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                        Depa!1ment of                    2016 Ohio IT 1041 
*      Ohio I Taxation 
                        Rev. 8/16
                                                Fiduciary Income Tax Return                                                                                               11111111111111111 161801061111111  *  
                                                                                                                                                                                                       
                                 Check here if amended return          Check here if final return                                                                          For taxable year beginning in
                                                                                                                                                                          MM/    2                     0 16
                                                                                                                                                                                 
FEIN                                    SSN of decedent (estates only)

Name of trust or estate   

Name of trust or estate (second line)   

Fiduciary name and title   

Address (if address change, check box)   

City                                                                             State         ZIP code   

Check Applicable Box(es)  
       Simple trust            OR               Complex trust                    Irrevocable trust                                                                        Testamentary trust   

       Resident trust          OR               Nonresident trust                Bankruptcy estate                                                                        Decedent’s estate   

                                    If the amount on a line is negative, place a negative sign (“–”) before the figure.  
1.   Federal taxable income (from line 22 of the federal 1041).Include page 1 of the federal   
     1041   ......................................................................................................................................................1.                                     .   00  

2. Net adjustments from Schedule A, line 42   ............................................................................................2.                                                             .   00   

3. Ohio taxable income (line 1 plus or minus line 2). Estates should skip lines 4-7  ..................................3.                                                                                .   00  

4. Allocated qualifying trust amount from Schedule F, line 61 (trusts only)   ...............................................4.                                                                          .   00  

5. Apportioned trust income from Schedule G, line 64 (trusts only)   ..........................................................5.                                                                        .   00   

6. Allocated trust income from Schedule H, line 67 (trusts only)    ..............................................................6.                                                                     .   00   

7. Modified Ohio taxable income (trusts add lines 4, 5 and 6; if less than zero, enter -0-).......................7.                                                                                      .   00   
8.  Tax on Ohio taxable income (estates, line 3) or tax on modified Ohio taxable income (trusts,        
     line 7). See tax table in the instructions ................................................................................................8.                                                       .   00   

9. Credits from Schedule B, line 50 (estates only)....................................................................................9.                                                                 .   00   

10. Resident credit from Schedule C (estates); nonresident credit from Schedule D (estates); busi-
     ness credit for estates and trusts from Schedule E (include Schedule E); and Schedule I credit  
     (resident trusts)...................................................................................................................................10.                                             .   00   

11. Tax after nonrefundable credits (line 8 minus the amount on lines 9 and 10) ....................................11.                                                                                  .   00   

12. Interest penalty on underpayment of estimated tax (include Ohio IT/SD 2210) .......................................12.                                                                               .   00   

13. Total Ohio tax (sum of lines 11 and 12)  ...............................................................................................13.                                                          .   00   

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

                                                                                                          2016 IT 1041 – pg. 1 of 5  

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                       Depa~ment of                                    2016 Ohio IT 1041 
*     Ohio I Taxation 
                       Rev. 8/16                      Fiduciary Income Tax Return                                                                                 IIII I Ill 1111111111111111          *  
                                                                                                                                                                              16180206   
FEIN   

14. Net payments from line 80 on page 5......................14.                                                     .   00    
15. Refundable business credits (include documen-
    tation) .......................................................................15.                               .   00     

16. Total (sum of lines 14 and 15)..................................16.                                              .  00     

17. If line 16 is more than line 13, subtract line 13 from line 16. This is your overpayment ....................17.                                                                          .  00    
18. Amount of line 17 to be credited to 2017 estimated tax   
    liability .....................................   CREDIT TO 2017 18.                                           .   00    

19. Amount of line 17 to be refunded (subtract line 18 from line 17) ......................   YOUR REFUND                       19.                                                         .  00     

20. Net amount due, if any (if line 13 is more than line 16, subtract line 16 from line 13, but not less than                                                                                         00     
    -0-)......................................................................................................................................................20.                             .
21. Interest and penalty on late-paid and/or late-filed return, if any ..............................................................21.                                                       .   00     
22. Total amount due, if any (sum of lines 20 and 21). Make check payable to Ohio Treasurer of State,   
    include Ohio IT 1041P and place FEIN on check .....................................TOTALAMOUNT                   DUE        22.                                                         .   00     

                    If your refund is $1.00 or less, no refund will be issued. If you owe $1.00 or less, no payment is necessary.   

