.00
                    23 Ohio historic preservation credit, nonrefundable carryforward portion                         $0.00
                    24 Total (add lines 13 through 23)                                                               $0.00
                    25 Tax less additional credits (line 12 minus line 24; if less than -0-, enter -0-)              $138.00
                       Nonresident Credit
                    26 Enter the portion of OAGI that was not earned or received in Ohio                             $0.00
                    27 Enter the OAGI                                                                                $0.00
                       Line 26/27 _____* Multiply this factor by the amount on line 25 to calculate your nonresident 
                    28 credit                                                                                        $0.00
                       Resident Credit
                    29 Enter the portion of OAGI subjected to tax by other states or DC while an OH resident         $0.00
                    30 Enter OAGI                                                                                    $0.00
                    31 Divide line 29 by line 30 ____*Multiply this factor by the amount on line 25                  $0.00
                    32 Enter the 2016 income tax, less all credits other than w/h and est tax pmts and CCFs          $0.00
                    33 Enter the smaller of line 31 or line 32. This is your Ohio resident tax credit.               $0.00
                    34 Total nonrefundable credits                                                                   $1,110.00
                       Refundable Credits
                    35 Historic preservation credit                                                                  $0.00
                    36 Business jobs credit                                                                          $0.00
                    37 Pass-through entity credit                                                                    $0.00
                    38 Motion picture production credit                                                              $0.00
                    39 Financial Institutions Tax (FIT) credit                                                       $0.00
                    40 Venture Capital credit                                                                        $0.00
                    41 Total refundable credits                                                                      $0.00

                                                                                                                      6-6

Ohio Test #6
Sch IT BUS
                                      Part 1
                                   1  Sch B - Interest and Ordinary Dividends                                                    $0.00
                                   2  Sch C - Profit or Loss From Business (Sole Proprietership)                                 $0.00
                                   3  Sch D - Capital Gains and Losses                                                           $0.00
                                   4  Sch E - Supplemental Income and Loss                                                       $0.00
                                      Guranteed payments, compensation and/or wages from each pass-through entity in which 
                                   5  you have at least a 20% direct or indirect ownership interest                              $0.00
                                   6  Sch F - Profit or Loss From Farming                                                        $0.00
                                      Other items of income and gain separately stated on federal Schedule K-1, federal 4787 
                                      gains and/or losses reported on federal 4787 and miscellaneous federal income tax 
                                   7  adjustments, if any                                                                        $0.00
                                   8  Total of business income                                                                   $0.00
                                      Part 2
                                      All business income. Enter here & on  IT 1040, line 6. If 0 or negative, stop here & don't 
                                   9  complete Part 3.                                                                           $0.00
                                   10 Enter $250,000 if single or MFJ, enter $125,000 if MFS                                     $0.00
                                   11 Lesser of line  9or line 10. Enter here and on Ohio Schedule A, line 11                    $0.00
                                      Part 3
                                   12 Line  9minus line 1 1(if less than -0-, enter -0-)                                         $0.00
                                   13 Taxable Business Income                                                                    $0.00
                                   14 Business income tax liability. Enter here and on Ohio IT 1040, line 8b.                    $0.00
School District Return Information 
                                   1  School district taxable income:  Traditional or Earned Income tax base                     $51,065.00
                                   2  School District Tax .____ times line 1.                                                    $766.00
                                   3  Senior Citizen Credit                                                                      $50.00
                                   4  School District Income Tax liability                                                       $716.00
                                   5  Interest Penalty on Underpayment of School District Estimated Tax                          $0.00
                                   6  Total school district income tax liability (line 4 plus line 5)                            $716.00
                                   6a Amount from line 6                                                                         $716.00
                                   7  School district income tax withheld                                                        $0.00
                                   8  SD100ES & SD40P, Extension Payments and Credit carryforward from previous year return      $769.00
                                   9  Amended return only - amount previously paid with original/amended return                  $0.00
                                   10 Total school district income tax payments (add lines 7, 8 and 9)                           $769.00
                                   11 Amended return only - overpayment previously received on original/amended return           $0.00
                                   12 Total Payments less overpayment previously received on original/amended return             $769.00
                                   13 Tax Liability                                                                              $0.00
                                   14 Interest and penalty due on late filing or payment of tax                                  $0.00
                                   15 Total Amount Due                                                                           $0.00
                                   16 Overpayment                                                                                $53.00
                                   17 Original return only - amount of line 16 to be credited toward 2016 income tax liability   $20.00
                                   18 Your Refund                                                                                $33.00

                                                                                                                                  6-7

Ohio Test #6
School District Schedule A "Traditional" Tax Base School District Amounts
                                                19 Ohio income tax base reported on line 5 of Ohio IT 1040                                    $51,065.00
                                                20 Business income deduction add-back                                                         $0.00
                                                21 Total Traditional Tax Base School District Income (Line 19 + Line 20)                      $51,065.00
                                                22 Amount of traditional tax base school district income that you earned while not a resident $0.00
                                                23 School District Taxable Income (Enter here and on line 1)                                  $51,065.00
School District Schedule B "Earned Income Only" Tax Base School District Amounts
                                                24 Wages and other compensation as described in the instructions                              $0.00
                                                25 Net Earnings from Self Employment                                                          $0.00
                                                26 Depreciation Expense Adjustments                                                           $0.00
                                                27 School District Taxable Income (Enter here and on line 1)                                  $0.00
What is Tested?
IT1040WithSD100
Paid Preparer
Preparer Contact - Authorized
MFJ status
Foreign address
Foreign W-2; Ohio 1099-R

IT1040 
Full year resident
Negative Federal adjusted gross income
[$42,100 - $84,200] tax bracket
Sch. A - Non-Ohio state or local int/div 
Sch. A - PTE addback 
Sch. A - Reimbursement of college tuition expenses 
Sch. A - Fed interest subject to state taxation 
Sch. A - Non-Education Expenditures
Sch. A - Disability and survivorship benefit 
Sch. A - Medical savings account 
Sch of Credits - Retirement income credit 
Sch of Credits - Lump sum distribution 
Sch of Credits - Campaign Contributions Credit
Use tax worksheet
MSA account worksheet
Installment payments

SD100
Traditional school district 
School district installment payments
Refund 

                                                                                                                                               6-8

Ohio Test #7                                                                IT1040 with SD100
Taxpayer Information                                    Description
                     Primary Social Security Number                   XX0-00-7607
                     Primary First Name                               TOM
                     Primary Middle Initial                           A 
                     Primary Last name                                TOE
                     Date of Birth - Primary                          05/05/1961
                     Occupation - Primary                             NATURALIST
                     Spouse's Social Security Number                  XX0-00-7657
                     Spouse First Name                                ANGELINA MARIAS 
                     Spouse Middle Initial                            N 
                     Spouse Last Name                                 TOE
                     Date of Birth - Spouse                           06/06/1961
                     Occupation - Spouse                              SALES
                     Address Line 1                                   100 WEST ST
                     City                                             WEST JEFFERSON
                     State                                            OH 
                     Zip Code                                         43162
                     Ohio County                                      MADISON
                     County Code (Ohio Public School District Number) 4901
                                             Income Statements
             W-2 #1
                     Employers Identification Number                  64-3456789
                     Employer's Name                                  TOMATOES TO GROW
                     Employer's Address                               17 E MAIN ST
                     Employer's City                                  REYNOLDSBURG 
                     Employer's State                                 OH 
                     Employer's Zip Code                              43068
                     Employee's Social Security Number                400-00-7607
                     Employee's Name                                  TOM A TOE
                     Employee's Address                               100 WEST ST
                     Employee's City                                  WEST JEFFERSON
                     Employee's State                                 OH 
                     Employee's Zip Code                              43162
                     Box 1 Wages, Tips, etc                           $11,200.00
                     Box 2 Federal Income Tax Withheld                $336.00
                     Box 3 Social Security Wages                      $11,200.00
                     Box 4 Social Security Tax Withheld               $694.00
                     Box 5 Medicare Wages and Tips                    $11,200.00
                     Box 6 Medicare Withheld                          $162.00
                     Box 15 State                                     OH
                     State ID Number                                  51-210654
                     State Wages                                      $11,200.00
                     State Income Tax Withheld                        $200.00
                     Local Wages                                      $6,700.00
                     Local Income Tax Withheld                        $151.00
                     Name of Locality                                 DAYTON
                     Local Wages                                      $4,500.00
                     Local Income Tax Withheld                        $35.00
                     Name of Locality                                 TROY
                     School District Wages                            $11,200.00
                     School District Tax Withheld                     $112.00
                     School District #                                4901

                                                                                    7-1

Ohio Test #7
            W-2 #2
                  Employers Identification Number    64-3456789
                  Employer's Name                    TOMATOES TO GROW
                  Employer's Address                 17 E MAIN ST
                  Employer's City                    REYNOLDSBURG 
                  Employer's State                   OH 
                  Employer's Zip Code                43068
                  Employee's Social Security Number  400-00-7657
                  Employee's Name                    ANGELINA MARIAS N TOE
                  Employee's Address                 100 WEST ST
                  Employee's City                    WEST JEFFERSON
                  Employee's State                   OH 
                  Employee's Zip Code                43162
                  Box 1 Wages, Tips, etc             $84,455.00
                  Box 2 Federal Income Tax Withheld  $5,000.00
                  Box 3 Social Security Wages        $84,455.00
                  Box 4 Social Security Tax Withheld $5,236.00
                  Box 5 Medicare Wages and Tips      $84,455.00
                  Box 6 Medicare Withheld            $1,225.00
                  Box 15 State                       OH
                  State ID Number                    51-210654
                  State Wages                        $66,670.00
                  State Income Tax Withheld          $2,800.00
                  Local Wages                        $31,670.00
                  Local Income Tax Withheld          $554.00
                  Name of Locality                   TROY
                  Local Wages                        $35,000.00
                  Local Income Tax Withheld          $788.00
                  Name of Locality                   DAYTON
                  Box 15 State                       IL
                  State ID Number                    52687
                  State Wages                        $17,785.00
                  State Income Tax Withheld          $0.00
                  School District Wages              $66,670.00
                  School District Tax Withheld       $1,288.00
                  School District #                  4901

                                                                   7-2

Ohio Test #7
            1099-B
                    Payer's Name                          MAIN STREET BANK
                    Payer's US Address                    1 MAIN ST
                    Payer's City                          MONTPELIER
                    Payer's State                         OH 
                    Payer's Zip Code                      43543
                    Payer's Federal Identification Number 30-3456789
                    Recipient's Identification Number     400-00-7657
                    Recipient's Name                      ANGELINA MARIAS N TOE
                    Recipient's US Address                100 WEST ST
                    Recipient's City                      WEST JEFFERSON
                    Recipient's State                     OH 
                    Recipient's Zip Code                  43162
                    Box 1d Proceeds                       $10.00
                    Box 14 State Tax Withheld             $1.00
                    Box 12 State                          OH
                    Box 13 State identification no        52-065432
                    Proceeds                              $10.00
            1099-DIV
                    Payer's Name                          MAIN STREET BANK
                    Payer's US Address                    1 MAIN ST
                    Payer's City                          MONTPELIER
                    Payer's State                         OH 
                    Payer's Zip Code                      43543
                    Payer's Federal Identification Number 30-3456789
                    Recipient's Identification Number     400-00-7657
                    Recipient's Name                      ANGELINA MARIAS N TOE
                    Recipient's US Address                100 WEST ST
                    Recipient's City                      WEST JEFFERSON
                    Recipient's State                     OH 
                    Recipient's Zip Code                  43162
                    Box 1a Total Ordinary Dividends       $1,240.00
                    Box 14 State Tax Withheld             $74.00
                    Box 12 State                          OH
                    Box 13 State identification no        52-065432
                    Total Ordinary Dividends              $1,240.00

                                                                      7-3

Ohio Test #7
Federal Return Information 1040                                      Description
                                Filing Status                                                                       Married Filing Jointly
                                Exemptions, self, spouse, 2 Children                                                4
                                Dependent 1 SSN                                                                     400-00-7682
                                Dependent 1 Date of Birth                                                           8/11/1987
                                Dependent 1 First Name                                                              SON
                                Dependent 1 Last Name                                                               TOE
                                Dependent 1 Relationship                                                            SON
                                Dependent 2 SSN                                                                     400-00-7683
                                Dependent 2 Date of Birth                                                           2/15/1997
                                Dependent 2 First Name                                                              DAUGHTER  
                                Dependent 2 Last Name                                                               TOE
                                Dependent 2 Relationship                                                            DAUGHTER
                                Line 7 Total Wages                                                                  $95,655.00
                                Line 9a Ordinary Dividends                                                          $1,240.00
                                Line 13, Capital gain or (loss)                                                     $10.00
                                Line 32 Adjusted Gross Income                                                       $96,905.00
State Return Information                                             Description
                                Is this an amended return?                                                          No
                                Self-Prepared                                                                       X
                                Filing Status                                                                       Married Filing Jointly
                                Ohio Residency Status (Primary)                                                     Full-Year Resident
                                Ohio Residency Status (Spouse)                                                      Part-Year Resident
                                Part-Year Resident - Begin Date                                                     6/1/2016
                                Part-Year Resident - End Date                                                       12/31/2016
                                Ohio Political Party Fund Contribution - Primary                                    No 
                                Ohio Political Party Fund Contribution - Spouse                                     No 
                                Did you file the federal extension 4868?                                            Yes
                                Is someone else claiming you or your spouse (if joint return) as a dependent?       No
                                Enter the number of dependents                                                      2
                                Ohio Adoption Credit                                                                $1,500.00
                                Eligible for JFC?                                                                   Yes
                                Job retention credit, nonrefundable portion                                         $4.00
                                Credit for eligible new employees in an enterprise zone                             $5.00
                                Credit for purchases of grape production property                                   $7.00
                                Credit for investing in an Ohio small business                                      $8.00
                                Technology investment credit carryforward                                           $6.00
                                Enterprise zone day care and training credits                                       $9.00
                                Research and development credit                                                     $10.00
                                Ohio historic preservation credit, nonrefundable carryforward portion               $1.00
                                Enter the Portion of OAGI that was not Earned or Received in Ohio                   $17,785.00
                                Ohio Estimated Tax, IT-40P Extension Payments, and Overpayments Credited to Current $100.00
                                Tax Year
                                Amount Credited to Next Year's Tax Liability                                        $100.00
                                Donation From Taxpayer - Ohio History Fund                                          $80.00
                                Donation From Taxpayer - Breast/cervical cancer                                     $60.00
                                Taxpayer's Phone Number                                                             740-554-3456
                                Taxpayer's E-mail Address                                                           TOE@YAHOO.COM
                                Perjury Statement Acceptance                                                        Yes
                                Preparer Authorization Check Box                                                    Yes

                                                                                                                                       7-4

Ohio Test #7
            Worksheets                                  Health Care Expenses
                       1 During the year, were you eligible to participate in any subsidized health insurance plan or No
                         Medicare?
                       2 Unreimbursed Health Care Expenses                                                            $5,000.00
                       7 Unreimbursed Premiums for Long Term Care Insurance                                           $200.00
                       8 Unreimbursed Premiums for Dental, Vision, and Health Insurance                               $4,300.00
                       9 Health Insurance Coverage for Certain Dependent Relatives - 26 year old son                  $1,000.00
            Worksheets                   Displaced Worker Training Credit
                       1 Did you lose your job because the place you worked either permanently closed or moved, or    Yes
                         because your employer abolished your job or shift
                       2 During the 12-month period beginning when you lost your job, did you pay for any displaced   Yes
                         worker training?
                       3 While you were receiving displaced worker training, were you either unemployed or working    Yes
                         no more than 20 hours per week?
                       1 Amount of displaced worker training expense you paid                                         $120.00
                       6 Amount of displaced worker training expense your spouse paid                                 $80.00
SD Return Information
                         Are you Filing the Ohio School District Income Tax Return Electronically                     Yes
                         What is the school district number for which you are filing the SD 100?                      4901
                         School District Residency (Primary)                                                          Full-Year Resident
                         School District Residency (Spouse)                                                           Part-Year Resident
                         School District Non-Residency Begin Date                                                     1/1/2016
                         School District Non-Residency End Date                                                       5/31/2016
                         Tax Type                                                                                     Earned Income Only

                                                                                                                                         7-5

Ohio Test #7
            OH Line #                                           Line Item                                      Amount
            1         Federal Adjusted Gross Income                                                                  $96,905.00
            2a        Additions to federal adjusted gross income                                                         $0.00
            2b        Deductions from federal adjusted gross income                                                  $5,500.00
            3         Ohio Adjusted Gross Income (OAGI)                                                              $91,405.00
            4         Personal and dependent exemption deduction                                                     $7,000.00
            5         Ohio income tax base                                                                           $84,405.00
            6         Taxable business income (Ohio IT BUS, line 13)                                                     $0.00
            7         Line 5 minus line 6 (if less than 0, enter 0)                                                  $84,405.00
            7a        Amount from line 7 on page 1                                                                   $84,405.00
            8a        Nonbusiness income tax liability                                                               $2,405.00
            8b        Business income tax liability (Ohio IT BUS, line 14)                                               $0.00
            8c        Tax liability (line 8a plus 8b)                                                                $2,405.00
            9         Ohio nonrefundable credits                                                                     $1,889.00
            10        Tax liability after nonrefundable credits                                                          $516.00
            11        Interest penalty on underpayment of estimated tax                                                  $0.00
            12        Sales and use tax due on Internet, mail order or other out-of-state purchases                      $0.00
            13        Total Ohio tax liability before withholding or estimated payments                                  $516.00
            14        Ohio income tax withheld                                                                       $3,075.00
            15        Add the Ohio estimated & extension payments & credit carryforward from previous year return        $100.00
            16        Refundable credits                                                                                 $0.00
            17        Amended return only - amount previously paid with original/amended return                          $0.00
            18        Total Ohio Tax Payments                                                                        $3,175.00
            19        Amended return only - overpayment previously received on original/amended return                   $0.00
            20        Line 18 minus line 19                                                                          $3,175.00
            21        Tax liability                                                                                      $0.00
            22        Interest and penalty due on late filing or payment of tax                                          $0.00
            23        Total Amount Due                                                                                   $0.00
            24        Overpayment                                                                                    $2,659.00
            25        Original return only - amount of line 24 to be credited toward 2016 income tax liability           $100.00
            26a       Amount of line 24 to be donated - Military injury relief                                           $0.00
            26b       Amount of line 24 to be donated - Ohio History Fund                                                $80.00
            26c       Amount of line 24 to be donated - State nature preserves                                           $0.00
            26d       Amount of line 24 to be donated - Breast/cervical cancer                                           $60.00
            26e       Amount of line 24 to be donated - Wishes for sick children                                         $0.00
            26f       Amount of line 24 to be donated - Wildlife species                                                 $0.00
            26g       Total                                                                                              $140.00
            27        Your Refund                                                                                    $2,419.00

                                                                                                                      7-6

Ohio Test #7
Schedule A     Additions
            1  Non-Ohio state or local government interest and dividends                                         $0.00
            2  Certain Ohio pass-through entity and financial institutions taxes paid                            $0.00
               Reimbursement of college tutition expenses and fees deducted in any previous year(s) and 
            3  noneducation expenditures from a college savings account                                          $0.00
            4  Losses from sale or disposition of Ohio public obligations                                        $0.00
            5  Nonmedical withdrawals from a medical savings account                                             $0.00
               Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if 
            6  the reimbursement is not in federal adjusted gross income                                         $0.00
            7  Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense                 $0.00
            8  Federal interest and dividends subject to state taxation                                          $0.00
            9  Miscellaneous federal income tax additions                                                        $0.00
            10 Total additions                                                                                   $0.00
Schedule A     Deductions
            11 Business income deduction (attach Ohio Schedule IT BUS, line 11)                                  $0.00
            12 Employee compensation earned in Ohio by residents of neighboring states                           $0.00
            13 State or municipal income tax overpayments shown on IRS form 1040, line 10                        $0.00
            14 Qualifying Social Security benefits and certain railroad retirement benefits                      $0.00
               Interest income from Ohio public obligations and from Ohio purchase obligations; gains from 
               the sale or disposition of Ohio public obligations; public service payments received from the 
            15 state of Ohio or income from a transfer agreement                                                 $0.00
            16 Amounts contributed to an individual development account                                          $0.00
            17 Amounts contributed to STABLE account; Ohio's ABLE plan                                           $0.00
            18 Federal interest and dividends exempt from state taxation                                         $0.00
            19 Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense                 $0.00
               Refund or reimbursements shown on IRS form 1040, line 21 for itemized deductions claimed 
            20 on a prior year federal income tax return                                                         $0.00
            21 Repayment of income reported in a prior year                                                      $0.00
            22 Wage expense not deducted due to claiming the federal work opportunity credit                     $0.00
            23 Miscellaneous federal income tax deductions                                                       $0.00
               Military pay for Ohio residents received while the military member was stationed outside 
            24 Ohio                                                                                              $0.00
            25 Certain income earned by military nonresidents and civilian nonresident spouses                   $0.00
            26 Uniformed services retirement income                                                              $0.00
            27 Military injury relief fund                                                                       $0.00
            28 Certain Ohio National Guard reimbursements and benefits                                           $0.00
            29 Ohio 529 contributions, tuition credit purchases                                                  $0.00
            30 Pell/Ohio College Opportunity taxable grant amounts used to pay room and board                    $0.00
            31 Disability and survivorship benefits (do not include pension continuation benefits)               $0.00
               Unreimbursed long-term care insurance premiums, unsubsidized health care insurance 
            32 premiums and excess health care expenses                                                      $5,500.00
               Funds deposited into, and earnings of, a medical savings account for eligible health care 
            33 expenses                                                                                          $0.00
            34 Qualified organ donor expenses                                                                    $0.00
            35 Total deductions                                                                              $5,500.00

