PDF document

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                                          Rev. 11/4/16

Scan Speciﬁ cations for the 

2016 Ohio IT 1040

Important Note

The following document (2016 Ohio IT 1040) contains grids for place-
ment of information on this speciﬁ c tax form. To accurately print, do not 
reduce the size, rotate or center this document. Doing so will jeopar-
dize the integrity of the grid. When printing from Adobe Reader, please 
select “None” for “Page Scaling,” which is under “Page Handling.”

       Ohio Department of Taxation

                        4485 Northland Ridge Blvd.

                        Columbus, OH 43229

                        tax.ohio.gov

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Grid layout 

with notations

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4                                                              Do not use staples. Use only black ink and UPPERCASE letters. 
5                  New! The date the return was gen-
                                                                                     2016 Ohio IT 1040 
6                  erated by the taxpayer (MM DD YY).
7                           Rev. 9/16                          Individual Income Tax Return
                                                                                                                                                                                                         
8  88 88 88
9                           Note: This form encompasses the IT 1040, IT 1040EZ and amended IT 1040X.

   Is this an amended return?                                             If yes, include Ohio IT RE (do not include a copy of the previously ﬁ led return)  
10                                       XYes      XNo                                                     Placement of the 1D bar code and tax year is critical. 
11                                                                                                         Make sure to follow the grid positions for layout. Do 
12 Is this a Net Operating Loss (NOL) carryback?                              X    Yes        X NoIf yes, includenotScheduleforget to getITyourNOLbar code(s) assignments for 
   Taxpayer’s SSN (required)                                              If deceased Spouse’s SSN (if ﬁ ling jointly)every form, version and page.                                      If deceased
13                                                                                                                                                                                                    Enter school district # for 
14 888 88  8888                                                                    X  888 88  8888                                                                                          X             this return (see instructions).
15                                                                        check box                                                                                                         check box     SD#      8888
16 First name                                                                         M.I.        Last name
17 JOHNXXXXXXXXXXX                                                                    Q           PUBL I   CXXXXXXXXXXXXXX
18
19 Spouse's ﬁ rst name (only if married ﬁ ling jointly)                               M.I.        Last name
20 JANEXXXXXXXXXXX                                                                    Q           PUBL I   CXXXXXXXXXXXXXX
21
22 Mailing address (for faster processing, use a street address)
23 8888  CHERRY    LANEXXXXXXXXXXXXXXXXXXX
24
25 City                                                                                                        State          ZIP code                                                      Ohio county (ﬁ rst four letters)