Sign Here (required):I declare under penalties of perjury that this report, including any ac-                                                                     Do not staple or otherwise attach.   
companying schedules and statements, has been examined                                   by me and to the best of my knowledge Place any supporting documents, including   
and belief is a true, correct and complete return and report.
                                                                                                                                                 K-1’s, after the last page of this return.   
Signature of fiduciary or trust officer                  Preparer’s name (print name)   
                                                                                                                                                                      Mail to: 
Title                   Date                          Preparer’s address (including ZIP code)                                     Ohio Department of Taxation 
                                                                                                                                                                  P.O. Box 2619 
Fiduciary’s or trust officer’s phone number             Preparer’s phone number   
                                                                                                                                    Columbus, OH 43216-2619   
Preparer’s e-mail address                             PTIN                                                                                          Instructions for this form are on our 
Do you authorize your preparer to contact us regarding this return? Yes                               No                                                          Web site at tax.ohio.gov.   

Schedule A – Adjustments to Federal Taxable Income Net of Related Expenses   
Additions   
23. Federal and/or non-Ohio state or local government interest and dividends not distributed...............23.                                                                                .        00     

24. Pass-through entity and financial institutions taxes paid and related member add-back...................24.                                                                                .   00     

25. Income from an ESBT not shown in federal taxable income..............................................................25.                                                                  .   00     

26. Losses from sale or other disposition of Ohio public obligations.......................................................26.                                                                .        00    

27. Recovery of amount previously deducted or excluded.......................................................................27.                                                              .        00     

28. Adjustment for Internal Revenue Code section 168(k) depreciation expense.                                                                                                                          00     
    2/3,   5/6 or   6/6 (check applicable box).............................................................................28.                                                          .   
29. Federal personal exemption (estates only) and miscellaneous federal tax adjustments...................29.                                                                                 .        00     

30. Expenses claimed on Ohio estate return (estates only).....................................................................30.                                                             .        00     

31. Total additions (add lines 23 through 30)...........................................................................................31.                                                   .        00     

                                                                                                                                                                  For Department Use Only   

                    Do not write in this area; for department use only.                                                                                           [IJ[IJ[IJ/   /          
                                                                                                                                                                  Postmark date       Code   

                                                                                                                                  2016 IT 1041 – pg. 2 of 5   

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                      Depa~ment of                         2016 Ohio IT 1041 
*     Ohio I Taxation 
                      Rev. 8/16                Fiduciary Income Tax Return                                                                                               11111111111111 161803061111111111 *  
                                                                                                                                                                                                  
FEIN   

                                   If the amount on a line is negative, place a negative sign (“–”) before the figure.   
Schedule A – Adjustments to Federal Taxable Income Net of Related Expenses...cont.   
Deductions – Note: Deduct income items described below only to the extent that those amounts   
are not already deducted or excluded from federal taxable income after distributions.   
32. Federal interest and dividends exempt from state taxation net of related expenses.........................32.                                                                                 .  00     

33. Certain state and municipal income tax overpayments......................................................................33.                                                                  .  00     

34. Losses from an ESBT not shown in federal taxable income..............................................................34.                                                                      .  00     
35. Wage and salary expense not previously deducted due to the federal   targeted jobs credit or 
      the work opportunity credit.................................................................................................................35.                                             .   00    
36. Interest income from Ohio public obligations and Ohio purchase obligations and gains from the 
      sale or other disposition of Ohio public obligations............................................................................36.                                                         .   00     
37. Refunds or reimbursements of prior year federal itemized deductions and miscellaneous federal   
      tax adjustments..................................................................................................................................37.                                        .   00   

38. Farm income from a farm of at least 10 acres (trusts only)................................................................38.                                                                 .   00    
39. Adjustment for Internal Revenue Code section 168(k) depreciation expense. Include a separate   
      schedule showing calculations designating 1/2, 1/5 or 1/6..........................................................39.                                                                      .   00     

40.Repayment of income reported in a prior year and not otherwise deducted......................................40.                                                                               .   00     

