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

                                           IT 10 – Ohio Income Tax 
                Rev. 10/16                          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 fi led          by the fi ling deadline.
Although you may not be required to fi le an Ohio income tax return, fi ling this notice may help you avoid being considered a delinquent taxpayer. If your 
fi ling status is married fi ling jointly and you want to fi le this notice, you can do so only if your spouse is eligible to fi le this notice.
Taxpayer SSN (required)                             Spouse’s SSN (only if joint notice)

Your fi rst name                                     M.I.     Last name

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

Address 

City                                                                          State    ZIP code          Ohio county (fi rst four letters)

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

                           I am not required to fi le 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 $10,000 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 fi ling of an income 
tax return. I have read this return. Under penalties of perjury, I declare that, to the best of my              Federal Privacy 
knowledge and belief, the return and all enclosures are true, correct and complete.                                Act Notice
                                                                                                   Because we require you to provide us with a Social 
 Your signature                                                      Date (MM/DD/YY)               Security number, the Federal Privacy Act of 1974 
                                                                                                   requires us to inform you that providing us with 
                                                                                                   your Social Security number is mandatory. Ohio 
 Spouse’s signature                                                  Phone number                  Revised Code sections 5703.05, 5703.057 and 
                                                                                                   5747.08 authorize us to request this information. 
 Preparer’s name (print name)                                        Phone number                  We need your Social Security number in order to 
                                                                                                   administer this tax. 
 Do you authorize your preparer to contact us regarding this return?          Yes   No

     Mail to: Ohio Department of Taxation, P.O. Box 2476, Columbus, OH 43216-2476                  Questions? Call us toll-free 
                                                                                                     at 1-800-282-1780.