26 CITYXXXXXXXXXXXXXXXX                                                                                        OH             88888                                                         PICK
27 Home address (if different from mailing address) – do NOT include city or state                                            ZIP code                                                      Ohio county (ﬁ rst four letters)
28 8888  BERRY AVEXXXXXXXXXX                                                                                                  88888                                                         FRAN
29
30 Foreign country (if the mailing address is outside the U.S.)                                                               Foreign postal code
31 JAPANXXXXXXXXXXXXXXX                                                                                                       8888888
32
33
   Ohio Residency Status – Check applicable box                                                            Filing Status – Check one (as reported on federal income tax return, 
34       Full-year            Part-year                              Nonresident                           with limited exceptions – see instructions)
35 X     resident           X resident                         X     Indicate state           XX             X          Single, head of household or qualifying widow(er)
36
   Check applicable box for spouse (only if married ﬁ ling jointly)
37       Full-year            Part-year                              Nonresident                               X          Married ﬁ ling jointly                                      X     Married ﬁ ling separately
                                                                                                                                                                                                                            Yes   No
38 X     resident           X resident                         X     Indicate state           XX
                                                                                                Yes  No    Did you ﬁ le the federal extensionNew! Do4868?not place......................................spaces be-
39 Ohio Political Party Fund                                                                                                                                                          tween whole dollar numbers. There     YesXXNo
40 Do you want $1 to go to this fund? ............................................              XX         Is someone else claimingisyouonlyora spaceyour spousebetween(ifdollarjoint return) as 
41                                                                                                         a dependent? If yes, enteramounts"0" on lineand4 ........................................cents ﬁ elds.           XX
42 If joint return, does your spouse want $1 to go to this fund? .....
                                                                                                XX
43 Note: Checking “Yes” will not increase your tax or decrease your refund.
44
    1. Federal adjusted gross income (from the federal 1040, line 37; 1040A, line 21; 
45         1040EZ, line 4; 1040NR, line 36; or 1040NR-EZ,For staticlinetext10)use.................................................................1.Arial font (black ink) and try to       88888888888 00
46                                                                   match size. For data entry ﬁ elds (shown in red 
47                                                                   for identiﬁ cation purposes only), use Arial font 
     2a. Additions to federal adjusted gross income(black(includeink). AllOhiothe dataScheduleentry ﬁA,eldslinemust10)follow.........................2a.                                    88888888888 00
48   2b. Deductions from federal adjusted grossgridincomelayout.(includeWhenOhioa  ﬁ eld Schedulereﬂ ects aA,negativeline 35) ..................2b.                                         88888888888 00
49                                                                   amount, make sure there is      no space between                                                                       88888888888 00
     3. Ohio adjusted gross income (line 1 plus linethe amount2a minusandlinethe2b)negative....................................................3.sign. Never hard 
50    4. Personal and dependent exemption deductioncode a(ifnegativeclaimingsign.dependent(s), include Schedule J) ...4.                                                                                  88888 00
51   5. Ohio income tax base (line 3 minus line 4; if less than -0-, enter -0-) ...........................................5.                                                               88888888888 00
52                                                                                                                                                                                                888888888 00
     6. Taxable business income (include Ohio Schedule IT BUS, line 13) ..............................................6.
53   7. Line 5 minus line2D barcode6 (if lessrequired.than -0-,Deleteenterthis-0-) ...............................................................................7.                        88888888888 00
54                      box with text and replace it with 
55                      the 2D barcode.
56
57                                                                                                                                                                                                Target marks or registration marks 
58                                                                                                                                                                                    Include your federal income tax returnmust measure 6 mm X 6 mm. The 
                                                                                                                                                                                      if line 1 of this return is -0- or negative.four target marks or registration 
59                 Do not write in this area; for department use only.                                                                                                                            marks on every page must follow 
                                                                                                                                                                                                  grid layout.
60                                                                                                                                                                                          /            /
61                                                                                                                                                                                          Postmark date            Code
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                                                                                                                                           2016 IT 1040 – page 1 of 2
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123456789 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
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                                                                  2016 Ohio IT 1040 
6
7                          Rev. 9/16               Individual Income Tax Return
                                                                                                                                                                          
8     SSN    888 88  8888
9                                                                                                                                                                 88888888888 00
     7a. Amount from line 7 on page 1 ..................................................................................................................7a. 
10  
11                                                                                                                                                                        888888888 00
     8a. Nonbusiness income tax liability on line 7a (see instructions for tax tables) ............................................8a.
     8b. Business income tax liability (include Ohio Schedule IT BUS, line 14) ................................................... 8b.                                      8888888 00
12                                                                                                                                                                        888888888 00
     8c. Income tax liability before credits (line 8a plus line 8b) ........................................................................... 8c.
13   9. Ohio nonrefundable credits (include  Ohio Schedule of Credits, line 34) .................................................. 9.                                     888888888 00
14                                                                                                                                                                        888888888 00
     10. Tax liability after nonrefundable credits (line 8c minus line 9; if less than -0-, enter -0-) ..........................10. 
15  
      11. Interest penalty on underpayment of estimated tax (include Ohio IT/SD 2210) .......................................11.                                          888888888 00
16  
17   12. Sales and use tax due on Internet, mail order or other out-of-state purchases (see instructions). 
        If you certify that no sales or use tax is due, check the box to the right ........................................  X ...12.                                     888888888 00
18                                                                                                                                                                        888888888 00
    13. Total Ohio tax liability before withholding or estimated payments (add lines 10, 11 and 12) ................13.
19
20   14. Ohio income tax withheld (W-2, box 17; W-2G, box 15; 1099-R, box 12). Include W-2(s), W-2G(s) and 
        1099-R(s) with the return ..........................................................................................................................14.           888888888 00
21
22  15. Estimated and extension payments made (2016 Ohio IT 1040ES and/or IT 40P) and credit 
        carryforward from previous year return ......................................................................................................15.                  888888888 00
23
24                                                                                                                                                                        888888888 00
     16. Refundable credits (include Ohio Schedule of Credits, line 41) ...............................................................16.
25  17. Amended return only – amount previously paid with original/amended return ......................................17.                                               888888888 00
26
27  
    18. Total Ohio tax payments (add lines 14, 15, 16 and 17) .........................................................................18.                                888888888 00
28  19. Amended return only – overpayment previously requested on original/amended return ......................19.                                                       888888888 00
29
    