                                                                                                              7-7

Ohio Test #7
Schedule of Credits    Nonrefundable credits
                    1  Total tax liability (From IT1040 8c)                                                              $2,405.00
                    2  Retirement Income Credit                                                                              $0.00
                    3  Lump sum retirement credit                                                                            $0.00
                    4  Senior citizen credit                                                                                 $0.00
                    5  Lump sum distribution credit                                                                          $0.00
                    6  Child care and dependent care credit                                                                  $0.00
                    7  If Ohio form IT 1040, line 5 is $10,000 or less, enter $88; otherwise, enter -0- (low income cred     $0.00
                    8  Displaced worker training credit                                                                      $100.00
                       Campaign contribution credit for Ohio statewide office or General 
                    9  Assembly                                                                                              $0.00
                    10 Income-based exemption credit                                                                         $0.00
                    11 Total (add lines 2 through 10)                                                                        $100.00
                    12 Tax less credits (line 1 minus line 11; if less than -0-, enter -0-)                              $2,305.00
                    13 Joint filing credit                                                                                   $115.00
                    14 Earned income credit                                                                                  $0.00
                    15 Ohio adoption credit                                                                              $1,500.00
                    16 Job retention credit, nonrefundable portion                                                           $4.00
                    17 Credit for eligible new employees in an enterprise zone                                               $5.00
                    18 Credit for purchases of grape production property                                                     $7.00
                    19 Credit for investing in an Ohio small business                                                        $8.00
                    20 Technology investment credit carryforward                                                             $6.00
                    21 Enterprise zone day care and training credits                                                         $9.00
                    22 Research and development credit                                                                       $10.00
                    23 Ohio historic preservation credit, nonrefundable carryforward portion                                 $1.00
                    24 Total (add lines 13 through 23)                                                                   $1,665.00
                    25 Tax less additional credits (line 12 minus line 24; if less than -0-, enter -0-)                      $640.00
                       Nonresident Credit
                    26 Enter the portion of OAGI that was not earned or received in Ohio                                 $17,785.00
                    27 Enter the OAGI                                                                                    $91,405.00
                       Line 26/27 _____* Multiply this factor by the amount on line 25 to calculate your nonresident 
                    28 credit                                                                                                $124.00
                       Resident Credit
                    29 Enter the portion of OAGI subjected to tax by other states or DC while an OH resident                 $0.00
                    30 Enter OAGI                                                                                            $0.00
                    31 Divide line 29 by line 30 ____*Multiply this factor by the amount on line 25                          $0.00
                    32 Enter the 2016 income tax, less all credits other than w/h and est tax pmts and CCFs                  $0.00
                    33 Enter the smaller of line 31 or line 32. This is your Ohio resident tax credit.                       $0.00
                    34 Total nonrefundable credits                                                                       $1,889.00
                       Refundable Credits
                    35 Historic preservation credit                                                                          $0.00
                    36 Business jobs credit                                                                                  $0.00
                    37 Pass-through entity credit                                                                            $0.00
                    38 Motion picture production credit                                                                      $0.00
                    39 Financial Institutions Tax (FIT) credit                                                               $0.00
                    40 Venture Capital credit                                                                                $0.00
                    41 Total refundable credits                                                                              $0.00

                                                                                                                          7-8

Ohio Test #7
Sch IT BUS
                                      Part 1
                                   1  Sch B - Interest and Ordinary Dividends                                                        $0.00
                                   2  Sch C - Profit or Loss From Business (Sole Proprietership)                                     $0.00
                                   3  Sch D - Capital Gains and Losses                                                               $0.00
                                   4  Sch E - Supplemental Income and Loss                                                           $0.00
                                      Guranteed payments, compensation and/or wages from each pass-through entity in which 
                                   5  you have at least a 20% direct or indirect ownership interest                                  $0.00
                                   6  Sch F - Profit or Loss From Farming                                                            $0.00
                                      Other items of income and gain separately stated on federal Schedule K-1, federal 4787 
                                      gains and/or losses reported on federal 4787 and miscellaneous federal income tax 
                                   7  adjustments, if any                                                                            $0.00
                                   8  Total of business income                                                                       $0.00
                                      Part 2
                                      All business income. Enter here & on  IT 1040, line 6. If 0 or negative, stop here & don't 
                                   9  complete Part 3.                                                                               $0.00
                                   10 Enter $250,000 if single or MFJ, enter $125,000 if MFS                                         $0.00
                                   11 Lesser of line  9or line 10. Enter here and on Ohio Schedule A, line 11                        $0.00
                                      Part 3
                                   12 Line  9minus line 1 1(if less than -0-, enter -0-)                                             $0.00
                                   13 Taxable Business Income                                                                        $0.00
                                   14 Business income tax liability. Enter here and on Ohio IT 1040, line 8b.                        $0.00
School District Return Information 
                                   1  School district taxable income:  Traditional or Earned Income tax base                     $77,870.00
                                   2  School District Tax .____ times line 1.                                                        $779.00
                                   3  Senior Citizen Credit                                                                          $0.00
                                   4  School District Income Tax liability                                                           $779.00
                                   5  Interest Penalty on Underpayment of School District Estimated Tax                              $0.00
                                   6  Total school district income tax liability (line 4 plus line 5)                                $779.00
                                   6a Amount from line 6                                                                             $779.00
                                   7  School district income tax withheld                                                        $1,400.00
                                   8  SD100ES & SD40P, Extension Payments and Credit carryforward from previous year return          $0.00
                                   9  Amended return only - amount previously paid with original/amended return                      $0.00
                                   10 Total school district income tax payments (add lines 7, 8 and 9)                           $1,400.00
                                   11 Amended return only - overpayment previously received on original/amended return               $0.00
                                   12 Total Payments less overpayment previously received on original/amended return             $1,400.00
                                   13 Tax Liability                                                                                  $0.00
                                   14 Interest and penalty due on late filing or payment of tax                                      $0.00
                                   15 Total Amount Due                                                                               $0.00
                                   16 Overpayment                                                                                    $621.00
                                   17 Original return only - amount of line 16 to be credited toward 2016 income tax liability       $0.00
                                   18 Your Refund                                                                                    $621.00

                                                                                                                                  7-9

Ohio Test #7
School District Schedule A "Traditional" Tax Base School District Amounts
                                                 19 Ohio income tax base reported on line 5 of Ohio IT 1040                                         $0.00
                                                 20 Business income deduction add-back                                                              $0.00
                                                 21 Total Traditional Tax Base School District Income (Line 19 + Line 20)                           $0.00
                                                 22 Amount of traditional tax base school district income that you earned while not a resident      $0.00
                                                 23 School District Taxable Income (Enter here and on line 1)                                       $0.00
School District Schedule B "Earned Income Only" Tax Base School District Amounts
                                                 24 Wages and other compensation as described in the instructions                              $77,870.00
                                                 25 Net Earnings from Self Employment                                                               $0.00
                                                 26 Depreciation Expense Adjustments                                                                $0.00
                                                 27 School District Taxable Income (Enter here and on line 1)                                  $77,870.00
               What is Tested?
IT1040WithSD100
Self-Prepared
MFJ status
 W-2 with Ohio & non-Ohio state information
1099-B
1099-DIV

IT1040  
Primary - Full year resident
Spouse - Part-year resident
FiledFedExtForm4868
Schedule J dependents
[$84,200 - $105,300] tax bracket
5% joint filing credit
Sch. A - Health/medical expenses
Sch of Credits - DWC 
Sch of Credits - Adoption credit 
Sch of Credits - Job retention
Sch of Credits - Eligible new employees in 
enterprise zone
Sch of Credits - Purchase of grape production
Sch of Credits - Investing in Ohio small business
Sch of Credits - Technology investment credit 
carryforward
Sch of Credits - Enterprise zone day care training
Sch of Credits - Research and development
Sch of Credits - Ohio historic preservation
Sch of Credits - Non-resident credit 
Installment payments 
Donations
Credit carryforward/Refund split

SD100
Earned income only school district
Primary - Full year resident
Spouse - Part-year resident

                                                                                                                                                7-10

Ohio Test #8                                                                                                             IT1040
Taxpayer Information                                                    Description
                                Primary Social Security Number                                                XX0-00-7608
                                Primary First Name                                                            BRUTUS
                                Primary Last Name                                                             BUCKEYE
                                Date of Birth - Primary                                                       02/01/1997
                                Occupation - Primary                                                          INVESTOR
                                Address Line 1                                                                123 S MAIN ST
                                City                                                                          COLUMBUS
                                State                                                                         OH
                                Zip Code                                                                      43229
                                Ohio County                                                                   FRANKLIN
                                County Code (Ohio Public School District Number)                              2503
Federal Return Information 1040                                         Description
                                Filing Status                                                                 Single
                                Exemptions, None - claimed on parent's return                                 0
                                Line 7 Total Wages                                                            $0.00
                                Line 37 Adjusted Gross Income                                                 $0.00
State Return Information                                                Description
                                Is this an amended return?                                                    No
                                NonPaid Preparer's name                                                       AVA WHITE
                                NonPaid Preparer's phone number                                               513-554-5545
                                NonPaid Preparer's Email Address                                              AVA@AVA.COM
                                NonPaid Preparer's PTIN                                                       P23568921
                                NonPaid Preparer's US Address                                                 200 SOUTH ST
                                City                                                                          COLUMBUS
                                State                                                                         OH
                                ZIP Code                                                                      43229
                                Filing Status                                                                 Single
                                Ohio Residency Status (Primary)                                               Full-Year Resident
                                Ohio Political Party Fund Contribution - Primary                              Yes
                                Is someone else claiming you or your spouse (if joint return) as a dependent? Yes
                                Enter the number of dependents                                                0
                                Eligible for JFC?                                                             No
                                Historic Preservation Credit                                                  $145,000.00
                                Business Jobs Credit                                                          $25,000.00
                                Please print the certificate on the next tab and submit as a PDF attachment.
                                Motion Picture Production Credit                                              $10,000.00
                                Financial Institutions Tax (FIT) Credit                                       $8,000.00
                                Venture Capital Credit                                                        $2,000.00
                                Taxpayer's Phone Number                                                       513-554-1234
                                Taxpayer's E-mail Address                                                     BRUTUS@MSN.COM
                                Perjury Statement Acceptance                                                  Yes
                                Preparer Authorization Check Box                                              Yes

                                                                                                                                 8-1

Ohio Test #8
                                                        Financial Institutions Tax (FIT) Credit Info
                                  Shareholder's SSN                                                                        400-00-7608
                                  Corporation's EIN                                                                        32-3456789
                                  Corporation's Name                                                                       SMITH INC
                                  Percentage of Stock Ownership                                                            20%
                                  Financial Institutions Tax (FIT) Credit                                                  $5,000.00
                                  Total Indirect Pass Through Credit                                                       $3,000.00
                                  Total Indirect Pass Through FEIN                                                         32-4567890
             Worksheets           Unpaid Use Tax
            a.                    Did you make any out of state purchases                                                  Yes
            b.                    Did the retailer charge you any sales tax                                                No
            c.                    Amount of Purchases that you did not pay sales tax                                       $75,000.00
            d.                    County sales tax rate                                                                    7.50%
SD Return Information
                                  Are you Filing the Ohio School District Income Tax Return Electronically                 No
                        OH Line #                                           Line Item                                       Amount
                        1         Federal Adjusted Gross Income                                                                           $0.00
                        2a        Additions to federal adjusted gross income                                                              $0.00
                        2b        Deductions from federal adjusted gross income                                                           $0.00
                        3         Ohio Adjusted Gross Income (OAGI)                                                                       $0.00
                        4         Personal and dependent exemption deduction                                                              $0.00
                        5         Ohio income tax base                                                                                    $0.00
                        6         Taxable business income (Ohio IT BUS, line 13)                                                          $0.00
                        7         Line 5 minus line 6 (if less than 0, enter 0)                                                           $0.00
                        7a        Amount from line 7 on page 1                                                                            $0.00
                        8a        Nonbusiness income tax liability                                                                        $0.00
                        8b        Business income tax liability (Ohio IT BUS, line 14)                                                    $0.00
                        8c        Total tax liability (line 8a plus 8b)                                                                   $0.00
                        9         Ohio nonrefundable credits                                                                              $88.00
                        10        Tax liability after nonrefundable credits                                                               $0.00
                        11        Interest penalty on underpayment of estimated tax                                                       $0.00
                        12        Sales and use tax due on Internet, mail order or other out-of-state purchases                       $5,625.00
                        13        Total Ohio tax liability before withholding or estimated payments                                   $5,625.00
                        14        Ohio income tax withheld                                                                                $0.00
                        15        Add the Ohio estimated & extension payments & credit carryforward from previous year retu               $0.00
                        16        Refundable credits                                                                                  $190,000.00
                        17        Amended return only - amount previously paid with original/amended return                               $0.00
                        18        Total Ohio Tax Payments                                                                             $190,000.00
                        19        Amended return only - overpayment previously received on original/amended return                        $0.00
                        20        Line 18 minus line 19                                                                               $190,000.00
                        21        Tax liability                                                                                           $0.00
                        22        Interest and penalty due on late filing or payment of tax                                               $0.00
                        23        Total Amount Due                                                                                        $0.00
                        24        Overpayment                                                                                         $184,375.00
                        25        Original return only - amount of line 24 to be credited toward 2016 income tax liability                $0.00
                        26a       Amount of line 24 to be donated - Military injury relief                                                $0.00
                        26b       Amount of line 24 to be donated - Ohio History Fund                                                     $0.00
                        26c       Amount of line 24 to be donated - State nature preserves                                                $0.00
                        26d       Amount of line 24 to be donated - Breast/cervical cancer                                                $0.00
                        26e       Amount of line 24 to be donated - Wishes for sick children                                              $0.00
                        26f       Amount of line 24 to be donated - Wildlife species                                                      $0.00
                        26g       Total                                                                                                   $0.00
                        27        Your Refund                                                                                         $184,375.00

                                                                                                                                       8-2

Ohio Test #8
Schedule A     Additions
            1  Non-Ohio state or local government interest and dividends                                                                               $0.00
            2  Certain Ohio pass-through entity and financial institutions taxes paid                                                                  $0.00
               Reimbursement of college tutition expenses and fees deducted in any previous year(s) and 
            3  noneducation expenditures from a college savings account                                                                                $0.00
            4  Losses from sale or disposition of Ohio public obligations                                                                              $0.00
            5  Nonmedical withdrawals from a medical savings account                                                                                   $0.00
               Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if 
            6  the reimbursement is not in federal adjusted gross income                                                                               $0.00
            7  Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense                                                       $0.00
            8  Federal interest and dividends subject to state taxation                                                                                $0.00
            9  Miscellaneous federal income tax additions                                                                                              $0.00
            10 Total additions                                                                                                                         $0.00
Schedule A     Deductions
            11 Business income deduction (attach Ohio Schedule IT BUS, line 11)                                                                        $0.00
            12 Employee compensation earned in Ohio by residents of neighboring states                                                                 $0.00
            13 State or municipal income tax overpayments shown on IRS form 1040, line 10                                                              $0.00
            14 Qualifying Social Security benefits and certain railroad retirement benefits                                                            $0.00
               Interest income from Ohio public obligations and from Ohio purchase obligations; gains 
               from the sale or disposition of Ohio public obligations; public service payments received 
            15 from the state of Ohio or income from a transfer agreement                                                                              $0.00
            16 Amounts contributed to an individual development account                                                                                $0.00
            17 Amounts contributed to STABLE account; Ohio's ABLE plan                                                                                 $0.00
            18 Federal interest and dividends exempt from state taxation                                                                               $0.00
            19 Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense                                                       $0.00
               Refund or reimbursements shown on IRS form 1040, line 21 for itemized deductions 
            20 claimed on a prior year federal income tax return                                                                                       $0.00
            21 Repayment of income reported in a prior year                                                                                            $0.00
            22 Wage expense not deducted due to claiming the federal work opportunity credit                                                           $0.00
            23 Miscellaneous federal income tax deductionsMilitary pay for Ohio residents received while the military member was stationed outside     $0.00
            24 Ohio                                                                                                                                    $0.00
            25 Certain income earned by military nonresidents and civilian nonresident spouses                                                         $0.00
            26 Uniformed services retirement income                                                                                                    $0.00
            27 Military injury relief fund                                                                                                             $0.00
            28 Certain Ohio National Guard reimbursements and benefits                                                                                 $0.00
            29 Ohio 529 contributions, tuition credit purchases                                                                                        $0.00
            30 Pell/Ohio College Opportunity taxable grant amounts used to pay room and board                                                          $0.00
            31 Disability and survivorship benefits (do not include pension continuation benefits)                                                     $0.00
               Unreimbursed long-term care insurance premiums, unsubsidized health care insurance 
            32 premiums and excess health care expenses                                                                                                $0.00
               Funds deposited into, and earnings of, a medical savings account for eligible health care 
            33 expenses                                                                                                                                $0.00
            34 Qualified organ donor expenses                                                                                                          $0.00
            35 Total deductions                                                                                                                        $0.00

                                                                                                                                                    8-3

Ohio Test #8
Schedule of Credits    Nonrefundable credits
                    1  Total tax liability (From IT1040 8c)                                                                $0.00
                    2  Retirement Income Credit                                                                            $0.00
                    3  Lump sum retirement credit                                                                          $0.00
                    4  Senior citizen credit                                                                               $0.00
                    5  Lump sum distribution credit                                                                        $0.00
                    6  Child care and dependent care credit                                                                $0.00
                    7  If Ohio form IT 1040, line 5 is $10,000 or less, enter $88; otherwise, enter -0- (low income cr     $88.00
                    8  Displaced worker training credit                                                                    $0.00
                       Campaign contribution credit for Ohio statewide office or General 
                    9  Assembly                                                                                            $0.00
                    10 Income-based exemption credit                                                                       $0.00
                    11 Total (add lines 2 through 10)                                                                      $88.00
                    12 Tax less credits (line 1 minus line 11; if less than -0-, enter -0-)                                $0.00
                    13 Joint filing credit                                                                                 $0.00
                    14 Earned income credit                                                                                $0.00
                    15 Ohio adoption credit                                                                                $0.00
                    16 Job retention credit, nonrefundable portion                                                         $0.00
                    17 Credit for eligible new employees in an enterprise zone                                             $0.00
                    18 Credit for purchases of grape production property                                                   $0.00
                    19 Credit for investing in an Ohio small business                                                      $0.00
                    20 Technology investment credit carryforward                                                           $0.00
                    21 Enterprise zone day care and training credits                                                       $0.00
                    22 Research and development credit                                                                     $0.00
                    23 Ohio historic preservation credit, nonrefundable carryforward portion                               $0.00
                    24 Total (add lines 13 through 23)                                                                     $0.00
                    25 Tax less additional credits (line 12 minus line 24; if less than -0-, enter -0-)                    $0.00
                       Nonresident Credit
                    26 Enter the portion of OAGI that was not earned or received in Ohio                                   $0.00
                    27 Enter the OAGI                                                                                      $0.00
                       Line 26/27 _____* Multiply this factor by the amount on line 25 to calculate your 
                    28 nonresident credit                                                                                  $0.00
                       Resident Credit
                    29 Enter the portion of OAGI subjected to tax by other states or DC while an OH resident               $0.00
                    30 Enter OAGI                                                                                          $0.00
                    31 Divide line 29 by line 30 ____*Multiply this factor by the amount on line 25                        $0.00
                    32 Enter the 2016 income tax, less all credits other than w/h and est tax pmts and CCFs                $0.00
                    33 Enter the smaller of line 31 or line 32. This is your Ohio resident tax credit.                     $0.00
                    34 Total nonrefundable credits                                                                         $88.00
                       Refundable Credits
                    35 Historic preservation credit                                                                    $145,000.00
                    36 Business jobs credit                                                                            $25,000.00
                    37 Pass-through entity credit                                                                          $0.00
                    38 Motion picture production credit                                                                $10,000.00
                    39 Financial Institutions Tax (FIT) credit                                                         $8,000.00
                    40 Venture Capital credit                                                                          $2,000.00
                    41 Total refundable credits                                                                        $190,000.00

                                                                                                                        8-4

Ohio Test #8
Sch IT BUS
                                                         Part 1
                                              1          Sch B - Interest and Ordinary Dividends                                                        $0.00
                                              2          Sch C - Profit or Loss From Business (Sole Proprietership)                                     $0.00
                                              3          Sch D - Capital Gains and Losses                                                               $0.00
                                              4          Sch E - Supplemental Income and Loss                                                           $0.00
                                                         Guranteed payments, compensation and/or wages from each pass-through entity in which 
                                              5          you have at least a 20% direct or indirect ownership interest                                  $0.00
                                              6          Sch F - Profit or Loss From Farming                                                            $0.00
                                                         Other items of income and gain separately stated on federal Schedule K-1, federal 4787 
                                                         gains and/or losses reported on federal 4787 and miscellaneous federal income tax 
                                              7          adjustments, if any                                                                            $0.00
                                              8          Total of business income                                                                       $0.00
                                                         Part 2
                                                         All business income. Enter here & on  IT 1040, line 6. If 0 or negative, stop here & don't 
                                              9          complete Part 3.                                                                               $0.00
                                              10         Enter $250,000 if single or MFJ, enter $125,000 if MFS                                         $0.00
                                              11         Lesser of line  9or line 10. Enter here and on Ohio Schedule A, line 11                        $0.00
                                                         Part 3
                                              12         Line  9minus line 1 1(if less than -0-, enter -0-)                                             $0.00
                                              13         Taxable Business Income                                                                        $0.00
                                              14         Business income tax liability. Enter here and on Ohio IT 1040, line 8b.                        $0.00
What is Tested?
IT1040
Non-paid preparer
Preparer Contact - Authorized
Single status
No W-2/1099 information