41. Total deductions (sum of lines 32 through 40)....................................................................................41.                                                          .   00     

42.Net adjustments (subtract line 41 from line 31). Enter here and on line 2..........................................42.                                                                         .   00     
Schedule B – Estate Credits   
43.Retirement income credit (see instructions for credit table) (limit – $200)..........................................43.                                                                       .   00     

44.Lump sum retirement credit (see instructions to calculate the credit)..................................................44.                                                                     .   00     

45. Senior citizen’s credit (limit – $50 per return)....................................................................................45.                                                       .   00     
46. Lump sum distribution credit (must be 65 or older to claim this credit; see instructions to 
      calculate this credit)............................................................................................................................. 46.                                     .   00    

47. Child and dependent care credit (see instructions and worksheet in Ohio IT 1040 booklet)...................47.                                                                                .   00     

48. Ohio political contributions credit.........................................................................................................48.                                               .   00     

49.Ohio adoption credit (limit $10,000)....................................................................................................49.                                                    .   00     

50. Total Schedule B credits (sum of lines 43 through 49) enter here and on line 9.............................50.                                                                              .   00     
Schedule C – Estate Ohio Resident Credit   
51. Enter the portion of Ohio taxable income (line 3) subjected to tax by other states or the 
      District of Columbia while an Ohio resident .......................................................................................51.                                                      .   00     

52. Enter Ohio taxable income (line 3).....................................................................................................52.                                                    .   00     
53. Divide line 51 by line 52 and enter percentage here              %. Multiply this percentage 
      by the amount shown on line 8 reduced by any amount shown on line 9..........................................53.                                                                            .   00     
54.   Enter the 2016 income tax, less all related credits other than withholding and estimated tax payments   
      and carryforwards from previous years, paid to other states or the District of Columbia................................54.                                                                  .   00     
55. Enter the smaller of line 53 or line 54. This is your Ohio resident tax credit. Enter here and on 
      line 10.................................................................................................................................................55.                                 .   00     

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

                                                                                                                 2016 IT 1041 – pg. 3 of 5   

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                      Depa~ment of 
*     Ohio I Taxation                                       2016 Ohio IT 1041                                                                                                                                *  

                      Rev. 8/16                  Fiduciary Income Tax Return                                                                                            111111111111111 16180406II II I IIII 
                                                                                                                                                                                                   
FEIN   

                                     If the amount on a line is negative, place a negative sign (“–”) before the figure.   
Schedule D – Estate Nonresident Credit   
56. Enter the portion of Ohio taxable income (line 3) not earned or received in Ohio (include   
      Ohio IT 2023)......................................................................................................................................56.                                          .   00     

57. Enter Ohio taxable income (line 3).....................................................................................................57.                                                        .   00     
58. Divide line 56 by line 57 and enter percentage here                 %.Multiply   this percentage   
      by the amount shown on line 8 reduced by the amount shown online       9. Enter here and on 
      line 10.................................................................................................................................................58.                                     .   00     

Schedule F – Allocated Qualifying Trust Amounts   
59. Enter the trust’s portion of capital gains/losses recognized to the extent included in Ohio 
      taxable income (line 3) if the location of the physical assets of the closely held investee is 
      available.............................................................................................................................................59.                                       .   00     

60. Enter the percentage of the closely held investee’s physical assets located within Ohio ..................60.                                                       
                                                                                                                                                                                                                  
61. Multiply the amount on line 59 by the percentage on line 60. Enter here and on line 4.....................61.                                                                                     .   00

Schedule G – Apportioned Income for Trusts   
62.   Enter (i) the trust’s business income not included in line 59 and (ii) the trust’s qualifying 
      investment income not otherwise a part of business income and not included in line 59..................62.                                                                                      .   00     

63. Enter the Ohio apportionment ratio from line 78 of the apportionment worksheet on page 5............63.                                                             
64. Multiply the amount on line 62 by the apportionment ratio on line 63. Enter here and on 
      line 5...................................................................................................................................................64.                                    .   00     