30   20. Line 18 minus line 19 ...............................................................................................................................20.         888888888 00
31  
32
33             If line 20 is MORE THAN line 13, skip to line 24. OTHERWISE, continue to line 21.
34
35   21. Tax liability (line 13 minus line 20) ............................................................................................................21.            888888888 00
36  22. Interest and penalty due on late ﬁ ling or late payment of tax (see instructions) ...........................................................22.                  888888888 00
37
38  23. TOTAL AMOUNT DUE (line 21 plus line 22). Include Ohio IT 40P (if original return) or IT 40XP
        (if amended return) and make check payable to “Ohio Treasurer of State” ........AMOUNT DUE23.                                                                    888888888 00
39
40    24. Overpayment (line 20 minus line 13) ........................................................................................................24.                 888888888 00
41  25. Original return only – amount of line 24 to be credited toward 2017 income tax liability .........................25.                                             888888888 00
42
43   26. Amount of line 24 to be donated:
44      a. Wildlife species             b. Military injury relief     c. Ohio History Fund

45         8888 00                          8888 00                      8888 00
46   
47      d. State nature preserves       e. Breast / cervical cancer   f. Wishes for Sick Children
48    8888 00                               8888 00                      8888 00                           Total.......26g.                                               888888888 00
49
50  27. YOUR REFUND (line 24 minus lines 25 and 26g) ...................................................YOUR  REFUND27.                                                  888888888 00
51
52
53    Sign Here (required): I have read this return. Under penalties of perjury, I declare that, to                          If your refund is $1.00 or less, no refund will be issued. 
54    the best of my knowledge and belief, the return and all enclosures are true, correct and complete.                     If you owe $1.00 or less, no payment is necessary.
55                                                                                                                                                       NO Payment Included   Mail–      to:
56  Your signature                                                          Date (MM/DD/YY)                                                                      Ohio Department of Taxation
                                                                                                                                                                  P.O. Box 2679
57                                                                                                                                                                Columbus, OH  43270-2679
58  Spouse’s signature (see instructions)                                   Phone number
                                                                                                                                                                  Payment Included   Mail–to:
59                                                                                                                                                                Ohio Department of Taxation
          Preparer’s printed name (see Instructions)       PTIN              Phone number
60                                                                                                                                                                P.O. Box 2057
          Do you authorize your preparer to contact us regarding this return?      XXYes                No                                                        Columbus, OH  43270-2057
61
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                                                                                                           2016 IT 1040 – page 2 of 2
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Grid layout

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123456789 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3
4                                          Do not use staples. Use only black ink and UPPERCASE letters. 
5
                                                          2016 Ohio IT 1040 
6
7                 Rev. 9/16                      Individual Income Tax Return
                                                                                                                                                          
8  88 88 88
9                          Note: This form encompasses the IT 1040, IT 1040EZ and amended IT 1040X.

10                              XYes      XNo
   Is this an amended return?                    If yes, include Ohio IT RE (do not include a copy of the previously ﬁ led return)  
11
12 Is this a Net Operating Loss (NOL) carryback?        X Yes        X             NoIf yes, include Schedule IT NOL
   Taxpayer’s SSN (required)                     If deceased          Spouse’s SSN (if ﬁ ling jointly)                                         If deceased
13                                                                                                                                                     Enter school district # for 
14 888 88  8888                                         X                          888 88  8888                                                X           this return (see instructions).
15                                               check box                                                                                     check box   SD#        8888
16 First name                                                   M.I.                 Last name
17 JOHNXXXXXXXXXXX                                              Q                    PUBL I   CXXXXXXXXXXXXXX
18
19 Spouse's ﬁ rst name (only if married ﬁ ling jointly)         M.I.                 Last name
20 JANEXXXXXXXXXXX                                              Q                    PUBL I   CXXXXXXXXXXXXXX
21
22 Mailing address (for faster processing, use a street address)
23 8888  CHERRY    LANEXXXXXXXXXXXXXXXXXXX
24
25 City                                                                                       State          ZIP code                          Ohio county (ﬁ rst four letters)