IT1040
Full year resident
Taxpayer claimed as a dependent on parent's return
[$0 - $5,250] tax bracket
$0 FAGI
Use tax
Sch of Credits - Low income credit 
Sch of Credits - Historic preservation credit 
Sch of Credits - Business jobs credit 
Sch of Credits - Motion picture production credit 
Sch of Credits - Financial Institutions Tax (FIT) Credit 
Sch of Credits - Venture Capital credit

No school district return

                                                                                                                                                     8-5

Ohio Test #9                                                               IT1040 with SD100
Taxpayer Information                                    Description
                     Primary Social Security Number                   XX0-00-7609
                     Primary First Name                               PAQUITA SUNITA
                     Primary Last Name                                JEFFERSON-WILLOUGHBY
                     Date of Birth - Primary                          6/30/1965
                     Occupation - Primary                             DRIVER
                     Spouse's Social Security Number                  XX0-00-7659
                     Spouse First Name                                JEFFREY
                     Spouse Last Name                                 JEFFERSON
                     Date of Birth - Spouse                           10/10/1968
                     Occupation - Spouse                              MERCHANDISER
                     Address Line 1                                   12345 REFUGEE RD
                     City                                             WEEHAWKEN
                     State                                            NJ
                     Zip Code                                         07086
                     Ohio County                                      FRANKLIN
                     County Code (Ohio Public School District Number) 9999
                                             Income Statements
             W-2 #1
                     Employers Identification Number                  31-9876543
                     Employer's Name                                  WEARABLE GARMENTS MFG
                     Employer's Address                               2 WASHINGTON CIR
                     Employer's City                                  WEST LIBERTY 
                     Employer's State                                 OH
                     Employer's Zip Code                              43357
                     Employee's Social Security Number                400-00-7609
                     Employee's Name                                  PAQUITA SUNITA JEFFERSON-
                                                                      WILLOUGHBY
                     Employee's Address                               12345 REFUGEE RD
                     Employee's City                                  WEEHAWKEN
                     Employee's State                                 NJ
                     Employee's Zip Code                              07086
                     Box 1 Wages, Tips, etc                           $106,963.00
                     Box 2 Federal Income Tax Withheld                $38,000.00
                     Box 3 Social Security Wages                      $106,963.00
                     Box 4 Social Security Tax Withheld               $6,632.00
                     Box 5 Medicare Wages and Tips                    $106,963.00
                     Box 6 Medicare Withheld                          $1,551.00
                     Box 15 State                                     NJ
                     State ID Number                                  123-456-789/123
                     State Wages                                      $106,963.00
                     State Income Tax Withheld                        $6,700.00

                                                                                      9-1

Ohio Test #9
            W-2 #2
                                Employers Identification Number                                               31-9876543
                                Employer's Name                                                               WEARABLE GARMENTS MFG
                                Employer's Address                                                            2 WASHINGTON CIR
                                Employer's City                                                               WEST LIBERTY 
                                Employer's State                                                              OH
                                Employer's Zip Code                                                           43357
                                Employee's Social Security Number                                             400-00-7659
                                Employee's Name                                                               JEFFREY JEFFERSON
                                Employee's Address                                                            12345 REFUGEE RD
                                Employee's City                                                               WEEHAWKEN
                                Employee's State                                                              NJ
                                Employee's Zip Code                                                           07086
                                Box 1 Wages, Tips, etc                                                        $50,000.00
                                Box 2 Federal Income Tax Withheld                                             $5,000.00
                                Box 3 Social Security Wages                                                   $50,000.00
                                Box 4 Social Security Tax Withheld                                            $3,100.00
                                Box 5 Medicare Wages and Tips                                                 $50,000.00
                                Box 6 Medicare Withheld                                                       $725.00
                                Box 15 State                                                                  OH
                                State ID Number                                                               54-6565657
                                State Wages                                                                   $50,000.00
                                State Income Tax Withheld                                                     $1,500.00
                                Ohio School District Wages                                                    $50,000.00
                                School District Tax Withheld                                                  $875.00
                                School District #                                                             1105
Federal Return Information 1040                                    Description
                                Filing Status                                                                 Married Filing Jointly
                                Exemptions, Self, Spouse                                                      2
                                Line 7 Total Wages                                                            $156,963.00
                                Line 37 Adjusted Gross Income                                                 $156,963.00
State Return Information                                           Description
                                Is this an amended return?                                                    No
                                Self-Prepared                                                                 X
                                Filing Status                                                                 Married Filing Jointly
                                Ohio Residency Status (Primary)                                               Full-Year Nonresident
                                Ohio Residency Status (Spouse)                                                Full-Year Nonresident
                                State of Residency for Nonresident Primary Taxpayer                           NJ
                                State of Residency for Nonresident Spouse                                     NJ
                                Ohio Political Party Fund Contribution - Primary                              Yes
                                Ohio Political Party Fund Contribution - Spouse                               Yes
                                Is someone else claiming you or your spouse (if joint return) as a dependent? No
                                Enter the number of dependents                                                0
                                Eligible for JFC?                                                             Yes
                                Non-Education Expenditures from College Savings Account                       $6,150.00
                                Enter the Portion of OAGI that was not Earned or Received in Ohio             $106,963.00
                                Taxpayer's Phone Number                                                       201-554-1234
                                Taxpayer's E-mail Address                                                     JEFFERSON@TAX.GOV
                                Perjury Statement Acceptance                                                  Yes
                                Preparer Authorization Check Box                                              Yes

                                                                                                                                     9-2

Ohio Test #9
SD Return Information
                               Are you Filing the Ohio School District Income Tax Return Electronically                 Yes
                               What is the school district number for which you are filing the SD 100?                  1105
                               School District Residency (Primary)                                                      Full-Year Nonresident
                               School District Residency (Spouse)                                                       Full-Year Nonresident
                               Tax Type                                                                                 Traditional
                     OH Line #                                           Line Item                                      Amount
                     1         Federal Adjusted Gross Income                                                                       $156,963.00
                     2a        Additions to federal adjusted gross income                                                                    $6,150.00
                     2b        Deductions from federal adjusted gross income                                                                 $0.00
                     3         Ohio Adjusted Gross Income (OAGI)                                                                   $163,113.00
                     4         Personal and dependent exemption deduction                                                                    $3,500.00
                     5         Ohio income tax base                                                                                $159,613.00
                     6         Taxable business income (Ohio IT BUS, line 13)                                                                $0.00
                     7         Line 5 minus line 6 (if less than 0, enter 0)                                                       $159,613.00
                     7a        Amount from line 7 on page 1                                                                        $159,613.00
                     8a        Nonbusiness income tax liability                                                                              $5,729.00
                     8b        Business income tax liability (Ohio IT BUS, line 14)                                                          $0.00
                     8c        Tax liability (line 8a plus 8b)                                                                               $5,729.00
                     9         Ohio nonrefundable credits                                                                                    $3,855.00
                     10        Tax liability after nonrefundable credits                                                                     $1,874.00
                     11        Interest penalty on underpayment of estimated tax                                                             $0.00
                     12        Sales and use tax due on Internet, mail order or other out-of-state purchases                                 $0.00
                     13        Total Ohio tax liability before withholding or estimated payments                                             $1,874.00
                     14        Ohio income tax withheld                                                                                      $1,500.00
                               Add the Ohio estimated & extension payments & credit carryforward from previous year 
                     15        return                                                                                                        $0.00
                     16        Refundable credits                                                                                            $0.00
                     17        Amended return only - amount previously paid with original/amended return                                     $0.00
                     18        Total Ohio Tax Payments                                                                                       $1,500.00
                     19        Amended return only - overpayment previously received on original/amended return                              $0.00
                     20        Line 18 minus line 19                                                                                         $1,500.00
                     21        Tax liability                                                                                                 $374.00
                     22        Interest and penalty due on late filing or payment of tax                                                     $0.00
                     23        Total Amount Due                                                                                              $374.00
                     24        Overpayment                                                                                                   $0.00
                     25        Original return only - amount of line 24 to be credited toward 2016 income tax liability                      $0.00
                     26a       Amount of line 24 to be donated - Military injury relief                                                      $0.00
                     26b       Amount of line 24 to be donated - Ohio History Fund                                                           $0.00
                     26c       Amount of line 24 to be donated - State nature preserves                                                      $0.00
                     26d       Amount of line 24 to be donated - Breast/cervical cancer                                                      $0.00
                     26e       Amount of line 24 to be donated - Wishes for sick children                                                    $0.00
                     26f       Amount of line 24 to be donated - Wildlife species                                                            $0.00
                     26g       Total                                                                                                         $0.00
                     27        Your Refund                                                                                                   $0.00

                                                                                                                                    9-3

Ohio Test #9
Schedule A     Additions
            1  Non-Ohio state or local government interest and dividends                                         $0.00
            2  Certain Ohio pass-through entity and financial institutions taxes paid                            $0.00
               Reimbursement of college tutition expenses and fees deducted in any previous year(s) and 
            3  noneducation expenditures from a college savings account                                      $6,150.00
            4  Losses from sale or disposition of Ohio public obligations                                        $0.00
            5  Nonmedical withdrawals from a medical savings account                                             $0.00
               Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if 
            6  the reimbursement is not in federal adjusted gross income                                         $0.00
            7  Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense                 $0.00
            8  Federal interest and dividends subject to state taxation                                          $0.00
            9  Miscellaneous federal income tax additions                                                        $0.00
            10 Total additions                                                                               $6,150.00
Schedule A     Deductions
            11 Business income deduction (attach Ohio Schedule IT BUS, line 11)                                  $0.00
            12 Employee compensation earned in Ohio by residents of neighboring states                           $0.00
            13 State or municipal income tax overpayments shown on IRS form 1040, line 10                        $0.00
            14 Qualifying Social Security benefits and certain railroad retirement benefits                      $0.00
               Interest income from Ohio public obligations and from Ohio purchase obligations; gains from 
               the sale or disposition of Ohio public obligations; public service payments received from the 
            15 state of Ohio or income from a transfer agreement                                                 $0.00
            16 Amounts contributed to an individual development account                                          $0.00
            17 Amounts contributed to STABLE account; Ohio's ABLE plan                                           $0.00
            18 Federal interest and dividends exempt from state taxation                                         $0.00
            19 Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense                 $0.00
               Refund or reimbursements shown on IRS form 1040, line 21 for itemized deductions claimed 
            20 on a prior year federal income tax return                                                         $0.00
            21 Repayment of income reported in a prior year                                                      $0.00
            22 Wage expense not deducted due to claiming the federal work opportunity credit                     $0.00
            23 Miscellaneous federal income tax  deductions                                                      $0.00
               Military pay for Ohio residents received while the military member was stationed outside 
            24 Ohio                                                                                              $0.00
            25 Certain income earned by military nonresidents and civilian nonresident spouses                   $0.00
            26 Uniformed services retirement income                                                              $0.00
            27 Military injury relief fund                                                                       $0.00
            28 Certain Ohio National Guard reimbursements and benefits                                           $0.00
            29 Ohio 529 contributions, tuition credit purchases                                                  $0.00
            30 Pell/Ohio College Opportunity taxable grant amounts used to pay room and board                    $0.00
            31 Disability and survivorship benefits (do not include pension continuation benefits)               $0.00
               Unreimbursed long-term care insurance premiums, unsubsidized health care insurance 
            32 premiums and excess health care expenses                                                          $0.00
               Funds deposited into, and earnings of, a medical savings account for eligible health care 
            33 expenses                                                                                          $0.00
            34 Qualified organ donor expenses                                                                    $0.00
            35 Total deductions                                                                                  $0.00

                                                                                                              9-4

Ohio Test #9
Schedule of Credits    Nonrefundable credits
                    1  Total tax liability (From IT1040 8c)                                                             $5,729.00
                    2  Retirement Income Credit                                                                             $0.00
                    3  Lump sum retirement credit                                                                           $0.00
                    4  Senior citizen credit                                                                                $0.00
                    5  Lump sum distribution credit                                                                         $0.00
                    6  Child care and dependent care credit                                                                 $0.00
                    7  If Ohio form IT 1040, line 5 is $10,000 or less, enter $88; otherwise, enter -0- (low income cre     $0.00
                    8  Displaced worker training credit                                                                     $0.00
                       Campaign contribution credit for Ohio statewide office or General 
                    9  Assembly                                                                                             $0.00
                    10 Income-based exemption credit                                                                        $0.00
                    11 Total (add lines 2 through 10)                                                                       $0.00
                    12 Tax less credits (line 1 minus line 11; if less than -0-, enter -0-)                             $5,729.00
                    13 Joint filing credit                                                                                  $286.00
                    14 Earned income credit                                                                                 $0.00
                    15 Ohio adoption credit                                                                                 $0.00
                    16 Job retention credit, nonrefundable portion                                                          $0.00
                    17 Credit for eligible new employees in an enterprise zone                                              $0.00
                    18 Credit for purchases of grape production property                                                    $0.00
                    19 Credit for investing in an Ohio small business                                                       $0.00
                    20 Technology investment credit carryforward                                                            $0.00
                    21 Enterprise zone day care and training credits                                                        $0.00
                    22 Research and development credit                                                                      $0.00
                    23 Ohio historic preservation credit, nonrefundable carryforward portion                                $0.00
                    24 Total (add lines 13 through 23)                                                                      $286.00
                    25 Tax less additional credits (line 12 minus line 24; if less than -0-, enter -0-)                 $5,443.00
                       Nonresident Credit
                    26 Enter the portion of OAGI that was not earned or received in Ohio                                $106,963.00
                    27 Enter the OAGI                                                                                   $163,113.00
                       Line 26/27 _____* Multiply this factor by the amount on line 25 to calculate your nonresident 
                    28 credit                                                                                           $3,569.00
                       Resident Credit
                    29 Enter the portion of OAGI subjected to tax by other states or DC while an OH resident                $0.00
                    30 Enter OAGI                                                                                           $0.00
                    31 Divide line 29 by line 30 ____*Multiply this factor by the amount on line 25                         $0.00
                    32 Enter the 2016 income tax, less all credits other than w/h and est tax pmts and CCFs                 $0.00
                    33 Enter the smaller of line 31 or line 32. This is your Ohio resident tax credit.                      $0.00
                    34 Total nonrefundable credits                                                                      $3,855.00
                       Refundable Credits
                    35 Historic preservation credit                                                                         $0.00
                    36 Business jobs credit                                                                                 $0.00
                    37 Pass-through entity credit                                                                           $0.00
                    38 Motion picture production credit                                                                     $0.00
                    39 Financial Institutions Tax (FIT) credit                                                              $0.00
                    40 Venture Capital credit                                                                               $0.00
                    41 Total refundable credits                                                                             $0.00

                                                                                                                         9-5

Ohio Test #9
Sch IT BUS
                                      Part 1
                                   1  Sch B - Interest and Ordinary Dividends                                                        $0.00
                                   2  Sch C - Profit or Loss From Business (Sole Proprietership)                                     $0.00
                                   3  Sch D - Capital Gains and Losses                                                               $0.00
                                   4  Sch E - Supplemental Income and Loss                                                           $0.00
                                      Guranteed payments, compensation and/or wages from each pass-through entity in which 
                                   5  you have at least a 20% direct or indirect ownership interest                                  $0.00
                                   6  Sch F - Profit or Loss From Farming                                                            $0.00
                                      Other items of income and gain separately stated on federal Schedule K-1, federal 4787 
                                      gains and/or losses reported on federal 4787 and miscellaneous federal income tax 
                                   7  adjustments, if any                                                                            $0.00
                                   8  Total of business income                                                                       $0.00
                                      Part 2
                                      All business income. Enter here & on  IT 1040, line 6. If 0 or negative, stop here & don't 
                                   9  complete Part 3.                                                                               $0.00
                                   10 Enter $250,000 if single or MFJ, enter $125,000 if MFS                                         $0.00
                                   11 Lesser of line  9or line 10. Enter here and on Ohio Schedule A, line 11                        $0.00
                                      Part 3
                                   12 Line  9minus line 1 1(if less than -0-, enter -0-)                                             $0.00
                                   13 Taxable Business Income                                                                        $0.00
                                   14 Business income tax liability. Enter here and on Ohio IT 1040, line 8b.                        $0.00

School District Return Information 
                                   1  School district taxable income:  Traditional or Earned Income tax base                         $0.00
                                   2  School District Tax .____ times line 1.                                                        $0.00
                                   3  Senior Citizen Credit                                                                          $0.00
                                   4  School District Income Tax liability                                                           $0.00
                                   5  Interest Penalty on Underpayment of School District Estimated Tax                              $0.00
                                   6  Total school district income tax liability (line 4 plus line 5)                                $0.00
                                   6a Amount from line 6                                                                             $0.00
                                   7  School district income tax withheld                                                            $875.00
                                   8  SD100ES & SD40P, Extension Payments and Credit carryforward from previous year return          $0.00
                                   9  Amended return only - amount previously paid with original/amended return                      $0.00
                                   10 Total school district income tax payments (add lines 7, 8 and 9)                               $875.00
                                   11 Amended return only - overpayment previously received on original/amended return               $0.00
                                   12 Total Payments less overpayment previously received on original/amended return                 $875.00
                                   13 Tax Liability                                                                                  $0.00
                                   14 Interest and penalty due on late filing or payment of tax                                      $0.00
                                   15 Total Amount Due                                                                               $0.00
                                   16 Overpayment                                                                                    $875.00
                                   17 Original return only - amount of line 16 to be credited toward 2016 income tax liability       $0.00
                                   18 Your Refund                                                                                    $875.00

                                                                                                                                  9-6

Ohio Test #9
School District Schedule A "Traditional" Tax Base School District Amounts
                                    19          Ohio income tax base reported on line 5 of Ohio IT 1040                                     $159,613.00
                                    20          Business income deduction add-back                                                              $0.00
                                    21          Total Traditional Tax Base School District Income (Line 19 + Line 20)                       $159,613.00
                                    22          Amount of traditional tax base school district income that you earned while not a resident  $159,613.00
                                    23          School District Taxable Income (Enter here and on line 1)                                       $0.00
School District Schedule B "Earned Income Only" Tax Base School District Amounts
                                    24          Wages and other compensation as described in the instructions                                   $0.00
                                    25          Net Earnings from Self Employment                                                               $0.00
                                    26          Depreciation Expense Adjustments                                                                $0.00
                                    27          School District Taxable Income (Enter here and on line 1)                                       $0.00

What is Tested?
IT1040WithSD100
Self-Prepared
MFJ status
Non-Ohio W-2; Ohio W-2                                                                                                                     `

IT1040  
Nonresident
[$105,300 - $210,600] tax bracket
5% joint filing credit
Sch A. - Reimbursement college tuition expenses 
Sch of Credits - Nonresident credit 
Tax due 

SD100
Traditional school district
Nonresident 

                                                                                                                                             9-7

Ohio Test #10                                                               IT1040 with SD100
Taxpayer Information                                    Description
                     Primary Social Security Number                   XX0-00-7610
                     Primary First Name                               CALEB
                     Primary Last Name                                CARDINAL
                     Date of Birth - Primary                          4/15/1945
                     Occupation - Primary                             ORNOTHOLOGIST
                     Spouse's Social Security Number                  XX0-00-7660
                     Spouse First Name                                CAITLYN
                     Spouse Last Name                                 CARDINAL
                     Date of Birth - Spouse                           11/25/1956
                     Occupation - Spouse                              DOMESTIC ENGINEER
                     Address Line 1                                   30 WOODLAWN AVE
                     City                                             PLAIN CITY
                     State                                            OH
                     Zip Code                                         43064
                     Ohio County                                      MADISON
                     County Code (Ohio Public School District Number) 4902
                                             Income Statements
              W-2 #1
                     Employers Identification Number                  33-9876543
                     Employer's Name                                  BIRDS UNLMTD
                     Employer's Address                               25 E 5TH ST APT 2
                     Employer's City                                  CANARY
                     Employer's State                                 NE
                     Employer's Zip                                   68792
                     Employees Social Security Number                 400-00-7610
                     Employee's Name                                  CALEB CARDINAL
                     Employee's Address                               30 WOODLAWN AVE
                     Employee's City                                  PLAIN CITY
                     Employee's State                                 OH
                     Employee's Zip Code                              43064
                     Box 1 Wages, Tips, etc                           $24,500.00
                     Box 2 Federal Income Tax Withheld                $2,125.00
                     Box 3 Social Security Wages                      $24,500.00
                     Box 4 Social Security Tax Withheld               $1,519.00
                     Box 5 Medicare Wages and Tips                    $24,500.00
                     Box 6 Medicare Tax Withheld                      $355
                     Box 15 State                                     NE
                     State ID Number                                  479623
                     State Wages                                      $24,500.00
                     State Income Tax Withheld                        $750.00

