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Depa~ment of 2015 Universal IT 1040
* Ohio I Taxation
Rev. 11/15
Individual Income Tax Return 1111111111 1111111 1111111 *
Note: For taxable year 2015 and forward, this form encompasses the IT 1040, IT 1040EZ and amended IT 1040X.
Are you fi ling this as an amended return? Yes No If yes, attach Ohio IT RE, 2015 Reason and Explanation of Corrections
Is this a Net Operating Loss (NOL) carryback? Yes No If yes, attach Schedule IT NOL
Taxpayer Social Security no. (required) If deceased Spouse’s Social Security no. (if filing jointly) If deceased Enter school district # for
this return (see instructions).
check box check box SD#
First name M.I. Last name
Spouse's fi rst name (only if married filing jointly) M.I. Last name
Mailing address (for faster processing, use a street address)
City State ZIP code Ohio county (fi rst four letters)
Home address (if different from mailing address) – do NOT show city or state ZIP code Ohio county (fi rst four letters)
Foreign country (if the mailing address is outside the U.S.) Foreign postal code
Ohio Residency Status – Check applicable box Filing Status – Check one (as reported on federal income tax return,
Full-year Part-year Nonresident with limited exceptions – see instructions)
resident resident Indicate state
Single, head of household or qualifying widow(er)
Check applicable box for spouse (only if married filing jointly)
Full-year Part-year Nonresident Married filing jointly Married filing separately
Yes No
resident resident Indicate state
Yes No Did you fi le federal extension form 4868? ....................................
Ohio Political Party Fund Yes No
Do you want $1 to go to this fund?............................................ Is someone else claiming you or your spouse (if joint return) as
a dependent? If yes, enter "0" on line 4........................................
If joint return, does your spouse want $1 to go to this fund?.....
Note: Checking “Yes” will not increase your tax or decrease your refund.
If the amount on a line is negative, place a negative sign ("–") in the box provided.
1. Federal adjusted gross income (from IRS forms 1040, line 37; 1040A, line 21;
1040EZ, line 4; 1040NR, line 36; or 1040NR-EZ, line 10)................................................................. 1. . 00
00
2a. Additions to federal adjusted gross income (attach Ohio Schedule A, line 11) ........................... 2a. .
2b. Deductions from federal adjusted gross income (attach Ohio Schedule A, line 35).................... 2b. . 00
3. Ohio adjusted gross income (line 1 plus line 2a minus line 2b) .................................................... 3. . 00
00
4. Personal and dependent exemption deduction (if claiming dependent(s), attach Schedule J)..... 4. .
5. Ohio income tax base (line 3 minus line 4; if less than -0-, enter -0-) ........................................... 5. . 00
6. Taxable business income (attach Ohio Schedule IT BUS, line 13) ............................................... 6. .00
7. Line 5 minus line 6 (if less than -0-, enter -0-)...............................................................................7. .00
Enclose your federal income tax return
if line 1 of this return is -0- or negative.
Do not write in this area; for department use only.
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2015 Universal IT 1040 – page 1 of 2
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