26 CITYXXXXXXXXXXXXXXXX                                                                       OH             88888                             PICK
27 Home address (if different from mailing address) – do NOT include city or state                           ZIP code                          Ohio county (ﬁ rst four letters)
28 8888  BERRY AVEXXXXXXXXXX                                                                                 88888                             FRAN
29
30 Foreign country (if the mailing address is outside the U.S.)                                              Foreign postal code
31 JAPANXXXXXXXXXXXXXXX                                                                                      8888888
32
33
   Ohio Residency Status – Check applicable box                                               Filing Status – Check one (as reported on federal income tax return, 
34      Full-year          Part-year             Nonresident                                  with limited exceptions – see instructions)
35 X    resident  X        resident   X          Indicate state                  XX         X              Single, head of household or qualifying widow(er)
36
   Check applicable box for spouse (only if married ﬁ ling jointly)
37      Full-year          Part-year             Nonresident                                  X              Married ﬁ ling jointly         X  Married ﬁ ling separately
                                                                                                                                                                                Yes No
38 X    resident  X        resident   X          Indicate state                  XX
                                                                                   Yes  No    Did you ﬁ le the federal extension 4868? ......................................
39 Ohio Political Party Fund                                                                                                                                                    YesXXNo
40 Do you want $1 to go to this fund? ............................................ XX         Is someone else claiming you or your spouse (if joint return) as 
41                                                                                            a dependent? If yes, enter "0" on line 4 ........................................ XX
42 If joint return, does your spouse want $1 to go to this fund? .....
                                                                                   XX
43 Note: Checking “Yes” will not increase your tax or decrease your refund.
44
    1. Federal adjusted gross income (from the federal 1040, line 37; 1040A, line 21; 
45      1040EZ, line 4; 1040NR, line 36; or 1040NR-EZ, line 10) .................................................................1.            88888888888 00
46
47  
     2a. Additions to federal adjusted gross income (include Ohio Schedule A, line 10) .........................2a.                            88888888888 00
48   2b. Deductions from federal adjusted gross income (include Ohio Schedule A, line 35) ..................2b.                                88888888888 00
49                                                                                                                                             88888888888 00
     3. Ohio adjusted gross income (line 1 plus line 2a minus line 2b) ....................................................3.
50    4. Personal and dependent exemption deduction (if claiming dependent(s), include Schedule J) ...4.                                                   88888 00
51   5. Ohio income tax base (line 3 minus line 4; if less than -0-, enter -0-) ...........................................5.                  88888888888 00
52                                                                                                                                               888888888 00
     6. Taxable business income (include Ohio Schedule IT BUS, line 13) ..............................................6.
53   7. Line 5 minus line 6 (if less than -0-, enter -0-) ...............................................................................7.    88888888888 00
54
55
56
57
58                                                                                                                           Include your federal income tax return
                                                                                                                             if line 1 of this return is -0- or negative.
59               Do not write in this area; for department use only.
60                                                                                                                                             /          /
61                                                                                                                                             Postmark date            Code
62
63
                                                                                                                 2016 IT 1040 – page 1 of 2
64
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123456789 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
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                                                                  2016 Ohio IT 1040 
6
7                          Rev. 9/16               Individual Income Tax Return
                                                                                                                                                                          
8     SSN    888 88  8888
9                                                                                                                                                                 88888888888 00
     7a. Amount from line 7 on page 1 ..................................................................................................................7a. 
10  
11                                                                                                                                                                        888888888 00
     8a. Nonbusiness income tax liability on line 7a (see instructions for tax tables) ............................................8a.
     8b. Business income tax liability (include Ohio Schedule IT BUS, line 14) ................................................... 8b.                                      8888888 00
12                                                                                                                                                                        888888888 00
     8c. Income tax liability before credits (line 8a plus line 8b) ........................................................................... 8c.
13   9. Ohio nonrefundable credits (include  Ohio Schedule of Credits, line 34) .................................................. 9.                                     888888888 00
14                                                                                                                                                                        888888888 00
     10. Tax liability after nonrefundable credits (line 8c minus line 9; if less than -0-, enter -0-) ..........................10. 
15  
      11. Interest penalty on underpayment of estimated tax (include Ohio IT/SD 2210) .......................................11.                                          888888888 00
16  
17   12. Sales and use tax due on Internet, mail order or other out-of-state purchases (see instructions). 
        If you certify that no sales or use tax is due, check the box to the right ........................................  X ...12.                                     888888888 00
18                                                                                                                                                                        888888888 00
    13. Total Ohio tax liability before withholding or estimated payments (add lines 10, 11 and 12) ................13.
19
20   14. Ohio income tax withheld (W-2, box 17; W-2G, box 15; 1099-R, box 12). Include W-2(s), W-2G(s) and 
        1099-R(s) with the return ..........................................................................................................................14.           888888888 00
21
22  15. Estimated and extension payments made (2016 Ohio IT 1040ES and/or IT 40P) and credit 
        carryforward from previous year return ......................................................................................................15.                  888888888 00
23
24                                                                                                                                                                        888888888 00
     16. Refundable credits (include Ohio Schedule of Credits, line 41) ...............................................................16.
25  17. Amended return only – amount previously paid with original/amended return ......................................17.                                               888888888 00
26
27  
    18. Total Ohio tax payments (add lines 14, 15, 16 and 17) .........................................................................18.                                888888888 00
28  19. Amended return only – overpayment previously requested on original/amended return ......................19.                                                       888888888 00
29
    