                                                                                        10-1

Ohio Test #10
             W-2 #2
                     Employers Identification Number    34-3456789
                     Employer's Name                    AAA CORP
                     Employer's Address                 500 OTTAWA ST
                     Employer's City                    DAYTON
                     Employer's State                   OH
                     Employer's Zip Code                45402
                     Employee's Social Security Number  400-00-7660
                     Employee's Name                    CAITLYN CARDINAL
                     Employee's Address                 30 WOODLAWN AVE
                     Employee's City                    PLAIN CITY
                     Employee's State                   OH
                     Employee's Zip Code                43064
                     Box 1 Wages, Tips, etc             $105,000.00
                     Box 2 Federal Income Tax Withheld  $1,050.00
                     Box 3 Social Security Wages        $105,000.00
                     Box 4 Social Security Tax Withheld $6,510.00
                     Box 5 Medicare Wages and Tips      $105,000.00
                     Box 6 Medicare Withheld            $1,746.00
                     Box 15 State                       OH
                     State ID Number                    51-065432
                     State Wages                        $105,000.00
                     State Income Tax Withheld          $372.00
                     Local Wages                        $105,000.00
                     Local Income Tax Withheld          $1,411.00
                     Name of Locality                   WILLARD
             1099R #1
                     Payer's Identification Number      21-9876543
                     Payer's Name                       SUNSET INC
                     Payer's Address                    98 N OBERLIN DR
                     Payer's City                       OBERLIN
                     Payer's State                      OH
                     Payer's Zip Code                   44074
                     Recipient's Social Security Number 400-00-7610
                     Recipient's Name                   CALEB CARDINAL
                     Recipient's Address                30 WOODLAWN AVE
                     Recipient's City                   PLAIN CITY
                     Recipient's State                  OH
                     Recipient's Zip Code               43064
                     Gross Distribution Amount          $5,900.00
                     Taxable Amount                     $5,900.00
                     Distribution Code                  7
                     Box 15 State                       OH
                     State Payer ID                     52-234567
                     State Distribution                 $5,900.00
                     State Income Tax Withheld          $10.00

                                                                         10-2

Ohio Test #10
             W-2G  
                                Payer's Name                                      STATE OF OHIO
                                Payer's Address                                   1030 E BROAD ST
                                Payer's City                                      COLUMBUS
                                Payer's State                                     OH
                                Payer's Zip Code                                  43229
                                Payer's Identification Number                     35-9876543
                                Box 1 Gross Winnings                              $25,376,355.00
                                Box 2 Date Won                                    2016-05-30
                                Box 3 Type of Wager                               LOTTERY
                                Box 4 Federal Income Tax Withheld                 $6,344,089
                                Recipient's Name                                  CAITLYN CARDINAL
                                Recipient's Address                               30 WOODLAWN AVE
                                Recipient's City                                  PLAIN CITY
                                Recipient's State                                 OH
                                Recipient's Zip Code                              43064
                                Recipient ID Number                               400-00-7660
                                Box 13 State                                      OH
                                Box 13 State ID Number                            52-345678
                                Box 14 State Winnings                             $25,376,355.00
                                Box 15 State Income Tax Withheld                  $761,291.00
Federal Return Information 1040                                   Description
                                Filing Status                                     Married Filing Jointly
                                Exemptions, Self, Spouse                          2
                                Line 7 Total Wages                                $129,500.00
                                Line 16b Pensions and Annuities                   $5,900.00
                                Line 20b Social Security Benefits, Taxable amount $500.00
                                Line 21 Other Income                              $25,376,355.00
                                Line 37 Adjusted Gross Income                     $25,512,255.00

                                                                                                         10-3

Ohio Test #10
State Return Information                                     Description
                         Is this an amended return?                                                    No
                         Self-Prepared                                                                 x
                         Filing Status                                                                 Married Filing Jointly
                         Ohio Residency Status (Primary)                                               Part-Year Resident
                         Ohio Residency Status (Spouse)                                                Full-Year Resident
                         Part-Year Resident - Begin Date                                               8/30/2016
                         Part-Year Resident - End Date                                                 12/31/2016
                         Ohio Political Party Fund Contribution - Primary                              No
                         Ohio Political Party Fund Contribution - Spouse                               Yes
                         Is someone else claiming you or your spouse (if joint return) as a dependent? No
                         Enter the number of dependents                                                0
                         Reimbursements Previously Deducted but not Included In FAGI                   $650.00
                         Qualifying Social Security Benefits & Some Railroad Benefits                  $500.00
                         Eligible for JFC?                                                             Yes
                         Enter the Portion of OAGI that was not Earned or Received in Ohio             $24,500.00
                         Taxpayer's Phone Number                                                       419-554-4567
                         Taxpayer's E-mail Address                                                     CARDINAL@MSN.COM
                         Perjury Statement Acceptance                                                  Yes
                         Preparer Authorization Check Box                                              Yes
                                           IT 2210 Interest Penalty Calculation (for line 18)
                         Short Method Ratio = .022907, T/P did not meet safe harbor, T/P did not make 
                         Estimated Payments in TY 2016, Ohio Income Tax in 2015 = $800,000
SD Return Information
                         Are you Filing the Ohio School District Income Tax Return Electronically      Yes
                         What is the school district number for which you are filing the SD 100?       4902
                         School District Residency (Primary)                                           Part-Year Resident
                         School District Residency (Spouse)                                            Full-Year Resident
                         School District Non-Residency Begin Date                                      1/1/2016
                         School District Non-Residency End Date                                        8/29/2016
                         Tax Type                                                                      Earned Income Only
                                           SD2210 Interest Penalty Calculation (for line 9)
                         Short Method Ratio = .022907, T/P did not meet safe harbor, T/P did not make 
                         Estimated Payments in TY 2016, Ohio School District Income Tax in 2015 = $900                                                                     

                                                                                                                              10-4

Ohio Test #10
             OH Line #                                           Line Item                                      Amount
             1         Federal Adjusted Gross Income                                                                  $25,512,255.00
             2a        Additions to federal adjusted gross income                                                     $650.00
             2b        Deductions from federal adjusted gross income                                                  $500.00
             3         Ohio Adjusted Gross Income (OAGI)                                                              $25,512,405.00
             4         Personal and dependent exemption deduction                                                     $3,500.00
             5         Ohio income tax base                                                                           $25,508,905.00
             6         Taxable business income (Ohio IT BUS, line 13)                                                 $0.00
             7         Line 5 minus line 6 (if less than 0, enter 0)                                                  $25,508,905.00
             7a        Amount from line 7 on page 1                                                                   $25,508,905.00
             8a        Nonbusiness income tax liability                                                               $1,272,229.00
             8b        Business income tax liability (Ohio IT BUS, line 14)                                           $0.00
             8c        Tax liability (line 8a plus 8b)                                                                $1,272,229.00
             9         Ohio nonrefundable credits                                                                     $1,794.00
             10        Tax liability after nonrefundable credits                                                      $1,270,435.00
             11        Interest penalty on underpayment of estimated tax                                              $878.00
             12        Sales and use tax due on Internet, mail order or other out-of-state purchases                  $0.00
             13        Total Ohio tax liability before withholding or estimated payments                              $1,271,313.00
             14        Ohio income tax withheld                                                                       $761,673.00
             15        Add the Ohio estimated & extension payments & credit carryforward from previous year retur     $0.00
             16        Refundable credits                                                                             $0.00
             17        Amended return only - amount previously paid with original/amended return                      $0.00
             18        Total Ohio Tax Payments                                                                        $761,673.00
             19        Amended return only - overpayment previously received on original/amended return               $0.00
             20        Line 18 minus line 19                                                                          $761,673.00
             21        Tax liability                                                                                  $509,640.00
             22        Interest and penalty due on late filing or payment of tax                                      $0.00
             23        Total Amount Due                                                                               $509,640.00
             24        Overpayment                                                                                    $0.00
             25        Original return only - amount of line 24 to be credited toward 2016 income tax liability       $0.00
             26a       Amount of line 24 to be donated - Military injury relief                                       $0.00
             26b       Amount of line 24 to be donated - Ohio History Fund                                            $0.00
             26c       Amount of line 24 to be donated - State nature preserves                                       $0.00
             26d       Amount of line 24 to be donated - Breast/cervical cancer                                       $0.00
             26e       Amount of line 24 to be donated - Wishes for sick children                                     $0.00
             26f       Amount of line 24 to be donated - Wildlife species                                             $0.00
             26g       Total                                                                                          $0.00
             27        Your Refund                                                                                    $0.00
Schedule A             Additions
             1         Non-Ohio state or local government interest and dividends                                      $0.00
             2         Certain Ohio pass-through entity and financial institutions taxes paid                         $0.00
                       Reimbursement of college tutition expenses and fees deducted in any previous year(s) and 
             3         noneducation expenditures from a college savings account                                       $0.00
             4         Losses from sale or disposition of Ohio public obligations                                     $0.00
             5         Nonmedical withdrawals from a medical savings account                                          $0.00
                       Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if 
             6         the reimbursement is not in federal adjusted gross income                                      $650.00
             7         Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense              $0.00
             8         Federal interest and dividends subject to state taxation                                       $0.00
             9         Miscellaneous federal income tax additions                                                     $0.00
             10        Total additions                                                                                $650.00

                                                                                                                       10-5

Ohio Test #10
Schedule A             Deductions
                    11 Business income deduction (attach Ohio Schedule IT BUS, line 11)                                 $0.00
                    12 Employee compensation earned in Ohio by residents of neighboring states                          $0.00
                    13 State or municipal income tax overpayments shown on IRS form 1040, line 10                       $0.00
                    14 Qualifying Social Security benefits and certain railroad retirement benefits                     $500.00
                       Interest income from Ohio public obligations and from Ohio purchase obligations; gains 
                       from the sale or disposition of Ohio public obligations; public service payments received 
                    15 from the state of Ohio or income from a transfer agreement                                       $0.00
                    16 Amounts contributed to an individual development account                                         $0.00
                    17 Amounts contributed to STABLE account; Ohio's ABLE plan                                          $0.00
                    18 Federal interest and dividends exempt from state taxation                                        $0.00
                    19 Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense                $0.00
                       Refund or reimbursements shown on IRS form 1040, line 21 for itemized deductions 
                    20 claimed on a prior year federal income tax return                                                $0.00
                    21 Repayment of income reported in a prior year                                                     $0.00
                    22 Wage expense not deducted due to claiming the federal work opportunity credit                    $0.00
                    23 Miscellaneous federal income tax  deductions                                                     $0.00
                       Military pay for Ohio residents received while the military member was stationed outside 
                    24 Ohio                                                                                             $0.00
                    25 Certain income earned by military nonresidents and civilian nonresident spouses                  $0.00
                    26 Uniformed services retirement income                                                             $0.00
                    27 Military injury relief fund                                                                      $0.00
                    28 Certain Ohio National Guard reimbursements and benefits                                          $0.00
                    29 Ohio 529 contributions, tuition credit purchases                                                 $0.00
                    30 Pell/Ohio College Opportunity taxable grant amounts used to pay room and board                   $0.00
                    31 Disability and survivorship benefits (do not include pension continuation benefits)              $0.00
                       Unreimbursed long-term care insurance premiums, unsubsidized health care insurance 
                    32 premiums and excess health care expenses                                                         $0.00
                       Funds deposited into, and earnings of, a medical savings account for eligible health care 
                    33 expenses                                                                                         $0.00
                    34 Qualified organ donor expenses                                                                   $0.00
                    35 Total deductions                                                                                 $500.00
Schedule of Credits    Nonrefundable credits
                    1  Total tax liability (From IT1040 8c)                                                             $1,272,229.00
                    2  Retirement Income Credit                                                                         $0.00
                    3  Lump sum retirement credit                                                                       $0.00
                    4  Senior citizen credit                                                                            $0.00
                    5  Lump sum distribution credit                                                                     $0.00
                    6  Child care and dependent care credit                                                             $0.00
                    7  If Ohio form IT 1040, line 5 is $10,000 or less, enter $88; otherwise, enter -0- (low income cre $0.00
                    8  Displaced worker training credit                                                                 $0.00
                       Campaign contribution credit for Ohio statewide office or General 
                    9  Assembly                                                                                         $0.00
                    10 Income-based exemption credit                                                                    $0.00
                    11 Total (add lines 2 through 10)                                                                   $0.00
                    12 Tax less credits (line 1 minus line 11; if less than -0-, enter -0-)                             $1,272,229.00
                    13 Joint filing credit                                                                              $650.00
                    14 Earned income credit                                                                             $0.00
                    15 Ohio adoption credit                                                                             $0.00
                    16 Job retention credit, nonrefundable portion                                                      $0.00
                    17 Credit for eligible new employees in an enterprise zone                                          $0.00
                    18 Credit for purchases of grape production property                                                $0.00
                    19 Credit for investing in an Ohio small business                                                   $0.00
                    20 Technology investment credit carryforward                                                        $0.00
                    21 Enterprise zone day care and training credits                                                    $0.00
                    22 Research and development credit                                                                  $0.00
                    23 Ohio historic preservation credit, nonrefundable carryforward portion                            $0.00
                    24 Total (add lines 13 through 23)                                                                  $650.00
                    25 Tax less additional credits (line 12 minus line 24; if less than -0-, enter -0-)                 $1,271,579.00

                                                                                                                         10-6

Ohio Test #10
                Nonresident Credit
             26 Enter the portion of OAGI that was not earned or received in Ohio                             $24,500.00
             27 Enter the OAGI                                                                                $25,512,405.00
                Line 26/27 _____* Multiply this factor by the amount on line 25 to calculate your nonresident 
             28 credit                                                                                        $1,144.00
                Resident Credit
             29 Enter the portion of OAGI subjected to tax by other states or DC while an OH resident         $0.00
             30 Enter OAGI                                                                                    $0.00
             31 Divide line 29 by line 30 ____*Multiply this factor by the amount on line 25                  $0.00
             32 Enter the 2016 income tax, less all credits other than w/h and est tax pmts and CCFs          $0.00
             33 Enter the smaller of line 31 or line 32. This is your Ohio resident tax credit.               $0.00
             34 Total nonrefundable credits                                                                   $1,794.00
                Refundable Credits
             35 Historic preservation credit                                                                  $0.00
             36 Business jobs credit                                                                          $0.00
             37 Pass-through entity credit                                                                    $0.00
             38 Motion picture production credit                                                              $0.00
             39 Financial Institutions Tax (FIT) credit                                                       $0.00
             40 Venture Capital credit                                                                        $0.00
             41 Total refundable credits                                                                      $0.00
Sch IT BUS
                Part 1
             1  Sch B - Interest and Ordinary Dividends                                                       $0.00
             2  Sch C - Profit or Loss From Business (Sole Proprietership)                                    $0.00
             3  Sch D - Capital Gains and Losses                                                              $0.00
             4  Sch E - Supplemental Income and Loss                                                          $0.00
                Guranteed payments, compensation and/or wages from each pass-through entity in which 
             5  you have at least a 20% direct or indirect ownership interest                                 $0.00
             6  Sch F - Profit or Loss From Farming                                                           $0.00
                Other items of income and gain separately stated on federal Schedule K-1, federal 4787 
                gains and/or losses reported on federal 4787 and miscellaneous federal income tax 
             7  adjustments, if any                                                                           $0.00
             8  Total of business income                                                                      $0.00
                Part 2
                All business income. Enter here & on  IT 1040, line 6. If 0 or negative, stop here & don't 
             9  complete Part 3.                                                                              $0.00
             10 Enter $250,000 if single or MFJ, enter $125,000 if MFS                                        $0.00
             11 Lesser of line  9or line 10. Enter here and on Ohio Schedule A, line 11                       $0.00
                Part 3
             12 Line  9minus line 1 1(if less than -0-, enter -0-)                                            $0.00
             13 Taxable Business Income                                                                       $0.00
             14 Business income tax liability. Enter here and on Ohio IT 1040, line 8b.                       $0.00

                                                                                                               10-7

Ohio Test #10
School District Return Information 
                                            1      School district taxable income:  Traditional or Earned Income tax base                     $105,000.00
                                            2      School District Tax .____ times line 1.                                                    $1,313.00
                                            3      Senior Citizen Credit                                                                      $50.00
                                            4      School District Income Tax liability                                                       $1,263.00
                                            5      Interest Penalty on Underpayment of School District Estimated Tax                          $17.00
                                            6      Total school district income tax liability (line 4 plus line 5)                            $1,280.00
                                            6a     Amount from line 6                                                                         $1,280.00
                                            7      School district income tax withheld                                                        $0.00
                                            8      SD100ES & SD40P, Extension Payments and Credit carryforward from previous year return      $0.00
                                            9      Amended return only - amount previously paid with original/amended return                  $0.00
                                            10     Total school district income tax payments (add lines 7, 8 and 9)                           $0.00
                                            11     Amended return only - overpayment previously received on original/amended return           $0.00
                                            12     Total Payments less overpayment previously received on original/amended return             $0.00
                                            13     Tax Liability                                                                              $1,280.00
                                            14     Interest and penalty due on late filing or payment of tax                                  $0.00
                                            15     Total Amount Due                                                                           $1,280.00
                                            16     Overpayment                                                                                $0.00
                                            17     Original return only - amount of line 16 to be credited toward 2016 income tax liability   $0.00
                                            18     Your Refund                                                                                $0.00
School District Schedule A "Traditional" Tax Base School District Amounts
                                            19     Ohio income tax base reported on line 5 of Ohio IT 1040                                    $0.00
                                            20     Business income deduction add-back                                                         $0.00
                                            21     Total Traditional Tax Base School District Income (Line 19 + Line 20)                      $0.00
                                            22     Amount of traditional tax base school district income that you earned while not a resident $0.00
                                            23     School District Taxable Income (Enter here and on line 1)                                  $0.00
School District Schedule B "Earned Income Only" Tax Base School District Amounts
                                            24     Wages and other compensation as described in the instructions                              $105,000.00
                                            25     Net Earnings from Self Employment                                                          $0.00
                                            26     Depreciation Expense Adjustments                                                           $0.00
                                            27     School District Taxable Income (Enter here and on line 1)                                  $105,000.00
Ohio Test #10
What is Tested?
IT1040WithSD100
Self Prepared
Preparer Contact - Authorized
MFJ status
Ohio W-2, Non-Ohio W-2
Ohio W-2G
1099-R

IT1040 
Primary - Part-year resident
Spouse - Full year resident
[$210,600 - higher] tax bracket
5% joint filing credit
Sch. A - Reimbursement of expenses
Sch. A - Qualifying social security benefits
OTI is over limit for RIC and Senior Citizen Credit
Sch of Credits - Nonresident credit 
Interest penalty 
Tax due 

SD100
Earned income only school district
Primary - Part-year resident
Spouse - Full year resident
Tax due 

                                                                                                                                               10-8

Ohio Test #11                                                            IT1040 with two SD100s
Taxpayer Information                                    Description
                     Primary Social Security Number                   XX0007611
                     Primary First Name                               JOHN 
                     Primary Middle Initial                           A
                     Primary Last Name                                FLOWERS
                     Date of Birth - Primary                          08/07/1937
                     Occupation - Primary                             PROGRAMMER
                     Spouse's Social Security Number                  XX0-00-7661
                     Spouse First Name                                PATRICIA
                     Spouse Middle Initial                            B
                     Spouse Last Name                                 FLOWERS
                     Date of Birth - Spouse                           2/21/1954
                     Occupation - Spouse                              PROGRAMMER
                     Address Line 1                                   40 S LINWOOD ST
                     City                                             WEST ALEXANDRIA
                     State                                            OH 
                     Zip Code                                         45381
                     Ohio County                                      PREBLE
                     County Code (Ohio Public School District Number) 6805
                                             Income Statements
              W-2 #1
                     Employers Identification Number                  36-3456789
                     Employer's Name                                  ON-TECH CONSULTING
                     Employer's Address                               4821 VIOLET BLVD
                     Employer's City                                  PICKERINGTON
                     Employer's State                                 OH
                     Employer's Zip                                   43147
                     Employees Social Security Number                 400-00-7611
                     Employee's Name                                  JOHN A FLOWERS
                     Employee's Address                               40 S LINWOOD ST
                     Employee's City                                  WEST ALEXANDRIA
                     Employee's State                                 OH 
                     Employee's Zip Code                              45381
                     Box 1 Wages, Tips, etc                           $21,856.00
                     Box 2 Federal Income Tax Withheld                $2,623.00
                     Box 3 Social Security Wages                      $21,856.00
                     Box 4 Social Security Tax Withheld               $1,355.00
                     Box 5 Medicare Wages and Tips                    $21,856.00
                     Box 6 Medicare Tax Withheld                      $317.00
                     Box 15 State                                     OH
                     State ID Number                                  52-567890
                     State Wages                                      $21,856.00
                     State Income Tax Withheld                        $657.00
                     Local Wages                                      $21,856.00
                     Local Income Tax Withheld                        $225.00
                     Name of Locality                                 DANVILLE
                     School District Wages                            $20,000.00
                     School District Tax Withheld                     $450.00
                     School District #                                6805
                     School District Wages                            $1,856.00
                     School District Tax Withheld                     $37.00
                     School District #                                2302