Schedule H – Allocated Nonbusiness Income for Trusts   
If distributive share is business income from a pass-through entity, use Schedule G.   
65. Resident trusts: Enter the trust’s portion of Ohio taxable income (line 3) not reported on lines   
      59 or 62 ..............................................................................................................................................65.                                      .   00     
66. Nonresident trusts: Enter the trust’s portion of Ohio taxable income (line 3) not reported on 
      lines 59 or 62 to the extent such income (i) was derived from real or tangible property located 
      in or based in Ohio or (ii) was sitused to Ohio (see instructions for line 66) ......................................66.                                                                        .   00     

67. Add lines 65 and 66 and enter here and on line 6 .............................................................................67.                                                                 .   00     

Schedule I – Tax Credit for Resident Trusts   
68. Enter the amount of allocated resident trust nonbusiness income (line 65, above) subject to 
      tax in one or more states or in the District of Columbia .....................................................................68.                                                               .   00     

69. Enter the amount from line 8..............................................................................................................69.                                                     .   00     

70. Enter the amount of modified Ohio taxable income from line 7  ..........................................................70.                                                                        .   00     
71. Divide line 69 by line 70 and enter the percentage here. This is the average effective tax 
      rate.....................................................................................................................................................71.      

72. Multiply the amount on line 68 by the percentage reported on line 71   ...............................................72.                                                                         .   00
73. Enter the amount of tax actually paid by the resident trustto   another state or the District of 
      Columbia on the trust’s allocated nonbusiness income .....................................................................73.                                                                   .   00     
74. Enter the smaller of the amount on lines 72 and 73. This   isthe resident trust’s Ohio tax credit. 
      Enter here and on line 10...................................................................................................................74.                                                 .   00     

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

                                                                                                          2016 IT 1041 – pg. 4 of 5   

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                   Depa~ment of 
*    Ohio I Taxation                                           2016 Ohio IT 1041                                                                                   *  

                   Rev. 8/16                Fiduciary Income Tax Return                                                        111111111111111 16180506IIII I IIII 
                                                                                                                                                        
FEIN   

Apportionment Worksheet   
Use this worksheet to calculate the apportionment ratio for thetrust’s       modified business income and qualifying investment income included in Ohio taxable 
income. Note:   All ratios are to be carried to six decimal places.   
75. Property                                                   Within Ohio                                                     Total Everywhere   
a) Owned (average cost)                                                                       .   00                                                        .   00    
                                                               Within Ohio                                                     Total Everywhere   
b) Rented (annual rental X 8)                                                                 .   00                                                        .   00    
                                                               Within Ohio                                                     Total Everywhere   
c) Total (lines 75a and 75b)                                                                  .   00     ÷                                                  .   00     
                                                                                     Ratio                            Weight            Weighted Ratio   
                                                                        =                                      x    0          =   
                                                               Within Ohio                                                     Total Everywhere   
76. Payroll                                                                                   .   00    ÷÷÷÷                                                . 00     
                                                                                     Ratio                            Weight            Weighted Ratio   
                                                                        =                                      x    0          =   
                                                               Within Ohio                                                     Total Everywhere   
77. Sales                                                                                     .   00   ÷                                                    .   00     
                                                                                     Ratio                            Weight            Weighted Ratio   
                                                                        =                                        x  0          =   
                                                                                                                                        Weighted Ratio   
78. Total weighted apportionment ratio (add weighted ratio from lines 75c, 76 and 77). Enter ratio here and on 
   Schedule G, line 63 (carry to six decimal places).   
Note: If the denominator of any factor is zero, the weight given to the other factors must be proportionately increased so that the total weight given to the 
combined number of factors used is 100%, i.e., if no property/payroll, use 25% and 75%; if no sales, use 50% property/payroll;if        only one factor, use 100%.   

Net Payment Worksheet – Include 1099(s) and W-2(s)   
79a. Estimated payments                                     79b.Prior   year credit carryover                  79c. 1099 withholdings   
                                    .   00                                                        .   00                                          .   00    
79d. W-2 withholdings                                       79e. Refunds previously claimed   
                                    .   00                                                        .   00    
80.  Net payments (sum of lines 79a-d minus line 79e). Enter here and on page 2, line 14.   
                                        .   00    

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

                                                                                                                    2016 IT 1041 – pg. 5 of 5   

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