30   20. Line 18 minus line 19 ...............................................................................................................................20.         888888888 00
31  
32
33             If line 20 is MORE THAN line 13, skip to line 24. OTHERWISE, continue to line 21.
34
35   21. Tax liability (line 13 minus line 20) ............................................................................................................21.            888888888 00
36  22. Interest and penalty due on late ﬁ ling or late payment of tax (see instructions) ...........................................................22.                  888888888 00
37
38  23. TOTAL AMOUNT DUE (line 21 plus line 22). Include Ohio IT 40P (if original return) or IT 40XP
        (if amended return) and make check payable to “Ohio Treasurer of State” ........AMOUNT DUE23.                                                                    888888888 00
39
40    24. Overpayment (line 20 minus line 13) ........................................................................................................24.                 888888888 00
41  25. Original return only – amount of line 24 to be credited toward 2017 income tax liability .........................25.                                             888888888 00
42
43   26. Amount of line 24 to be donated:
44      a. Wildlife species             b. Military injury relief     c. Ohio History Fund

45         8888 00                          8888 00                      8888 00
46   
47      d. State nature preserves       e. Breast / cervical cancer   f. Wishes for Sick Children
48    8888 00                               8888 00                      8888 00                           Total.......26g.                                               888888888 00
49
50  27. YOUR REFUND (line 24 minus lines 25 and 26g) ...................................................YOUR  REFUND27.                                                  888888888 00
51
52
53    Sign Here (required): I have read this return. Under penalties of perjury, I declare that, to                          If your refund is $1.00 or less, no refund will be issued. 
54    the best of my knowledge and belief, the return and all enclosures are true, correct and complete.                     If you owe $1.00 or less, no payment is necessary.
55                                                                                                                                                       NO Payment Included   Mail–      to:
56  Your signature                                                          Date (MM/DD/YY)                                                                      Ohio Department of Taxation
                                                                                                                                                                  P.O. Box 2679
57                                                                                                                                                                Columbus, OH  43270-2679
58  Spouse’s signature (see instructions)                                   Phone number
                                                                                                                                                                  Payment Included   Mail–to:
59                                                                                                                                                                Ohio Department of Taxation
          Preparer’s printed name (see Instructions)       PTIN              Phone number
60                                                                                                                                                                P.O. Box 2057
          Do you authorize your preparer to contact us regarding this return?      XXYes                No                                                        Columbus, OH  43270-2057
61
62
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                                                                                                           2016 IT 1040 – page 2 of 2
64
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66

- 8 -

Layout 

without grid

- 9 -

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

2016 Ohio IT 1040
Rev. 9/16 Individual Income Tax Return

88 88 88 Note: This form encompasses the IT 1040, IT 1040EZ and amended IT 1040X.

Is this an amended return? XYes XNo If yes, include Ohio IT RE (do not include a copy of the previously ﬁ led return)

Is this a Net Operating Loss (NOL) carryback? X Yes X NoIf yes, include Schedule IT NOL
Taxpayer’s SSN (required) If deceased Spouse’s SSN (if ﬁ ling jointly) If deceased
  Enter school district # for
888 88 8888 X 888 88 8888 X this return (see instructions).
check box check box SD# 8888
First name M.I. Last name
JOHNXXXXXXXXXXX Q PUBL I CXXXXXXXXXXXXXX
Spouse's ﬁ rst name (only if married ﬁ ling jointly) M.I. Last name
JANEXXXXXXXXXXX Q PUBL I CXXXXXXXXXXXXXX
Mailing address (for faster processing, use a street address)
8888 CHERRY LANEXXXXXXXXXXXXXXXXXXX
City State ZIP code Ohio county (ﬁ rst four letters)

CITYXXXXXXXXXXXXXXXX OH 88888 PICK
Home address (if different from mailing address) – do NOT include city or state ZIP code Ohio county (ﬁ rst four letters)
8888 BERRY AVEXXXXXXXXXX 88888 FRAN
Foreign country (if the mailing address is outside the U.S.) Foreign postal code
JAPANXXXXXXXXXXXXXXX 8888888