                                                                                       11-1

Ohio Test #11
             W-2 #2
                   Employers Identification Number    37-9876543
                   Employer's Name                    CC SOFTWARE SERVICES LLC
                   Employer's Address                 100 WASHINGTON ST
                   Employer's City                    LANCASTER
                   Employer's State                   OH
                   Employer's Zip Code                43130
                   Employee's Social Security Number  400-00-7661
                   Employee's Name                    PATRICIA B FLOWERS
                   Employee's Address                 40 S LINWOOD ST
                   Employee's City                    WEST ALEXANDRIA
                   Employee's State                   OH 
                   Employee's Zip Code                45381
                   Box 1 Wages, Tips, etc             $28,643.00
                   Box 2 Federal Income Tax Withheld  $3,437.00
                   Box 3 Social Security Wages        $28,643.00
                   Box 4 Social Security Tax Withheld $1,776.00
                   Box 5 Medicare Wages and Tips      $28,643.00
                   Box 6 Medicare Withheld            $415.00
                   Box 15 State                       OH
                   State ID Number                    51-678901
                   State Wages                        $28,643.00
                   State Income Tax Withheld          $350.00
                   Local Wages                        $28,643.00
                   Local Income Tax Withheld          $245.00
                   Name of Locality                   NORTH BALTIMORE
                   School District Wages              $28,643.00
                   School District Tax Withheld       $573.00
                   School District #                  2302
             1099R
                   Payer's Name                       FIDELITY INSURANCE
                   Payer's Address                    123 MAIN ST
                   City                               DANVILLE
                   State                              OH
                   Zip Code                           43014
                   Payer Federal ID Number            38-3456789
                   Recipient ID Number                400-00-7611
                   Recipient Name                     JOHN A FLOWERS
                   Recipient Address                  40 S LINWOOD ST
                   City                               WEST ALEXANDRIA
                   State                              OH 
                   Zip Code                           45381
                   Gross Distribution Amount          $25,000.00
                   Taxable Amount                     $25,000.00
                   Federal Income Tax Withheld Amount $5,000.00
                   State Tax Withheld Amount          $100.00
                   State                              OH
                   Payers State ID Number             52-789012
                   State Distribution Amount          $25,000.00

                                                                      11-2

Ohio Test #11
Federal Return Information      1040                                       Description
                                     Filing Status                                                                        Married Filing Jointly
                                     Exemptions, Self, Spouse, 1 Dependent                                                3
                                     Dependent 1 SSN  (Qualifying Relative)                                               400-00-7684
                                     Dependent 1 Date of Birth                                                            9/7/2001
                                     Dependent 1 First Name                                                               GRANDBABY  
                                     Dependent 1 Last Name                                                                FLOWERS
                                     Dependent 1 Relationship                                                             GRANDCHILD
                                     Line 7 Total Wages                                                                   $50,499.00
                                     Line 16b Taxable Pensions and Annuities                                              $25,000.00
                                     Line 10 Taxable Refunds, credits or offsets of state and local income taxes          $283.00
                                     Line 37 Adjusted Gross Income                                                        $75,782.00
State Return Information                                                   Description
                                     Is this an amended return?                                                           No
                                     Self Prepared                                                                        x
                                     Filing Status                                                                        Married Filing Jointly
                                     Ohio Residency Status (Primary)                                                      Full-Year Resident
                                     Ohio Residency Status (Spouse)                                                       Full-Year Resident
                                     Ohio Political Party Fund Contribution - Primary                                     No  
                                     Ohio Political Party Fund Contribution - Spouse                                      No
                                     Is someone else claiming you or your spouse (if joint return) as a dependent?        No
                                     Enter the number of dependents                                                       1
                                     Contributions to a College Advantage 529 Savings Account and/or purchases of tuition $2,000.00
                                     credits
                                     Eligible for JFC?                                                                    Yes
                                     Late filed interest and penalty                                                      $50.00
                                     Taxpayer's Phone Number                                                              937-554-5678
                                     Taxpayer's E-mail Address                                                            FLOWERS@FLOWERS.COM
                                     Perjury Statement Acceptance                                                         Yes
                                     Preparer Authorization Check Box                                                     No
                                                             Lump Sum Retirement Credit Worksheet
                                1    Amount of Retirement Income                                                          $25,000 
                                2    Lump Sum distribution recipient's age                                                79
                                3    Life expectancy from Table 2                                                         10
                                4    Divide line 1 by line 3                                                              $2,500 
                                5    Retirement income credit from Table 1                                                $50 
                                6    Lump sum retirement credit (line 3 times line 5)                                     $500 
SD Return Information (SD #6805)
                                     Are you Filing the Ohio School District Income Tax Return Electronically             Yes
                                     What is the school district number for which you are filing the SD 100?              6805
                                     School District Residency (Primary)                                                  Part-Year Resident
                                     School District Non-Residency Begin Date                                             9/1/2016
                                     School District Non-Residency End Date                                               12/31/2016
                                     School District Residency (Spouse)                                                   Part-Year Resident
                                     School District Non-Residency Begin Date (Spouse)                                    9/1/2016
                                     School District Non-Residency End Date (Spouse)                                      12/31/2016
                                     Tax Type                                                                             Traditional
                                     Contribution to College Advantage 529 plan made and taxable refund received while 
                                     resident of traditional school district 6805

                                                                                                                                             11-3

Ohio Test #11
SD Return Information (SD #2302)
                                          Are you Filing the Ohio School District Income Tax Return Electronically                 Yes
                                          What is the school district number for which you are filing the SD 100?                  2302
                                          School District Residency (Primary)                                                      Part-Year Resident
                                          School District Non-Residency Begin Date (Primary)                                       1/1/2016
                                          School District Non-Residency End Date (Primary)                                         8/31/2016
                                          School District Residency (Spouse)                                                       Part-Year Resident
                                          School District Non-Residency Begin Date (Spouse)                                        1/1/2016
                                          School District Non-Residency End Date (Spouse)                                          8/31/2016
                                          Tax Type                                                                                 Earned Income Only
                                          1099R Income received while resident of earned income school district 2302               $25,000.00
                                OH Line #                                           Line Item                                       Amount
                                1         Federal Adjusted Gross Income                                                                              $75,782.00
                                2a        Additions to federal adjusted gross income                                                                      $0.00
                                2b        Deductions from federal adjusted gross income                                                              $2,283.00
                                3         Ohio Adjusted Gross Income (OAGI)                                                                          $73,499.00
                                4         Personal and dependent exemption deduction                                                                 $6,000.00
                                5         Ohio income tax base                                                                                       $67,499.00
                                6         Taxable business income (Ohio IT BUS, line 13)                                                                  $0.00
                                7         Line 5 minus line 6 (if less than 0, enter 0)                                                              $67,499.00
                                7a        Amount from line 7 on page 1                                                                               $67,499.00
                                8a        Nonbusiness income tax liability                                                                           $1,818.00
                                8b        Business income tax liability (Ohio IT BUS, line 14)                                                            $0.00
                                8c        Tax liability (line 8a plus 8b)                                                                            $1,818.00
                                9         Ohio nonrefundable credits                                                                                 $677.00
                                10        Tax liability after nonrefundable credits                                                                  $1,141.00
                                11        Interest penalty on underpayment of estimated tax                                                               $0.00
                                12        Sales and use tax due on Internet, mail order or other out-of-state purchases                                   $0.00
                                13        Total Ohio tax liability before withholding or estimated payments                                          $1,141.00
                                14        Ohio income tax withheld                                                                                   $1,107.00
                                15        Add the Ohio estimated & extension payments & credit carryforward from previous year retu                       $0.00
                                16        Refundable credits                                                                                              $0.00
                                17        Amended return only - amount previously paid with original/amended return                                       $0.00
                                18        Total Ohio Tax Payments                                                                                    $1,107.00
                                19        Amended return only - overpayment previously received on original/amended return                                $0.00
                                20        Line 18 minus line 19                                                                                      $1,107.00
                                21        Tax liability                                                                                                   $34.00
                                22        Interest and penalty due on late filing or payment of tax                                                       $50.00
                                23        Total Amount Due                                                                                                $84.00
                                24        Overpayment                                                                                                     $0.00
                                25        Original return only - amount of line 24 to be credited toward 2016 income tax liability                        $0.00
                                26a       Amount of line 24 to be donated - Military injury relief                                                        $0.00
                                26b       Amount of line 24 to be donated - Ohio History Fund                                                             $0.00
                                26c       Amount of line 24 to be donated - State nature preserves                                                        $0.00
                                26d       Amount of line 24 to be donated - Breast/cervical cancer                                                        $0.00
                                26e       Amount of line 24 to be donated - Wishes for sick children                                                      $0.00
                                26f       Amount of line 24 to be donated - Wildlife species                                                              $0.00
                                26g       Total                                                                                                           $0.00
                                27        Your Refund                                                                                                     $0.00

                                                                                                                                                      11-4

Ohio Test #11
Schedule A      Additions
             1  Non-Ohio state or local government interest and dividends                                      $0.00
             2  Certain Ohio pass-through entity and financial institutions taxes paid                         $0.00
                Reimbursement of college tutition expenses and fees deducted in any previous year(s) and 
             3  noneducation expenditures from a college savings account                                       $0.00
             4  Losses from sale or disposition of Ohio public obligations                                     $0.00
             5  Nonmedical withdrawals from a medical savings account                                          $0.00
                Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if 
             6  the reimbursement is not in federal adjusted gross income                                      $0.00
             7  Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense              $0.00
             8  Federal interest and dividends subject to state taxation                                       $0.00
             9  Miscellaneous federal income tax additions                                                     $0.00
             10 Total additions                                                                                $0.00
Schedule A      Deductions
             11 Business income deduction (attach Ohio Schedule IT BUS, line 11)                               $0.00
             12 Employee compensation earned in Ohio by residents of neighboring states                        $0.00
             13 State or municipal income tax overpayments shown on IRS form 1040, line 10                $283.00
             14 Qualifying Social Security benefits and certain railroad retirement benefits                   $0.00
                Interest income from Ohio public obligations and from Ohio purchase obligations; gains 
                from the sale or disposition of Ohio public obligations; public service payments received 
             15 from the state of Ohio or income from a transfer agreement                                     $0.00
             16 Amounts contributed to an individual development account                                       $0.00
             17 Amounts contributed to STABLE account; Ohio's ABLE plan                                        $0.00
             18 Federal interest and dividends exempt from state taxation                                      $0.00
             19 Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense              $0.00
                Refund or reimbursements shown on IRS form 1040, line 21 for itemized deductions 
             20 claimed on a prior year federal income tax return                                              $0.00
             21 Repayment of income reported in a prior year                                                   $0.00
             22 Wage expense not deducted due to claiming the federal work opportunity credit                  $0.00
             23 Miscellaneous federal income tax deductions                                                    $0.00
                Military pay for Ohio residents received while the military member was stationed outside 
             24 Ohio                                                                                           $0.00
             25 Certain income earned by military nonresidents and civilian nonresident spouses                $0.00
             26 Uniformed services retirement income                                                           $0.00
             27 Military injury relief fund                                                                    $0.00
             28 Certain Ohio National Guard reimbursements and benefits                                        $0.00
             29 Ohio 529 contributions, tuition credit purchases                                          $2,000.00
             30 Pell/Ohio College Opportunity taxable grant amounts used to pay room and board                 $0.00
             31 Disability and survivorship benefits (do not include pension continuation benefits)            $0.00
                Unreimbursed long-term care insurance premiums, unsubsidized health care insurance 
             32 premiums and excess health care expenses                                                       $0.00
                Funds deposited into, and earnings of, a medical savings account for eligible health care 
             33 expenses                                                                                       $0.00
             34 Qualified organ donor expenses                                                                 $0.00
             35 Total deductions                                                                          $2,283.00

                                                                                                           11-5

Ohio Test #11
Schedule of Credits    Nonrefundable credits
                    1  Total tax liability (From IT1040 8c)                                                         $1,818.00
                    2  Retirement Income Credit                                                                          $0.00
                    3  Lump sum retirement credit                                                                   $500.00
                    4  Senior citizen credit                                                                             $50.00
                    5  Lump sum distribution credit                                                                      $0.00
                    6  Child care and dependent care credit                                                              $0.00
                       If Ohio form IT 1040, line 5 is $10,000 or less, enter $88; otherwise, enter -0- (low income 
                    7  credit)                                                                                           $0.00
                    8  Displaced worker training credit                                                                  $0.00
                       Campaign contribution credit for Ohio statewide office or General 
                    9  Assembly                                                                                          $0.00
                    10 Income-based exemption credit                                                                     $0.00
                    11 Total (add lines 2 through 10)                                                               $550.00
                    12 Tax less credits (line 1 minus line 11; if less than -0-, enter -0-)                         $1,268.00
                    13 Joint filing credit                                                                          $127.00
                    14 Earned income credit                                                                              $0.00
                    15 Ohio adoption credit                                                                              $0.00
                    16 Job retention credit, nonrefundable portion                                                       $0.00
                    17 Credit for eligible new employees in an enterprise zone                                           $0.00
                    18 Credit for purchases of grape production property                                                 $0.00
                    19 Credit for investing in an Ohio small business                                                    $0.00
                    20 Technology investment credit carryforward                                                         $0.00
                    21 Enterprise zone day care and training credits                                                     $0.00
                    22 Research and development credit                                                                   $0.00
                    23 Ohio historic preservation credit, nonrefundable carryforward portion                             $0.00
                    24 Total (add lines 13 through 23)                                                              $127.00
                    25 Tax less additional credits (line 12 minus line 24; if less than -0-, enter -0-)             $1,141.00
                       Nonresident Credit
                    26 Enter the portion of OAGI that was not earned or received in Ohio                                 $0.00
                    27 Enter the OAGI                                                                                    $0.00
                       Line 26/27 _____* Multiply this factor by the amount on line 25 to calculate your 
                    28 nonresident credit                                                                                $0.00
                       Resident Credit
                    29 Enter the portion of OAGI subjected to tax by other states or DC while an OH resident             $0.00
                    30 Enter OAGI                                                                                        $0.00
                    31 Divide line 29 by line 30 ____*Multiply this factor by the amount on line 25                      $0.00
                    32 Enter the 2016 income tax, less all credits other than w/h and est tax pmts and CCFs              $0.00
                    33 Enter the smaller of line 31 or line 32. This is your Ohio resident tax credit.                   $0.00
                    34 Total nonrefundable credits                                                                  $677.00
                       Refundable Credits
                    35 Historic preservation credit                                                                      $0.00
                    36 Business jobs credit                                                                              $0.00
                    37 Pass-through entity credit                                                                        $0.00
                    38 Motion picture production credit                                                                  $0.00
                    39 Financial Institutions Tax (FIT) credit                                                           $0.00
                    40 Venture Capital credit                                                                            $0.00
                    41 Total refundable credits                                                                          $0.00

                                                                                                                     11-6

Ohio Test #11
Sch IT BUS
                                            Part 1
                                         1  Sch B - Interest and Ordinary Dividends                                                         $0.00
                                         2  Sch C - Profit or Loss From Business (Sole Proprietership)                                      $0.00
                                         3  Sch D - Capital Gains and Losses                                                                $0.00
                                         4  Sch E - Supplemental Income and Loss                                                            $0.00
                                            Guranteed payments, compensation and/or wages from each pass-through entity in which 
                                         5  you have at least a 20% direct or indirect ownership interest                                   $0.00
                                         6  Sch F - Profit or Loss From Farming                                                             $0.00
                                            Other items of income and gain separately stated on federal Schedule K-1, federal 4787 
                                            gains and/or losses reported on federal 4787 and miscellaneous federal income tax 
                                         7  adjustments, if any                                                                             $0.00
                                         8  Total of business income                                                                        $0.00
                                            Part 2
                                            All business income. Enter here & on  IT 1040, line 6. If 0 or negative, stop here & don't 
                                         9  complete Part 3.                                                                                $0.00
                                         10 Enter $250,000 if single or MFJ, enter $125,000 if MFS                                          $0.00
                                         11 Lesser of line  9or line     10. Enter here and on Ohio Schedule A, line 11                     $0.00
                                            Part 3
                                         12 Line 9minus line 1  (if1 less than -0-, enter -0-)                                              $0.00
                                         13 Taxable Business Income                                                                         $0.00
                                         14 Business income tax liability. Enter here and on Ohio IT 1040, line 8b.                         $0.00

School District Return Information (6805)
                                         1  School district taxable income:  Traditional or Earned Income tax base                     $12,000.00
                                         2  School District Tax .____ times line 1.                                                    $180.00
                                         3  Senior Citizen Credit                                                                           $50.00
                                         4  School District Income Tax liability                                                       $130.00
                                         5  Interest Penalty on Underpayment of School District Estimated Tax                               $0.00
                                         6  Total school district income tax liability (line 4 plus line 5)                            $130.00
                                         6a Amount from line 6                                                                         $130.00
                                         7  School district income tax withheld                                                        $450.00
                                         8  SD100ES & SD40P, Extension Payments and Credit carryforward from previous year return           $0.00
                                         9  Amended return only - amount previously paid with original/amended return                       $0.00
                                         10 Total school district income tax payments (add lines 7, 8 and 9)                           $450.00
                                         11 Amended return only - overpayment previously received on original/amended return                $0.00
                                         12 Total Payments less overpayment previously received on original/amended return             $450.00
                                         13 Tax Liability                                                                                   $0.00
                                         14 Interest and penalty due on late filing or payment of tax                                       $0.00
                                         15 Total Amount Due                                                                                $0.00
                                         16 Overpayment                                                                                $320.00
                                         17 Original return only - amount of line 16 to be credited toward 2016 income tax liability        $0.00
                                         18 Your Refund                                                                                $320.00
School District Schedule A "Traditional" Tax Base School District Amounts
                                         19 Ohio income tax base reported on line 5 of Ohio IT 1040                                    $67,499.00
                                         20 Business income deduction add-back                                                              $0.00
                                         21 Total Traditional Tax Base School District Income (Line 19 + Line 20)                      $67,499.00
                                         22 Amount of traditional tax base school district income that you earned while not a resident $55,499.00
                                         23 School District Taxable Income (Enter here and on line 1)                                  $12,000.00

                                                                                                                                        11-7

Ohio Test #11
School District Schedule B "Earned Income Only" Tax Base School District Amounts
                                            24 Wages and other compensation as described in the instructions                                   $0.00
                                            25 Net Earnings from Self Employment                                                               $0.00
                                            26 Depreciation Expense Adjustments                                                                $0.00
                                            27 School District Taxable Income (Enter here and on line 1)                                       $0.00
School District Return Information (2302)
                                            1  School district taxable income:  Traditional or Earned Income tax base                     $30,499.00
                                            2  School District Tax .____ times line 1.                                                    $610.00
                                            3  Senior Citizen Credit                                                                           $50.00
                                            4  School District Income Tax liability                                                       $560.00
                                            5  Interest Penalty on Underpayment of School District Estimated Tax                               $0.00
                                            6  Total school district income tax liability (line 4 plus line 5)                            $560.00
                                            6a Amount from line 6                                                                         $560.00
                                            7  School district income tax withheld                                                        $610.00
                                            8  SD100ES & SD40P, Extension Payments and Credit carryforward from previous year return           $0.00
                                            9  Amended return only - amount previously paid with original/amended return                       $0.00
                                            10 Total school district income tax payments (add lines 7, 8 and 9)                           $610.00
                                            11 Amended return only - overpayment previously received on original/amended return                $0.00
                                            12 Total Payments less overpayment previously received on original/amended return             $610.00
                                            13 Tax Liability                                                                                   $0.00
                                            14 Interest and penalty due on late filing or payment of tax                                       $0.00
                                            15 Total Amount Due                                                                                $0.00
                                            16 Overpayment                                                                                     $50.00
                                            17 Original return only - amount of line 16 to be credited toward 2016 income tax liability        $0.00
                                            18 Your Refund                                                                                     $50.00
School District Schedule A "Traditional" Tax Base School District Amounts
                                            19 Ohio income tax base reported on line 5 of Ohio IT 1040                                         $0.00
                                            20 Business income deduction add-back                                                              $0.00
                                            21 Total Traditional Tax Base School District Income (Line 19 + Line 20)                           $0.00
                                            22 Amount of traditional tax base school district income that you earned while not a resident      $0.00
                                            23 School District Taxable Income (Enter here and on line 1)                                       $0.00
School District Schedule B "Earned Income Only" Tax Base School District Amounts
                                            24 Wages and other compensation as described in the instructions                              $30,499.00
                                            25 Net Earnings from Self Employment                                                               $0.00
                                            26 Depreciation Expense Adjustments                                                                $0.00
                                            27 School District Taxable Income (Enter here and on line 1)                                  $30,499.00
Ohio Test #11
What is Tested?
IT1040WithSD100
Self-Prepared
Preparer Contact - Declined
MFJ status
Ohio W-2; 1099R

IT1040  
Full year resident
Sch A - Taxable refund 
Sch A - 529 Contribution 
Sch of Credits - Senior Citizen Credit 
Sch of Credits - Lump Sum Retirement Credit 
Interest and late payment penalty - do not 
calculate interest for testing purposes
Tax Due 

SD100
Multiple SD100s
Part-year resident

                                                                                                                                           11-8

Ohio Test #12                                                              IT1040 with SD100
Taxpayer Information                                    Description
                     Primary Social Security Number                   XX0007614
                     Primary First Name                               LOIS
                     Primary Last Name                                LANE
                     Date of Birth - Primary                          11/14/1985
                     Occupation - Primary                             REPORTER
                     Address Line 1                                   1234 METROPOLIS LANE
                     City                                             OXFORD
                     State                                            OHIO
                     Zip Code                                         45056
                     Ohio County                                      MIAMI
                     County Code (Ohio Public School District Number) 5506
              K-1                                       Description
                     Shareholder's SSN                                400-00-7614
                     Corporation's EIN                                34-5678909
                     Corporation's Name                               THE DAILY PLANET
                     Percentage of Stock Ownership                    25%
                     Ohio PTE Credit Amount                           $600.00
                     Total Indirect Pass Through Credit               $400.00
                     Total Indirect Pass Through FEIN                 34-3456789
                     Partner's Name                                   LOIS LANE
                     Ordinary business income                         $80,000.00
                     Guaranteed Payments                              $5,000.00
                     Interest Income                                  $10,000.00
                     Ordinary dividends                               $10,000.00
                     Net long-term capital gain (loss)                -$3,000.00
                     Other income (loss)                              $15,000.00

