Do not staple or paper clip. Use only black ink and UPPERCASE letters. 

                                             IT 10 – Ohio Income Tax 

                   Rev.  /119                        Information Notice                                                  07120102

                                                                    Taxable Year
                For use only by individuals claiming to owe no Ohio individual income tax for the year.
                              This notice must be filed by the filing deadline for the Ohio IT 1040.
Taxpayer SSN (required)                                      Spouse’s SSN (only if joint notice)

Your first name                                              M.I.   Last name

Spouse's first name (only if joint notice)                   M.I.   Last name

Address 

City                                                                          State             ZIP code  Ohio county (first four letters)

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

Filing Status – Check one (as reported on federal income tax return)
   Single, head of household or qualifying widow(er)         Married filing jointly             Married filing separately

                              I am not required to file an Ohio income tax return because:
1.      I moved out of the state of Ohio before Jan. 1st of the taxable year, 3.    I had an Ohio income tax base (Ohio IT 1040, line 5) of $10,850 or 
        and I had no income in Ohio during the taxable year.                        less on the last day of the taxable year. Therefore, I owe no Ohio 
                                                                                    income tax. I understand that I may owe school district income tax 
        I moved to the state of                                                     if I am domiciled in a school district that imposes school district 
                                                                                    income tax.
        Date moved            /            /                                  4.    I was in the military stationed in Ohio during the taxable year and 
2.      During the taxable year I was a full-year resident of one of the            my only source of income earned in Ohio is from the military, but 
        following states, and I had no taxable income in Ohio other                 I am a resident of the state of
        than compensation (wages, salaries or tips) from unrelated 
        employers:       
        Kentucky          Indiana          West Virginia                      5.    I am using an Ohio address for mailing purposes only.
        Michigan          Pennsylvania                                        6.    I am a civilian spouse of a nonresident service member on duty 
                                                                                    stationed in Ohio, solely because of military orders. My state of 
                                                                                    residence is

Sign Here (required): Sending in this notice does not constitute the filing of an income
tax return. I have read this notice. Under penalties of perjury, I declare that, to the best of my 
knowledge and belief, the notice information is true, correct and complete.
                                                                                                                         Mail to: 
Your signature                                                     Date (MM/DD/YY)                       Ohio Department of Taxation
                                                                                                                         P.O. Box 2476
                                                                                                                         Columbus, OH 43216-2476
Spouse’s signature                                                 Phone number

 Preparer’s name (print name)                                       Phone number
        Check here to authorize your preparer to discuss this notice with Taxation.
                                                     Federal Privacy Act Notice
     Because we require you to provide us with a Social Security number, the Federal Privacy Act of 1974 requires us to inform you that 
     providing us with your Social Security number is mandatory. Ohio Revised Code sections 5703.05, 5703.057 and 5747.08 authorize 
     us to request this information. We need your Social Security number in order to administer this tax.