                                                                                  12-1

Ohio Test #12                                                                                                           IT1040 with SD100
Federal Return Information                                     Description
                           Filing Status                                                                          Single
                           Exemption, Self                                                                        1
                           Lines 8a and 9a Schedule B                                                             $20,000.00
                           Line 12 Schedule C                                                                     $250,000.00
                           Line 13 Schedule D                                                                     -$3,000.00
                           Line 17 Schedule E (includes $5000 of guaranteed payments separately stated on federal $85,000.00
                           Schedule K-1)
                           Line 18 Schedule F                                                                     -$50,000.00
                           Line 21 Other income (loss)                                                            $15,000.00
                           Line  27 Self Employment Tax Deduction                                                 $10,025.00
                           Line 37 Adjusted Gross Income                                                          $306,975.00
State Return Information                                       Description
                           Is this an amended return?                                                             No
                           Self-Prepared                                                                          X
                           Filing Status                                                                          Single
                           Ohio Residency Status (Primary)                                                        Full-Year Resident
                           Ohio Political Party Fund Contribution - Primary                                       Yes
                           Is someone else claiming you or your spouse (if joint return) as a dependent?          No
                           Enter the number of dependents                                                         0
                           Taxpayer's Phone Number                                                                614-554-9238
                           Taxpayer's E-mail Address                                                              LANE@MSN.COM
                           Perjury Statement Acceptance                                                           Yes
                           Preparer Authorization Check Box                                                       Yes
SD Return Information
                           Are you Filing the Ohio School District Income Tax Return Electronically               Yes
                           What is the school district number for which you are filing the SD 100?                5506
                           School District Residency (Primary)                                                    Full-Year Resident
                           Tax Type                                                                               Traditional

                                                                                                                                     12-2

Ohio Test #12
             OH Line #                                           Line Item                                      Amount
             1         Federal Adjusted Gross Income                                                                   $306,975.00
             2a        Additions to federal adjusted gross income                                                          $0.00
             2b        Deductions from federal adjusted gross income                                                   $250,000.00
             3         Ohio Adjusted Gross Income (OAGI)                                                               $56,975.00
             4         Personal and dependent exemption deduction                                                        $2,000.00
             5         Ohio income tax base                                                                            $54,975.00
             6         Taxable business income (Ohio IT BUS, line 13)                                                  $54,975.00
             7         Line 5 minus line 6 (if less than 0, enter 0)                                                       $0.00
             7a        Amount from line 7 on page 1                                                                        $0.00
             8a        Nonbusiness income tax liability                                                                    $0.00
             8b        Business income tax liability (Ohio IT BUS, line 14)                                              $1,649.00
             8c        Tax liability (line 8a plus 8b)                                                                   $1,649.00
             9         Ohio nonrefundable credits                                                                          $0.00
             10        Tax liability after nonrefundable credits                                                         $1,649.00
             11        Interest penalty on underpayment of estimated tax                                                   $0.00
             12        Sales and use tax due on Internet, mail order or other out-of-state purchases                       $0.00
             13        Total Ohio tax liability before withholding or estimated payments                                 $1,649.00
             14        Ohio income tax withheld                                                                            $0.00
             15        Add the Ohio estimated & extension payments & credit carryforward from previous year return         $0.00
             16        Refundable credits                                                                                $1,000.00
             17        Amended return only - amount previously paid with original/amended return                           $0.00
             18        Total Ohio Tax Payments                                                                           $1,000.00
             19        Amended return only - overpayment previously received on original/amended return                    $0.00
             20        Line 18 minus line 19                                                                             $1,000.00
             21        Tax liability                                                                                     $649.00
             22        Interest and penalty due on late filing or payment of tax                                           $0.00
             23        Total Amount Due                                                                                  $649.00
             24        Overpayment                                                                                         $0.00
             25        Original return only - amount of line 24 to be credited toward 2016 income tax liability            $0.00
             26a       Amount of line 24 to be donated - Military injury relief                                            $0.00
             26b       Amount of line 24 to be donated - Ohio History Fund                                                 $0.00
             26c       Amount of line 24 to be donated - State nature preserves                                            $0.00
             26d       Amount of line 24 to be donated - Breast/cervical cancer                                            $0.00
             26e       Amount of line 24 to be donated - Wishes for sick children                                          $0.00
             26f       Amount of line 24 to be donated - Wildlife species                                                  $0.00
             26g       Total                                                                                               $0.00
             27        Your Refund                                                                                         $0.00

                                                                                                                       12-3

Ohio Test #12
Schedule A      Additions
             1  Non-Ohio state or local government interest and dividends                                          $0.00
             2  Certain Ohio pass-through entity and financial institutions taxes paid                             $0.00
                Reimbursement of college tutition expenses and fees deducted in any previous year(s) and 
             3  noneducation expenditures from a college savings account                                           $0.00
             4  Losses from sale or disposition of Ohio public obligations                                         $0.00
             5  Nonmedical withdrawals from a medical savings account                                              $0.00
                Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if 
             6  the reimbursement is not in federal adjusted gross income                                          $0.00
             7  Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense                  $0.00
             8  Federal interest and dividends subject to state taxation                                           $0.00
             9  Miscellaneous federal income tax additions                                                         $0.00
             10 Total additions                                                                                    $0.00
Schedule A      Deductions
             11 Business income deduction (attach Ohio Schedule IT BUS, line 11)                               $250,000.00
             12 Employee compensation earned in Ohio by residents of neighboring states                            $0.00
             13 State or municipal income tax overpayments shown on IRS form 1040, line 10                         $0.00
             14 Qualifying Social Security benefits and certain railroad retirement benefits                       $0.00
                Interest income from Ohio public obligations and from Ohio purchase obligations; gains from 
                the sale or disposition of Ohio public obligations; public service payments received from the 
             15 state of Ohio or income from a transfer agreement                                                  $0.00
             16 Amounts contributed to an individual development account                                           $0.00
             17 Amounts contributed to STABLE account; Ohio's ABLE plan                                            $0.00
             18 Federal interest and dividends exempt from state taxation                                          $0.00
             19 Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense                  $0.00
                Refund or reimbursements shown on IRS form 1040, line 21 for itemized deductions claimed 
             20 on a prior year federal income tax return                                                          $0.00
             21 Repayment of income reported in a prior year                                                       $0.00
             22 Wage expense not deducted due to claiming the federal work opportunity credit                      $0.00
             23 Miscellaneous federal income tax deductions                                                        $0.00
             24 Military pay for Ohio residents received while the military member was stationed outside Ohio      $0.00
             25 Certain income earned by military nonresidents and civilian nonresident spouses                    $0.00
             26 Uniformed services retirement income                                                               $0.00
             27 Military injury relief fund                                                                        $0.00
             28 Certain Ohio National Guard reimbursements and benefits                                            $0.00
             29 Ohio 529 contributions, tuition credit purchases                                                   $0.00
             30 Pell/Ohio College Opportunity taxable grant amounts used to pay room and board                     $0.00
             31 Disability and survivorship benefits (do not include pension continuation benefits)                $0.00
                Unreimbursed long-term care insurance premiums, unsubsidized health care insurance 
             32 premiums and excess health care expenses                                                           $0.00
                Funds deposited into, and earnings of, a medical savings account for eligible health care 
             33 expenses                                                                                           $0.00
             34 Qualified organ donor expenses                                                                     $0.00
             35 Total deductions                                                                               $250,000.00

                                                                                                               12-4

Ohio Test #12
Schedule of Credits    Nonrefundable credits
                    1  Total tax liability (From IT1040 8c)                                                                $1,649.00
                    2  Retirement Income Credit                                                                              $0.00
                    3  Lump sum retirement credit                                                                            $0.00
                    4  Senior citizen credit                                                                                 $0.00
                    5  Lump sum distribution credit                                                                          $0.00
                    6  Child care and dependent care credit                                                                  $0.00
                    7  If Ohio form IT 1040, line 5 is $10,000 or less, enter $88; otherwise, enter -0- (low income cred     $0.00
                    8  Displaced worker training credit                                                                      $0.00
                       Campaign contribution credit for Ohio statewide office or General 
                    9  Assembly                                                                                              $0.00
                    10 Income-based exemption credit                                                                         $0.00
                    11 Total (add lines 2 through 10)                                                                        $0.00
                    12 Tax less credits (line 1 minus line 11; if less than -0-, enter -0-)                                $1,649.00
                    13 Joint filing credit                                                                                   $0.00
                    14 Earned income credit                                                                                  $0.00
                    15 Ohio adoption credit                                                                                  $0.00
                    16 Job retention credit, nonrefundable portion                                                           $0.00
                    17 Credit for eligible new employees in an enterprise zone                                               $0.00
                    18 Credit for purchases of grape production property                                                     $0.00
                    19 Credit for investing in an Ohio small business                                                        $0.00
                    20 Technology investment credit carryforward                                                             $0.00
                    21 Enterprise zone day care and training credits                                                         $0.00
                    22 Research and development credit                                                                       $0.00
                    23 Ohio historic preservation credit, nonrefundable carryforward portion                                 $0.00
                    24 Total (add lines 13 through 23)                                                                       $0.00
                    25 Tax less additional credits (line 12 minus line 24; if less than -0-, enter -0-)                    $1,649.00
                       Nonresident Credit
                    26 Enter the portion of OAGI that was not earned or received in Ohio                                     $0.00
                    27 Enter the OAGI                                                                                        $0.00
                       Line 26/27 _____* Multiply this factor by the amount on line 25 to calculate your nonresident 
                    28 credit                                                                                                $0.00
                       Resident Credit
                    29 Enter the portion of OAGI subjected to tax by other states or DC while an OH resident                 $0.00
                    30 Enter OAGI                                                                                            $0.00
                    31 Divide line 29 by line 30 ____*Multiply this factor by the amount on line 25                          $0.00
                    32 Enter the 2016 income tax, less all credits other than w/h and est tax pmts and CCFs                  $0.00
                    33 Enter the smaller of line 31 or line 32. This is your Ohio resident tax credit.                       $0.00
                    34 Total nonrefundable credits                                                                           $0.00

                                                                                                                         12-5

Ohio Test #12
                Refundable Credits
             35 Historic preservation credit                                                                                    $0.00
             36 Business jobs credit                                                                                            $0.00
             37 Pass-through entity credit                                                                                    $1,000.00
             38 Motion picture production credit                                                                                $0.00
             39 Financial Institutions Tax (FIT) credit                                                                         $0.00
             40 Venture Capital credit                                                                                          $0.00
             41 Total refundable credits                                                                                      $1,000.00
Sch IT BUS
                Part 1
             1  Sch B - Interest and Ordinary Dividends                                                                     $20,000.00
             2  Sch C - Profit or Loss From Business (Sole Proprietership)                                                  $250,000.00
             3  Sch D - Capital Gains and Losses                                                                            ($3,000.00)
             4  Sch E - Supplemental Income and Loss                                                                        $80,000.00
                Guranteed payments, compensation and/or wages from each pass-through entity in which 
             5  you have at least a 20% direct or indirect ownership interest                                                 $5,000.00
             6  Sch F - Profit or Loss From Farming                                                                         ($50,000.00)
                Other items of income and gain separately stated on federal Schedule K-1, federal 4787 
                gains and/or losses reported on federal 4787 and miscellaneous federal income tax 
             7  adjustments, if any                                                                                         $15,000.00
             8  Total of business income                                                                                    $317,000.00
                Part 2
                All business income. Enter here & on  IT 1040, line 6. If 0 or negative, stop here & don't 
             9  complete Part 3.                                                                                            $306,975.00
             10 Enter $250,000 if single or MFJ, enter $125,000 if MFS                                                      $250,000.00
             11 Lesser of line  9or line 10. Enter here and on Ohio Schedule A, line 11                                     $250,000.00
                Part 3
             12 Line  9minus line 1 1(if less than -0-, enter -0-)                                                          $56,975.00
             13 Taxable Business Income                                                                                     $54,975.00
             14 Business income tax liability. Enter here and on Ohio IT 1040, line 8b.                                       $1,649.00
                Part 4
             1  Name of Entity                                                                             The Daily Planet
             1  FEIN/SS#                                                                                   34-5678909
             1  Percentage of Ownership                                                                    25%

                                                                                                                            12-6

Ohio Test #12
School District Return Information 
                                       1  School district taxable income:  Traditional or Earned Income tax base                      $304,975.00
                                       2  School District Tax .____ times line 1.                                                       $5,337.00
                                       3  Senior Citizen Credit                                                                           $0.00
                                       4  School District Income Tax liability                                                          $5,337.00
                                       5  Interest Penalty on Underpayment of School District Estimated Tax                               $0.00
                                       6  Total school district income tax liability (line 4 plus line 5)                               $5,337.00
                                       6a Amount from line 6                                                                            $5,337.00
                                       7  School district income tax withheld                                                             $0.00
                                       8  SD100ES & SD40P, Extension Payments and Credit carryforward from previous year return           $0.00
                                       9  Amended return only - amount previously paid with original/amended return                       $0.00
                                       10 Total school district income tax payments (add lines 7, 8 and 9)                                $0.00
                                       11 Amended return only - overpayment previously received on original/amended return                $0.00
                                       12 Total Payments less overpayment previously received on original/amended return                  $0.00
                                       13 Tax Liability                                                                                 $5,337.00
                                       14 Interest and penalty due on late filing or payment of tax                                       $0.00
                                       15 Total Amount Due                                                                              $5,337.00
                                       16 Overpayment                                                                                     $0.00
                                       17 Original return only - amount of line 16 to be credited toward 2016 income tax liability        $0.00
                                       18 Your Refund                                                                                     $0.00
School District Schedule A "Traditional" Tax Base School District Amounts
                                       19 Ohio income tax base reported on line 5 of Ohio IT 1040                                     $54,975.00
                                       20 Business income deduction add-back                                                          $250,000.00
                                       21 Total Traditional Tax Base School District Income (Line 19 + Line 20)                       $304,975.00
                                       22 Amount of traditional tax base school district income that you earned while not a resident      $0.00
                                       23 School District Taxable Income (Enter here and on line 1)                                   $304,975.00
School District Schedule B "Earned Income Only" Tax Base School District Amounts
                                       24 Wages and other compensation as described in the instructions                                   $0.00
                                       25 Net Earnings from Self Employment                                                               $0.00
                                       26 Depreciation Expense Adjustments                                                                $0.00
                                       27 School District Taxable Income (Enter here and on line 1)                                       $0.00
What is Tested?
IT1040WithSD100
K-1

IT1040  
Sch. A - Business income deduction
Sch of Credits - Refundable PTE credit 
IT BUS - Business Income schedule

SD100
Business Income deduction add-back

                                                                                                                                      12-7

Ohio Test #13                                                                    IT1040
Taxpayer Information                                    Description
                     Primary Social Security Number                   XX0007615
                     Primary First Name                               MICKEY
                     Primary Last Name                                MOUSE
                     Date of Birth - Primary                          12-14-1943
                     Occupation - Primary                             ACTOR
                     Spouse's Social Security Number                  XX0007665
                     Spouse First Name                                DAISY
                     Spouse Last Name                                 DUCK
                     Date of Birth - Spouse                           07/18/1975
                     Occupation - Spouse                              ACTRESS
                     Address Line 1                                   455 CLUBHOUSE CIR
                     City                                             COLUMBUS
                     State                                            OH
                     Zip Code                                         43229
                     Ohio County                                      FRANKLIN
                     County Code (Ohio Public School District Number) 2503

                                             Income Statements
              W-2
                     Employers Identification Number                  36-3456789
                     Employer's Name                                  ON-TECH CONSULTING
                     Employer's Address                               4821 VIOLET BLVD
                     Employer's City                                  COLUMBUS
                     Employer's State                                 OH
                     Employer's Zip                                   43229
                     Employees Social Security Number                 400-00-7665
                     Employee's Name                                  DAISY DUCK
                     Employee's Address                               455 CLUBHOUSE CIR
                     Employee's City                                  COLUMBUS
                     Employee's State                                 OH
                     Employee's Zip Code                              43229
                     Box 1 Wages, Tips, etc                           $21,856.00
                     Box 2 Federal Income Tax Withheld                $2,623.00
                     Box 3 Social Security Wages                      $21,856.00
                     Box 4 Social Security Tax Withheld               $1,355.00
                     Box 5 Medicare Wages and Tips                    $21,856.00
                     Box 6 Medicare Tax Withheld                      $317.00
                     Box 15 State                                     OH
                     State ID Number                                  52-567890
                     State Wages                                      $21,856.00
                     State Income Tax Withheld                        $657.00

                                                                                        13-1

Ohio Test #13                                                        IT1040
              1099R
                       Payer's Identification Number      21-9876543
                       Payer's Name                       SUNSET INC
                       Payer's Address                    98 N OBERLIN DR
                       Payer's City                       OBERLIN
                       Payer's State                      OH
                       Payer's Zip Code                   44074
                       Recipient's Social Security Number 400-00-7615
                       Recipient's Name                   MICKEY MOUSE
                       Recipient's Address                455 CLUBHOUSE CIR
                       Recipient's City                   COLUMBUS
                       Recipient's State                  OH
                       Recipient's Zip Code               43229
                       Gross Distribution Amount          $58,000.00
                       Taxable Amount                     $58,000.00
                       Distribution Code                  7
                       Box 15 State                       OH
                       State Payer ID                     52-234567
                       State Distribution                 $58,000.00
                       State Income Tax Withheld          $100.00
              1099-Misc
                       Payer's Name                       MICE UNLIMITED
                       Payer's US Address                 123 MICKEY LN
                       Payer's City                       COLUMBUS
                       Payer's State                      OH
                       Payer's Zip Code                   43229
                       Payer's Identification Number      40-3456789
                       Recipient's SSN                    400-00-7615
                       Recipient's Name                   MICKEY MOUSE
                       Recipient's US Address             455 CLUBHOUSE CIR
                       Recipient's City                   COLUMBUS
                       Recipient's State                  OH
                       Recipient's Zip Code               43229
                       Box 3 Other Income                 $52,000.00
                       Box 16 State tax withheld          $1,400.00
                       Box 17 State                       OH
                       Box 17 Payer's state no.           52-801923
                       State Distribution Amount          $52,000.00

                                                                           13-2

Ohio Test #13                                                                                                                      IT1040
Federal Return Information 1040                                  Description
                                Filing Status                                                                           Married Filing Jointly
                                Exemptions, Self & Spouse                                                               2
                                Line 7 Wages                                                                            $21,856.00
                                Line 16b Pensions and Annuities                                                         $58,000.00
                                Line 21 Other Income                                                                    $52,000.00
                                Line 37 Adjusted Gross Income                                                           $131,856.00
State Return Information                                         Description
                                Is this an amended return?                                                              No
                                Self-Prepared                                                                           x
                                Filing Status                                                                           Married Filing Jointly
                                Ohio Residency Status (Primary)                                                         Full-Year Resident
                                Ohio Residency Status (Spouse)                                                          Full-Year Nonresident
                                State of Residency for Nonresident Spouse                                               Indiana
                                Ohio Political Party Fund Contribution - Primary                                        No
                                Ohio Political Party Fund Contribution - Spouse                                         No
                                Is someone else claiming you or your spouse (if joint return) as a dependent?           No
                                Enter the number of dependents                                                          0
                                Eligible for JFC?                                                                       No
                                Preparer Authorization Check Box                                                        Yes
                                Perjury Statement Acceptance                                                            Yes
                                Taxpayer's Phone Number                                                                 614-554-3456
                                Taxpayer's E-mail Address                                                               MOUSE@GMAIL.COM
                                                     Lump Sum Distribution Credit Worksheet
              Section 2         1 Is your Adjusted Gross Income less exemptions (Line 5 on Ohio form IT 1040) less than No
                                $100,000?

                                                                                                                                              13-3

Ohio Test #13
             OH Line #                                           Line Item                                      Amount
             1         Federal Adjusted Gross Income                                                                  $131,856.00
             2a        Additions to federal adjusted gross income                                                     $0.00
             2b        Deductions from federal adjusted gross income                                                  $21,856.00
             3         Ohio Adjusted Gross Income (OAGI)                                                              $110,000.00
             4         Personal and dependent exemption deduction                                                     $3,500.00
             5         Ohio income tax base                                                                           $106,500.00
             6         Taxable business income (Ohio IT BUS, line 13)                                                 $0.00
             7         Line 5 minus line 6 (if less than 0, enter 0)                                                  $106,500.00
             7a        Amount from line 7 on page 1                                                                   $106,500.00
             8a        Nonbusiness income tax liability                                                               $3,287.00
             8b        Business income tax liability (Ohio IT BUS, line 14)                                           $0.00
             8c        Tax liability (line 8a plus 8b)                                                                $3,287.00
             9         Ohio nonrefundable credits                                                                     $0.00
             10        Tax liability after nonrefundable credits                                                      $3,287.00
             11        Interest penalty on underpayment of estimated tax                                              $0.00
             12        Sales and use tax due on Internet, mail order or other out-of-state purchases                  $0.00
             13        Total Ohio tax liability before withholding or estimated payments                              $3,287.00
             14        Ohio income tax withheld                                                                       $2,157.00
                       Add the Ohio estimated & extension payments & credit carryforward from previous year 
             15        return                                                                                         $0.00
             16        Refundable credits                                                                             $0.00
             17        Amended return only - amount previously paid with original/amended return                      $0.00
             18        Total Ohio Tax Payments                                                                        $2,157.00
             19        Amended return only - overpayment previously received on original/amended return               $0.00
             20        Line 18 minus line 19                                                                          $2,157.00
             21        Tax liability                                                                                  $1,130.00
             22        Interest and penalty due on late filing or payment of tax                                      $0.00
             23        Total Amount Due                                                                               $1,130.00
             24        Overpayment                                                                                    $0.00
             25        Original return only - amount of line 24 to be credited toward 2016 income tax liability       $0.00
             26a       Amount of line 24 to be donated - Military injury relief                                       $0.00
             26b       Amount of line 24 to be donated - Ohio History Fund                                            $0.00
             26c       Amount of line 24 to be donated - State nature preserves                                       $0.00
             26d       Amount of line 24 to be donated - Breast/cervical cancer                                       $0.00
             26e       Amount of line 24 to be donated - Wishes for sick children                                     $0.00
             26f       Amount of line 24 to be donated - Wildlife species                                             $0.00
             26g       Total                                                                                          $0.00
             27        Your Refund                                                                                    $0.00

                                                                                                                      13-4

Ohio Test #13
Schedule A      Additions
             1  Non-Ohio state or local government interest and dividends                                     $0.00
             2  Certain Ohio pass-through entity and financial institutions taxes paid                        $0.00
                Reimbursement of college tutition expenses and fees deducted in any previous year(s) and 
             3  noneducation expenditures from a college savings account                                      $0.00
             4  Losses from sale or disposition of Ohio public obligations                                    $0.00
             5  Nonmedical withdrawals from a medical savings account                                         $0.00
                Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if 
             6  the reimbursement is not in federal adjusted gross income                                     $0.00
             7  Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense             $0.00
             8  Federal interest and dividends subject to state taxation                                      $0.00
             9  Miscellaneous federal income tax additions                                                    $0.00
             10 Total additions                                                                               $0.00
Schedule A      Deductions
             11 Business income deduction (attach Ohio Schedule IT BUS, line 11)                              $0.00
             12 Employee compensation earned in Ohio by residents of neighboring states                       $21,856.00
             13 State or municipal income tax overpayments shown on IRS form 1040, line 10                    $0.00
             14 Qualifying Social Security benefits and certain railroad retirement benefits                  $0.00
                Interest income from Ohio public obligations and from Ohio purchase obligations; gains from 
                the sale or disposition of Ohio public obligations; public service payments received from the 
             15 state of Ohio or income from a transfer agreement                                             $0.00
             16 Amounts contributed to an individual development account                                      $0.00
             17 Amounts contributed to STABLE account; Ohio's ABLE plan                                       $0.00
             18 Federal interest and dividends exempt from state taxation                                     $0.00
             19 Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense             $0.00
                Refund or reimbursements shown on IRS form 1040, line 21 for itemized deductions claimed 
             20 on a prior year federal income tax return                                                     $0.00
             21 Repayment of income reported in a prior year                                                  $0.00
             22 Wage expense not deducted due to claiming the federal work opportunity credit                 $0.00
             23 Miscellaneous federal income tax deductions                                                   $0.00
             24 Military pay for Ohio residents received while the military member was stationed outside Ohio $0.00
             25 Certain income earned by military nonresidents and civilian nonresident spouses               $0.00
             26 Uniformed services retirement income                                                          $0.00
             27 Military injury relief fund                                                                   $0.00
             28 Certain Ohio National Guard reimbursements and benefits                                       $0.00
             29 Ohio 529 contributions, tuition credit purchases                                              $0.00
             30 Pell/Ohio College Opportunity taxable grant amounts used to pay room and board                $0.00
             31 Disability and survivorship benefits (do not include pension continuation benefits)           $0.00
                Unreimbursed long-term care insurance premiums, unsubsidized health care insurance 
             32 premiums and excess health care expenses                                                      $0.00
                Funds deposited into, and earnings of, a medical savings account for eligible health care 
             33 expenses                                                                                      $0.00
             34 Qualified organ donor expenses                                                                $0.00
             35 Total deductions                                                                              $21,856.00

                                                                                                              13-5

Ohio Test #13
Schedule of Credits    Nonrefundable credits
                    1  Total tax liability (From IT1040 8c)                                                              $3,287.00
                    2  Retirement Income Credit                                                                          $0.00
                    3  Lump sum retirement credit                                                                        $0.00
                    4  Senior citizen credit                                                                             $0.00
                    5  Lump sum distribution credit                                                                      $0.00
                    6  Child care and dependent care credit                                                              $0.00
                    7  If Ohio form IT 1040, line 5 is $10,000 or less, enter $88; otherwise, enter -0- (low income cred $0.00
                    8  Displaced worker training credit                                                                  $0.00
                       Campaign contribution credit for Ohio statewide office or General 
                    9  Assembly                                                                                          $0.00
                    10 Income-based exemption credit                                                                     $0.00
                    11 Total (add lines 2 through 10)                                                                    $0.00
                    12 Tax less credits (line 1 minus line 11; if less than -0-, enter -0-)                              $3,287.00
                    13 Joint filing credit                                                                               $0.00
                    14 Earned income credit                                                                              $0.00
                    15 Ohio adoption credit                                                                              $0.00
                    16 Job retention credit, nonrefundable portion                                                       $0.00
                    17 Credit for eligible new employees in an enterprise zone                                           $0.00
                    18 Credit for purchases of grape production property                                                 $0.00
                    19 Credit for investing in an Ohio small business                                                    $0.00
                    20 Technology investment credit carryforward                                                         $0.00
                    21 Enterprise zone day care and training credits                                                     $0.00
                    22 Research and development credit                                                                   $0.00
                    23 Ohio historic preservation credit, nonrefundable carryforward portion                             $0.00
                    24 Total (add lines 13 through 23)                                                                   $0.00
                    25 Tax less additional credits (line 12 minus line 24; if less than -0-, enter -0-)                  $3,287.00
                       Nonresident Credit
                    26 Enter the portion of OAGI that was not earned or received in Ohio                                 $0.00
                    27 Enter the OAGI                                                                                    $0.00
                       Line 26/27 _____* Multiply this factor by the amount on line 25 to calculate your nonresident 
                    28 credit                                                                                            $0.00
                       Resident Credit
                    29 Enter the portion of OAGI subjected to tax by other states or DC while an OH resident             $0.00
                    30 Enter OAGI                                                                                        $0.00
                    31 Divide line 29 by line 30 ____*Multiply this factor by the amount on line 25                      $0.00
                    32 Enter the 2016 income tax, less all credits other than w/h and est tax pmts and CCFs              $0.00
                    33 Enter the smaller of line 31 or line 32. This is your Ohio resident tax credit.                   $0.00
                    34 Total nonrefundable credits                                                                       $0.00

                                                                                                                         13-6

Ohio Test #13
                                            Refundable Credits
                                         35 Historic preservation credit                                                               $0.00
                                         36 Business jobs credit                                                                       $0.00
                                         37 Pass-through entity credit                                                                 $0.00
                                         38 Motion picture production credit                                                           $0.00
                                         39 Financial Institutions Tax (FIT) credit                                                    $0.00
                                         40 Venture Capital credit                                                                     $0.00
                                         41 Total refundable credits                                                                   $0.00
Sch IT BUS
                                            Part 1
                                         1  Sch B - Interest and Ordinary Dividends                                                    $0.00
                                         2  Sch C - Profit or Loss From Business (Sole Proprietership)                                 $0.00
                                         3  Sch D - Capital Gains and Losses                                                           $0.00
                                         4  Sch E - Supplemental Income and Loss                                                       $0.00
                                            Guranteed payments, compensation and/or wages from each pass-through entity in which 
                                         5  you have at least a 20% direct or indirect ownership interest                              $0.00
                                         6  Sch F - Profit or Loss From Farming                                                        $0.00
                                            Other items of income and gain separately stated on federal Schedule K-1, federal 4787 
                                            gains and/or losses reported on federal 4787 and miscellaneous federal income tax 
                                         7  adjustments, if any                                                                        $0.00
                                         8  Total of business income                                                                   $0.00
                                            Part 2
                                            All business income. Enter here & on  IT 1040, line 6. If 0 or negative, stop here & don't 
                                         9  complete Part 3.                                                                           $0.00
                                         10 Enter $250,000 if single or MFJ, enter $125,000 if MFS                                     $0.00
                                         11 Lesser of line  9or line 10. Enter here and on Ohio Schedule A, line 11                    $0.00
                                            Part 3
                                         12 Line 9minus line 1 1(if less than -0-, enter -0-)                                          $0.00
                                         13 Taxable Business Income                                                                    $0.00
                                         14 Business income tax liability. Enter here and on Ohio IT 1040, line 8b.                    $0.00
                  What is Tested?
IT1040
Self-Prepared
MFJ status
Sch. A Neighboring state deduction
Ohio W-2
Ohio 1099-MISC
Ohio 1099-R

IT1040  
OTI is over limit for lump sum retirement
Full year resident
Tax due 

No school district return

                                                                                                                                       13-7

Ohio Test #14                                                                                           IT10
    Taxpayer Information                                        Description
                               Primary Social Security Number                               XX0-00-7617
                               Primary First Name                                           CLARK
                               Primary Middle Initial                                       S
                               Primary Last Name                                            KENT
                               Date of Birth - Primary                                      2/21/1953
                               Address Line 1                                               123 INDIANA WAY
                               City                                                         COLUMBUS
                               State                                                        OH
                               Zip Code                                                     43229
                               Ohio County                                                  FRANKLIN
                               County Code (Ohio Public School District Number)             9999
    State Return Information                                    Description
                               Self-Prepared                                                x
                               Filing Status                                                Single
                               Ohio Residency Status (Primary)                              Full-Year Nonresident
                               Taxpayer's E-mail Address                                    CLARK@AOL.COM
                               Taxpayer's Phone Number                                      937-554-3456
                               Perjury Statement                                            Yes
                               Preparer Authorization Check Box                             Yes
               IT 10                                            Description
                             2 Neighbor State                                               IN
                             4 Military stationed in Ohio                                   X
                               State of Residency for Military Nonresident Primary Taxpayer IN
                             5 Using an Ohio address for mailing purposes only              X
What is Tested?
IT10

                                                                                                            14-1

Ohio Test #15                                                             IT1040X with SD100X
Taxpayer Information                                    Description
                     Primary Social Security Number                   XX0007619
                     Primary First Name                               HARMONY
                     Primary Last Name                                CAREBEAR
                     Date of Birth - Primary                          01/01/1980
                     Occupation - Primary                             FACTORY WORKER
                     Address Line 1                                   10 STUFFED ANIMAL LN
                     City                                             BEXLEY
                     State                                            OH
                     Zip Code                                         43209
                     Ohio County                                      FRANKLIN
                     County Code (Ohio Public School District Number) 2501
                                             Income Statements
              W-2 #1
                     Employers Identification Number                  33-9876543
                     Employer's Name                                  BIRDS UNLMTD
                     Employer's Address                               25 E 5TH ST APT 2
                     Employer's City                                  CANARY
                     Employer's State                                 NE
                     Employer's Zip                                   68792
                     Employees Social Security Number                 400-00-7619
                     Employee's Name                                  HARMONY CAREBEAR
                     Employee's Address                               10 STUFFED ANIMAL LN
                     Employee's City                                  BEXLEY
                     Employee's State                                 OH
                     Employee's Zip Code                              43209
                     Box 1 Wages, Tips, etc                           $15,000.00
                     Box 2 Federal Income Tax Withheld                $1,500.00
                     Box 3 Social Security Wages                      $15,000.00
                     Box 4 Social Security Tax Withheld               $930.00
                     Box 5 Medicare Wages and Tips                    $15,000.00
                     Box 6 Medicare Tax Withheld                      $218.00
                     Box 15 State                                     OH
                     State ID Number                                  52-789456
                     State Wages                                      $15,000.00
                     State Income Tax Withheld                        $200.00
                     School District Wages                            $15,000.00
                     School District Tax Withheld                     $113.00
                     School District #                                2501

                                                                                        15-1

Ohio Test #15                                                                                                          IT1040X with SD100X
Federal Return Information      1040                                     Description
                                     Filing Status                                                                 Single
                                     Exemptions, Self                                                              1
                                     Line 7 Total Wages                                                            $15,000.00
                                     Line 33 Student Loan Interest Deduction                                       $1,000.00
                                     Line 37 Adjusted Gross Income                                                 $14,000.00
State Return Information                                                 Description
                                     Is this an amended return?                                                    Yes
                                     Is this a net operating loss (NOL) carryback?                                 No
                                     Self-Prepared                                                                 x
                                     Filing Status                                                                 Single
                                     Ohio Residency Status (Primary)                                               Full-Year Resident
                                     Ohio Political Party Fund Contribution - Primary                              Yes
                                     Is someone else claiming you or your spouse (if joint return) as a dependent? No
                                     Enter the number of dependents                                                0
                                     Eligible for JFC?                                                             No
                                     Amount previously paid with original/amended return                           $83.00
                                     Taxpayer's Phone Number                                                       614-223-1234
                                     Taxpayer's E-mail Address                                                     CARE@BEAR.COM
                                     Perjury Statement Acceptance                                                  Yes
                                     Preparer Authorization Check Box                                              Yes
                                     Reason for Corrections                                                        Ohio withholding increased
                                     Explanation of Corrections                                                    Added W-2
SD Return Information (SD #2501)
                                     Are you Filing the Ohio School District Income Tax Return Electronically      Yes
                                     Is this an amended return?                                                    Yes
                                     Is this a net operating loss (NOL) carryback?                                 No
                                     What is the school district number for which you are filing the SD 100?       2501
                                     School District Residency (Primary)                                           Full-Year Resident
                                     Tax Type                                                                      Traditional
                                     Amount previously paid with original/amended return                           $88 
                                     Reason for Corrections                                                        School district withholding 
                                                                                                                   increased
                                     Explanation of Corrections                                                    Added W-2

                                                                                                                                      15-2

Ohio Test #15
             OH Line #                                           Line Item                                      Amount
             1         Federal Adjusted Gross Income                                                                  $14,000.00
             2a        Additions to federal adjusted gross income                                                       $0.00
             2b        Deductions from federal adjusted gross income                                                    $0.00
             3         Ohio Adjusted Gross Income (OAGI)                                                              $14,000.00
             4         Personal and dependent exemption deduction                                                     $2,250.00
             5         Ohio income tax base                                                                           $11,750.00
             6         Taxable business income (Ohio IT BUS, line 13)                                                   $0.00
             7         Line 5 minus line 6 (if less than 0, enter 0)                                                  $11,750.00
             7a        Amount from line 7 on page 1                                                                   $11,750.00
             8a        Nonbusiness income tax liability                                                               $103.00
             8b        Business income tax liability (Ohio IT BUS, line 14)                                             $0.00
             8c        Tax liability (line 8a plus 8b)                                                                $103.00
             9         Ohio nonrefundable credits                                                                     $20.00
             10        Tax liability after nonrefundable credits                                                      $83.00
             11        Interest penalty on underpayment of estimated tax                                                $0.00
             12        Sales and use tax due on Internet, mail order or other out-of-state purchases                    $0.00
             13        Total Ohio tax liability before withholding or estimated payments                              $83.00
             14        Ohio income tax withheld                                                                       $200.00
             15        Add the Ohio estimated & extension payments & credit carryforward from previous year return      $0.00
             16        Refundable credits                                                                               $0.00
             17        Amended return only - amount previously paid with original/amended return                      $83.00
             18        Total Ohio Tax Payments                                                                        $283.00
             19        Amended return only - overpayment previously received on original/amended return                 $0.00
             20        Line 18 minus line 19                                                                          $283.00
             21        Tax liability                                                                                    $0.00
             22        Interest and penalty due on late filing or payment of tax                                        $0.00
             23        Total Amount Due                                                                                 $0.00
             24        Overpayment                                                                                    $200.00
             25        Original return only - amount of line 24 to be credited toward 2016 income tax liability         $0.00
             26a       Amount of line 24 to be donated - Military injury relief                                         $0.00
             26b       Amount of line 24 to be donated - Ohio History Fund                                              $0.00
             26c       Amount of line 24 to be donated - State nature preserves                                         $0.00
             26d       Amount of line 24 to be donated - Breast/cervical cancer                                         $0.00
             26e       Amount of line 24 to be donated - Wishes for sick children                                       $0.00
             26f       Amount of line 24 to be donated - Wildlife species                                               $0.00
             26g       Total                                                                                            $0.00
             27        Your Refund                                                                                    $200.00

                                                                                                                      15-3

Ohio Test #15
Schedule A      Additions
             1  Non-Ohio state or local government interest and dividends                                                                      $0.00
             2  Certain Ohio pass-through entity and financial institutions taxes paid                                                         $0.00
                Reimbursement of college tutition expenses and fees deducted in any previous year(s) and 
             3  noneducation expenditures from a college savings account                                                                       $0.00
             4  Losses from sale or disposition of Ohio public obligations                                                                     $0.00
             5  Nonmedical withdrawals from a medical savings account                                                                          $0.00
                Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if 
             6  the reimbursement is not in federal adjusted gross income                                                                      $0.00
             7  Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense                                              $0.00
             8  Federal interest and dividends subject to state taxation                                                                       $0.00
             9  Miscellaneous federal income tax additions                                                                                     $0.00
             10 Total additions                                                                                                                $0.00
Schedule A      Deductions
             11 Business income deduction (attach Ohio Schedule IT BUS, line 11)                                                               $0.00
             12 Employee compensation earned in Ohio by residents of neighboring states                                                        $0.00
             13 State or municipal income tax overpayments shown on IRS form 1040, line 10                                                     $0.00
             14 Qualifying Social Security benefits and certain railroad retirement benefits                                                   $0.00
                Interest income from Ohio public obligations and from Ohio purchase obligations; gains from 
                the sale or disposition of Ohio public obligations; public service payments received from the 
             15 state of Ohio or income from a transfer agreement                                                                              $0.00
             16 Amounts contributed to an individual development account                                                                       $0.00
             17 Amounts contributed to STABLE account; Ohio's ABLE plan                                                                        $0.00
             18 Federal interest and dividends exempt from state taxation                                                                      $0.00
             19 Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense                                              $0.00
                Refund or reimbursements shown on IRS form 1040, line 21 for itemized deductions claimed 
             20 on a prior year federal income tax return                                                                                      $0.00
             21 Repayment of income reported in a prior year                                                                                   $0.00
             22 Wage expense not deducted due to claiming the federal work opportunity credit                                                  $0.00
             23 MilitaryMiscellaneouspay forfederalOhio residentsincome taxreceiveddeductionswhile the military member was stationed outside   $0.00
             24 Ohio                                                                                                                           $0.00
             25 Certain income earned by military nonresidents and civilian nonresident spouses                                                $0.00
             26 Uniformed services retirement income                                                                                           $0.00
             27 Military injury relief fund                                                                                                    $0.00
             28 Certain Ohio National Guard reimbursements and benefits                                                                        $0.00
             29 Ohio 529 contributions, tuition credit purchases                                                                               $0.00
             30 Pell/Ohio College Opportunity taxable grant amounts used to pay room and board                                                 $0.00
             31 Disability and survivorship benefits (do not include pension continuation benefits)                                            $0.00
                Unreimbursed long-term care insurance premiums, unsubsidized health care insurance 
             32 premiums and excess health care expenses                                                                                       $0.00
                Funds deposited into, and earnings of, a medical savings account for eligible health care 
             33 expenses                                                                                                                       $0.00
             34 Qualified organ donor expenses                                                                                                 $0.00
             35 Total deductions                                                                                                               $0.00

                                                                                                                                              15-4

Ohio Test #15
Schedule of Credits    Nonrefundable credits
                    1  Total tax liability (From IT1040 8c)                                                             $103.00
                    2  Retirement Income Credit                                                                           $0.00
                    3  Lump sum retirement credit                                                                         $0.00
                    4  Senior citizen credit                                                                              $0.00
                    5  Lump sum distribution credit                                                                       $0.00
                    6  Child care and dependent care credit                                                               $0.00
                    7  If Ohio form IT 1040, line 5 is $10,000 or less, enter $88; otherwise, enter -0- (low income cre   $0.00
                    8  Displaced worker training credit                                                                   $0.00
                       Campaign contribution credit for Ohio statewide office or General 
                    9  Assembly                                                                                           $0.00
                    10 Income-based exemption credit                                                                     $20.00
                    11 Total (add lines 2 through 10)                                                                    $20.00
                    12 Tax less credits (line 1 minus line 11; if less than -0-, enter -0-)                              $83.00
                    13 Joint filing credit                                                                                $0.00
                    14 Earned income credit                                                                               $0.00
                    15 Ohio adoption credit                                                                               $0.00
                    16 Job retention credit, nonrefundable portion                                                        $0.00
                    17 Credit for eligible new employees in an enterprise zone                                            $0.00
                    18 Credit for purchases of grape production property                                                  $0.00
                    19 Credit for investing in an Ohio small business                                                     $0.00
                    20 Technology investment credit carryforward                                                          $0.00
                    21 Enterprise zone day care and training credits                                                      $0.00
                    22 Research and development credit                                                                    $0.00
                    23 Ohio historic preservation credit, nonrefundable carryforward portion                              $0.00
                    24 Total (add lines 13 through 23)                                                                    $0.00
                    25 Tax less additional credits (line 12 minus Line 24; if less than -0-, enter -0-)                  $83.00
                       Nonresident Credit
                    26 Enter the portion of OAGI that was not earned or received in Ohio                                  $0.00
                    27 Enter the OAGI                                                                                     $0.00
                       Line 26/27 _____* Multiply this factor by the amount on line 25 to calculate your nonresident 
                    28 credit                                                                                             $0.00
                       Resident Credit
                    29 Enter the portion of OAGI subjected to tax by other states or DC while an OH resident              $0.00
                    30 Enter OAGI                                                                                         $0.00
                    31 Divide line 29 by line 30 ____*Multiply this factor by the amount on line 25                       $0.00
                    32 Enter the 2016 income tax, less all credits other than w/h and est tax pmts and CCFs               $0.00
                    33 Enter the smaller of line 31 or line 32. This is your Ohio resident tax credit.                    $0.00
                    34 Total nonrefundable credits                                                                       $20.00
                       Refundable Credits
                    35 Historic preservation credit                                                                       $0.00
                    36 Business jobs credit                                                                               $0.00
                    37 Pass-through entity credit                                                                         $0.00
                    38 Motion picture production credit                                                                   $0.00
                    39 Financial Institutions Tax (FIT) credit                                                            $0.00
                    40 Venture Capital credit                                                                             $0.00
                    41 Total refundable credits                                                                           $0.00

                                                                                                                         15-5

Ohio Test #15
Sch IT BUS
                                               Part 1
                                            1  Sch B - Interest and Ordinary Dividends                                                      $0.00
                                            2  Sch C - Profit or Loss From Business (Sole Proprietership)                                   $0.00
                                            3  Sch D - Capital Gains and Losses                                                             $0.00
                                            4  Sch E - Supplemental Income and Loss                                                         $0.00
                                               Guranteed payments, compensation and/or wages from each pass-through entity in which 
                                            5  you have at least a 20% direct or indirect ownership interest                                $0.00
                                            6  Sch F - Profit or Loss From Farming                                                          $0.00
                                               Other items of income and gain separately stated on federal Schedule K-1, federal 4787 
                                               gains and/or losses reported on federal 4787 and miscellaneous federal income tax 
                                            7  adjustments, if any                                                                          $0.00
                                            8  Total of business income                                                                     $0.00
                                               Part 2
                                               All business income. Enter here & on  IT 1040, line 6. If 0 or negative, stop here & don't 
                                            9  complete Part 3.                                                                             $0.00
                                            10 Enter $250,000 if single or MFJ, enter $125,000 if MFS                                       $0.00
                                            11 Lesser of line  9or line 10. Enter here and on Ohio Schedule A, line 11                      $0.00
                                               Part 3
                                            12 Line  9minus line 11(if less than -0-, enter -0-)                                            $0.00
                                            13 Taxable Business Income                                                                      $0.00
                                            14 Business income tax liability. Enter here and on Ohio IT 1040, line 8b.                      $0.00
School District Return Information (SD#2501)
                                            1  School district taxable income:  Traditional or Earned Income tax base                     $11,750.00
                                            2  School District Tax .____ times line 1.                                                     $88.00
                                            3  Senior Citizen Credit                                                                        $0.00
                                            4  School District Income Tax liability                                                        $88.00
                                            5  Interest Penalty on Underpayment of School District Estimated Tax                            $0.00
                                            6  Total school district income tax liability (line 4 plus line 5)                             $88.00
                                            6a Amount from line 6                                                                          $88.00
                                            7  School district income tax withheld                                                        $113.00
                                            8  SD100ES & SD40P, Extension Payments and Credit carryforward from previous year return        $0.00
                                            9  Amended return only - amount previously paid with original/amended return                   $88.00
                                            10 Total school district income tax payments (add lines 7, 8 and 9)                           $201.00
                                            11 Amended return only - overpayment previously received on original/amended return             $0.00
                                            12 Total Payments less overpayment previously received on original/amended return             $201.00
                                            13 Tax Liability                                                                                $0.00
                                            14 Interest and penalty due on late filing or payment of tax                                    $0.00
                                            15 Total Amount Due                                                                             $0.00
                                            16 Overpayment                                                                                $113.00
                                            17 Original return only - amount of line 16 to be credited toward 2016 income tax liability     $0.00
                                            18 Your Refund                                                                                $113.00

                                                                                                                                           15-6

Ohio Test #15
School District Schedule A "Traditional" Tax Base School District Amounts
                                     19            Ohio income tax base reported on line 5 of Ohio IT 1040                                    $11,750.00
                                     20            Business income deduction add-back                                                           $0.00
                                     21            Total Traditional Tax Base School District Income (Line 19 + Line 20)                      $11,750.00
                                     22            Amount of traditional tax base school district income that you earned while not a resident   $0.00
                                     23            School District Taxable Income (Enter here and on line 1)                                  $11,750.00
School District Schedule B "Earned Income Only" Tax Base School District Amounts
                                     24            Wages and other compensation as described in the instructions                                $0.00
                                     25            Net Earnings from Self Employment                                                            $0.00
                                     26            Depreciation Expense Adjustments                                                             $0.00
                                     27            School District Taxable Income (Enter here and on line 1)                                    $0.00
What is Tested?
IT1040X
NOL Indicator
Amount previously paid with original/amended return
Reason and explanation of corrections

SD100X
NOL Indicator
Amount previously paid with original/amended return
Reason and explanation of corrections

                                                                                                                                               15-7

Ohio Test #16                                                             IT1040X with SD100X
Taxpayer Information                                    Description
                     Primary Social Security Number                   XX0007620
                     Primary First Name                               PETER
                     Primary Last Name                                PARKER
                     Date of Birth - Primary                          01/01/1959
                     Occupation - Primary                             RETIRED
                     Address Line 1                                   1 SPIDER LN
                     City                                             BEXLEY
                     State                                            OH
                     Zip Code                                         43209
                     Ohio County                                      FRANKLIN
                     County Code (Ohio Public School District Number) 2501
                                             Income Statements
              1099R
                     Payer's Name                                     FIDELITY INSURANCE
                     Payer's Address                                  123 MAIN ST
                     City                                             DANVILLE
                     State                                            OH
                     Zip Code                                         43014
                     Payer Federal ID Number                          38-3456789
                     Recipient ID Number                              400-00-7620
                     Recipient Name                                   PETER PARKER
                     Recipient Address                                1 SPIDER LN
                     City                                             BEXLEY
                     State                                            OH 
                     Zip Code                                         43209
                     Gross Distribution Amount                        $30,000
                     Taxable Amount                                   $30,000
                     Federal Income Tax Withheld Amount               $5,000
                     Distribution Code                                7
                     State                                            OH
                     Payers State ID Number                           52-789012
                     State Distribution Amount                        $30,000
                     State Income Tax Withheld                        $700.00

                                                                                   16-1

Ohio Test #16                                                                                                           IT1040X with SD100X
Federal Return Information      1040                                     Description
                                     Filing Status                                                                 Single
                                     Exemptions, Self, 1 Dependent                                                 2
                                     Dependent 1 SSN                                                               400-00-7690
                                     Dependent 1 Date of Birth                                                     5/13/1996
                                     Dependent 1 First Name                                                        BENJAMIN RICHARD
                                     Dependent 1 Last Name                                                         PARKER
                                     Dependent 1 Relationship                                                      SON  
                                     Line 16b Pension and Annuities                                                $30,000.00
                                     Line 37 Adjusted Gross Income                                                 $30,000.00
State Return Information                                                 Description
                                     Is this an amended return?                                                    Yes
                                     Is this a net operating loss (NOL) carryback?                                 No
                                     Self-Prepared                                                                 x
                                     Filing Status                                                                 Single
                                     Ohio Residency Status (Primary)                                               Full-Year Resident
                                     Ohio Political Party Fund Contribution - Primary                              Yes
                                     Is someone else claiming you or your spouse (if joint return) as a dependent? No
                                     Enter the number of dependents                                                1
                                     Eligible for JFC?                                                             No
                                     Overpayment previously received on original/amended return                    $800 
                                     Taxpayer's Phone Number                                                       614-222-1234
                                     Taxpayer's E-mail Address                                                     SPIDERMAN@GMAIL.COM
                                     Perjury Statement Acceptance                                                  Yes
                                     Preparer Authorization Check Box                                              Yes
                                     Reason for Corrections                                                        Exemptions decreased
                                     Explanation of Corrections                                                    Removed dependent
SD Return Information (SD #2501)
                                     Are you Filing the Ohio School District Income Tax Return Electronically      Yes
                                     Is this an amended return?                                                    Yes
                                     Is this a net operating loss (NOL) carryback?                                 No
                                     What is the school district number for which you are filing the SD 100?       2501
                                     School District Residency (Primary)                                           Full-Year Resident
                                     Tax Type                                                                      Traditional
                                     Overpayment previously received on original/amended return                    $16 
                                     Reason for Corrections                                                        Exemptions decreased
                                     Explanation of Corrections                                                    Removed dependent

                                                                                                                                      16-2

Ohio Test #16
             OH Line #                                           Line Item                                      Amount
             1         Federal Adjusted Gross Income                                                                     $30,000.00
             2a        Additions to federal adjusted gross income                                                          $0.00
             2b        Deductions from federal adjusted gross income                                                       $0.00
             3         Ohio Adjusted Gross Income (OAGI)                                                                 $30,000.00
             4         Personal and dependent exemption deduction                                                        $4,500.00
             5         Ohio income tax base                                                                              $25,500.00
             6         Taxable business income (Ohio IT BUS, line 13)                                                      $0.00
             7         Line 5 minus line 6 (if less than 0, enter 0)                                                     $25,500.00
             7a        Amount from line 7 on page 1                                                                      $25,500.00
             8a        Nonbusiness income tax liability                                                                    $445.00
             8b        Business income tax liability (Ohio IT BUS, line 14)                                                $0.00
             8c        Tax liability (line 8a plus 8b)                                                                     $445.00
             9         Ohio nonrefundable credits                                                                          $240.00
             10        Tax liability after nonrefundable credits                                                           $205.00
             11        Interest penalty on underpayment of estimated tax                                                   $0.00
             12        Sales and use tax due on Internet, mail order or other out-of-state purchases                       $0.00
             13        Total Ohio tax liability before withholding or estimated payments                                   $205.00
             14        Ohio income tax withheld                                                                            $700.00
             15        Add the Ohio estimated & extension payments & credit carryforward from previous year return         $0.00
             16        Refundable credits                                                                                  $0.00
             17        Amended return only - amount previously paid with original/amended return                           $0.00
             18        Total Ohio Tax Payments                                                                             $700.00
             19        Amended return only - overpayment previously received on original/amended return                    $800.00
             20        Line 18 minus line 19                                                                               ($100.00)
             21        Tax liability                                                                                       $305.00
             22        Interest and penalty due on late filing or payment of tax                                           $0.00
             23        Total Amount Due                                                                                    $305.00
             24        Overpayment                                                                                         $0.00
             25        Original return only - amount of line 24 to be credited toward 2016 income tax liability            $0.00
             26a       Amount of line 24 to be donated - Military injury relief                                            $0.00
             26b       Amount of line 24 to be donated - Ohio History Fund                                                 $0.00
             26c       Amount of line 24 to be donated - State nature preserves                                            $0.00
             26d       Amount of line 24 to be donated - Breast/cervical cancer                                            $0.00
             26e       Amount of line 24 to be donated - Wishes for sick children                                          $0.00
             26f       Amount of line 24 to be donated - Wildlife species                                                  $0.00
             26g       Total                                                                                               $0.00
             27        Your Refund                                                                                         $0.00

                                                                                                                       16-3

Ohio Test #16
Schedule A      Additions
             1  Non-Ohio state or local government interest and dividends                                          $0.00
             2  Certain Ohio pass-through entity and financial institutions taxes paid                             $0.00
                Reimbursement of college tutition expenses and fees deducted in any previous year(s) and 
             3  noneducation expenditures from a college savings account                                           $0.00
             4  Losses from sale or disposition of Ohio public obligations                                         $0.00
             5  Nonmedical withdrawals from a medical savings account                                              $0.00
                Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if 
             6  the reimbursement is not in federal adjusted gross income                                          $0.00
             7  Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense                  $0.00
             8  Federal interest and dividends subject to state taxation                                           $0.00
             9  Miscellaneous federal income tax additions                                                         $0.00
             10 Total additions                                                                                    $0.00
Schedule A      Deductions
             11 Business income deduction (attach Ohio Schedule IT BUS, line 11)                                   $0.00
             12 Employee compensation earned in Ohio by residents of neighboring states                            $0.00
             13 State or municipal income tax overpayments shown on IRS form 1040, line 10                         $0.00
             14 Qualifying Social Security benefits and certain railroad retirement benefits                       $0.00
                Interest income from Ohio public obligations and from Ohio purchase obligations; gains from 
                the sale or disposition of Ohio public obligations; public service payments received from the 
             15 state of Ohio or income from a transfer agreement                                                  $0.00
             16 Amounts contributed to an individual development account                                           $0.00
             17 Amounts contributed to STABLE account; Ohio's ABLE plan                                            $0.00
             18 Federal interest and dividends exempt from state taxation                                          $0.00
             19 Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense                  $0.00
                Refund or reimbursements shown on IRS form 1040, line 21 for itemized deductions claimed 
             20 on a prior year federal income tax return                                                          $0.00
             21 Repayment of income reported in a prior year                                                       $0.00
             22 Wage expense not deducted due to claiming the federal work opportunity credit                      $0.00
             23 Miscellaneous federal income tax deductions                                                        $0.00
             24 Military pay for Ohio residents received while the military member was stationed outside Ohio      $0.00
             25 Certain income earned by military nonresidents and civilian nonresident spouses                    $0.00
             26 Uniformed services retirement income                                                               $0.00
             27 Military injury relief fund                                                                        $0.00
             28 Certain Ohio National Guard reimbursements and benefits                                            $0.00
             29 Ohio 529 contributions, tuition credit purchases                                                   $0.00
             30 Pell/Ohio College Opportunity taxable grant amounts used to pay room and board                     $0.00
             31 Disability and survivorship benefits (do not include pension continuation benefits)                $0.00
                Unreimbursed long-term care insurance premiums, unsubsidized health care insurance 
             32 premiums and excess health care expenses                                                           $0.00
                Funds deposited into, and earnings of, a medical savings account for eligible health care 
             33 expenses                                                                                           $0.00
             34 Qualified organ donor expenses                                                                     $0.00
             35 Total deductions                                                                                   $0.00

                                                                                                               16-4

Ohio Test #16
Schedule of Credits    Nonrefundable credits
                    1  Total tax liability (From IT1040 8c)                                                                   $445.00
                    2  Retirement Income Credit                                                                               $200.00
                    3  Lump sum retirement credit                                                                             $0.00
                    4  Senior citizen credit                                                                                  $0.00
                    5  Lump sum distribution credit                                                                           $0.00
                    6  Child care and dependent care credit                                                                   $0.00
                    7  If Ohio form IT 1040, line 5 is $10,000 or less, enter $88; otherwise, enter -0- (low income cred      $0.00
                    8  Displaced worker training credit                                                                       $0.00
                       Campaign contribution credit for Ohio statewide office or General 
                    9  Assembly                                                                                               $0.00
                    10 Income-based exemption credit                                                                          $40.00
                    11 Total (add lines 2 through 10)                                                                         $240.00
                    12 Tax less credits (line 1 minus line 11; if less than -0-, enter -0-)                                   $205.00
                    13 Joint filing credit                                                                                    $0.00
                    14 Earned income credit                                                                                   $0.00
                    15 Ohio adoption credit                                                                                   $0.00
                    16 Job retention credit, nonrefundable portion                                                            $0.00
                    17 Credit for eligible new employees in an enterprise zone                                                $0.00
                    18 Credit for purchases of grape production property                                                      $0.00
                    19 Credit for investing in an Ohio small business                                                         $0.00
                    20 Technology investment credit carryforward                                                              $0.00
                    21 Enterprise zone day care and training credits                                                          $0.00
                    22 Research and development credit                                                                        $0.00
                    23 Ohio historic preservation credit, nonrefundable carryforward portion                                  $0.00
                    24 Total (add lines 13 through 23)                                                                        $0.00
                    25 Tax less additional credits (line 12 minus line 24; if less than -0-, enter -0-)                       $205.00
                       Nonresident Credit
                    26 Enter the portion of OAGI that was not earned or received in Ohio                                      $0.00
                    27 Enter the OAGI                                                                                         $0.00
                       Line 26/27 _____* Multiply this factor by the amount on line 25 to calculate your nonresident 
                    28 credit                                                                                                 $0.00
                       Resident Credit
                    29 Enter the portion of OAGI subjected to tax by other states or DC while an OH resident                  $0.00
                    30 Enter OAGI                                                                                             $0.00
                    31 Divide line 29 by line 30 ____*Multiply this factor by the amount on line 25                           $0.00
                    32 Enter the 2016 income tax, less all credits other than w/h and est tax pmts and CCFs                   $0.00
                    33 Enter the smaller of line 31 or line 32. This is your Ohio resident tax credit.                        $0.00
                    34 Total nonrefundable credits                                                                            $240.00

                                                                                                                          16-5

Ohio Test #16
                                            Refundable Credits
                                         35 Historic preservation credit                                                                    $0.00
                                         36 Business jobs credit                                                                            $0.00
                                         37 Pass-through entity credit                                                                      $0.00
                                         38 Motion picture production credit                                                                $0.00
                                         39 Financial Institutions Tax (FIT) credit                                                         $0.00
                                         40 Venture Capital credit                                                                          $0.00
                                         41 Total refundable credits                                                                        $0.00
Sch IT BUS
                                            Part 1
                                         1  Sch B - Interest and Ordinary Dividends                                                         $0.00
                                         2  Sch C - Profit or Loss From Business (Sole Proprietership)                                      $0.00
                                         3  Sch D - Capital Gains and Losses                                                                $0.00
                                         4  Sch E - Supplemental Income and Loss                                                            $0.00
                                            Guranteed payments, compensation and/or wages from each pass-through entity in which 
                                         5  you have at least a 20% direct or indirect ownership interest                                   $0.00
                                         6  Sch F - Profit or Loss From Farming                                                             $0.00
                                            Other items of income and gain separately stated on federal Schedule K-1, federal 4787 
                                            gains and/or losses reported on federal 4787 and miscellaneous federal income tax 
                                         7  adjustments, if any                                                                             $0.00
                                         8  Total of business income                                                                        $0.00
                                            Part 2
                                            All business income. Enter here & on  IT 1040, line 6. If 0 or negative, stop here & don't 
                                         9  complete Part 3.                                                                                $0.00
                                         10 Enter $250,000 if single or MFJ, enter $125,000 if MFS                                          $0.00
                                         11 Lesser of line  9or line 10. Enter here and on Ohio Schedule A, line 11                         $0.00
                                            Part 3
                                         12 Line  9minus line 11 (if less than -0-, enter -0-)                                              $0.00
                                         13 Taxable Business Income                                                                         $0.00
                                         14 Business income tax liability. Enter here and on Ohio IT 1040, line 8b.                         $0.00
School District Return Information (2501)
                                         1  School district taxable income:  Traditional or Earned Income tax base                        $25,500.00
                                         2  School District Tax .____ times line 1.                                                         $191.00
                                         3  Senior Citizen Credit                                                                           $0.00
                                         4  School District Income Tax liability                                                            $191.00
                                         5  Interest Penalty on Underpayment of School District Estimated Tax                               $0.00
                                         6  Total school district income tax liability (line 4 plus line 5)                                 $191.00
                                         6a Amount from line 6                                                                              $191.00
                                         7  School district income tax withheld                                                             $0.00
                                         8  SD100ES & SD40P, Extension Payments and Credit carryforward from previous year return           $0.00
                                         9  Amended return only - amount previously paid with original/amended return                       $0.00
                                         10 Total school district income tax payments (add lines 7, 8 and 9)                                $0.00
                                         11 Amended return only - overpayment previously received on original/amended return                $16.00
                                         12 Total Payments less overpayment previously received on original/amended return                  ($16.00)
                                         13 Tax Liability                                                                                   $207.00
                                         14 Interest and penalty due on late filing or payment of tax                                       $0.00
                                         15 Total Amount Due                                                                                $207.00
                                         16 Overpayment                                                                                     $0.00
                                         17 Original return only - amount of line 16 to be credited toward 2016 income tax liability        $0.00
                                         18 Your Refund                                                                                     $0.00

                                                                                                                                        16-6

Ohio Test #16
School District Schedule A "Traditional" Tax Base School District Amounts
                                     19          Ohio income tax base reported on line 5 of Ohio IT 1040                                       $25,500.00
                                     20          Business income deduction add-back                                                              $0.00
                                     21          Total Traditional Tax Base School District Income (Line 19 + Line 20)                         $25,500.00
                                     22          Amount of traditional tax base school district income that you earned while not a resident      $0.00
                                     23          School District Taxable Income (Enter here and on line 1)                                     $25,500.00
School District Schedule B "Earned Income Only" Tax Base School District Amounts
                                     24          Wages and other compensation as described in the instructions                                   $0.00
                                     25          Net Earnings from Self Employment                                                               $0.00
                                     26          Depreciation Expense Adjustments                                                                $0.00
                                     27          School District Taxable Income (Enter here and on line 1)                                       $0.00
What is Tested?
IT1040X
NOL Indicator
Overpayment previously recvd. on original/amended
Reason and explanation of corrections

SD100X
NOL Indicator
Overpayment previously recvd. on original/amended
Reason and explanation of corrections

                                                                                                                                             16-7

         2016 Ohio IT 
                                1040, 

Schedules and SD100

                Recent Updates

12/15/16

1040 Schema, Primary and Spouse Deceased checkboxes updated:
Yes=1 and No=0

Test Scenario 5 values updated: 
FAGI= $37,500.00
Federal Schedule A Repayment of Income Reported= $750.00

                                Ohio Department of Taxation

                                4485 Northland Ridge Blvd.

                                Columbus, OH 43229

                                tax.ohio.gov