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)
X resident X resident X Indicate state XX X Single, head of household or qualifying widow(er)
Check applicable box for spouse (only if married ﬁ ling jointly)
Full-year Part-year Nonresident X Married ﬁ ling jointly X Married ﬁ ling separately
Yes No
X resident X resident X Indicate state XX
Yes No Did you ﬁ le the federal extension 4868? ......................................
Ohio Political Party Fund YesXXNo
Do you want $1 to go to this fund? ............................................ XX Is someone else claiming you or your spouse (if joint return) as
a dependent? If yes, enter "0" on line 4 ........................................ XX
If joint return, does your spouse want $1 to go to this fund? .....
XX
Note: Checking “Yes” will not increase your tax or decrease your refund.
1. Federal adjusted gross income (from the federal 1040, line 37; 1040A, line 21;
1040EZ, line 4; 1040NR, line 36; or 1040NR-EZ, line 10) .................................................................1. 88888888888 00

2a. Additions to federal adjusted gross income (include Ohio Schedule A, line 10) .........................2a. 88888888888 00
2b. Deductions from federal adjusted gross income (include Ohio Schedule A, line 35) ..................2b. 88888888888 00
3. Ohio adjusted gross income (line 1 plus line 2a minus line 2b) ....................................................3. 88888888888 00
4. Personal and dependent exemption deduction (if claiming dependent(s), include Schedule J) ...4. 88888 00
5. Ohio income tax base (line 3 minus line 4; if less than -0-, enter -0-) ...........................................5. 88888888888 00
6. Taxable business income (include Ohio Schedule IT BUS, line 13) ..............................................6. 888888888 00
7. Line 5 minus line 6 (if less than -0-, enter -0-) ...............................................................................7. 88888888888 00

Include 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.
/ /
Postmark date Code

2016 IT 1040 – page 1 of 2

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                                                               2016 Ohio IT 1040 
                           Rev. 9/16             Individual Income Tax Return
                                                                                                                                                                       
   SSN     888 88  8888
   7a. Amount from line 7 on page 1 ..................................................................................................................7a.      88888888888 00
   8a. Nonbusiness income tax liability on line 7a (see instructions for tax tables) ............................................8a.                                   888888888 00
  8b. Business income tax liability (include Ohio Schedule IT BUS, line 14) ................................................... 8b.                                      8888888 00
  8c. Income tax liability before credits (line 8a plus line 8b) ........................................................................... 8c.                       888888888 00
  9. Ohio nonrefundable credits (include  Ohio Schedule of Credits, line 34) .................................................. 9.                                     888888888 00
   10. Tax liability after nonrefundable credits (line 8c minus line 9; if less than -0-, enter -0-) ..........................10.                                     888888888 00
   11. Interest penalty on underpayment of estimated tax (include Ohio IT/SD 2210) .......................................11.                                          888888888 00
 
  12. Sales and use tax due on Internet, mail order or other out-of-state purchases (see instructions). 
     If you certify that no sales or use tax is due,   check the box to the right ........................................  X ...12.                                   888888888 00
 13. Total Ohio tax liability before withholding or estimated payments (add lines 10, 11 and 12) ................13.                                                   888888888 00
  14. Ohio income tax withheld (W-2, box 17; W-2G, box 15; 1099-R, box 12). Include W-2(s), W-2G(s) and 
     1099-R(s) with the return ..........................................................................................................................14.           888888888 00
 15. Estimated and extension payments made (2016 Ohio IT 1040ES and/or IT 40P) and credit 
     carryforward from previous year return ......................................................................................................15.                  888888888 00

  16. Refundable credits (include Ohio Schedule of Credits, line 41) ...............................................................16.                                888888888 00
 17. Amended return only – amount previously paid with original/amended return ......................................17.                                               888888888 00
 
 18. Total Ohio tax payments (add lines 14, 15, 16 and 17) .........................................................................18.                                888888888 00
 19. Amended return only – overpayment previously requested on original/amended return ......................19.                                                       888888888 00
 
  20. Line 18 minus line 19 ...............................................................................................................................20.         888888888 00
 
            If line 20 is MORE THAN line 13, skip to line 24. OTHERWISE, continue to line 21.

  21. Tax liability (line 13 minus line 20) ............................................................................................................21.            888888888 00
 22. Interest and penalty due on late ﬁ ling or late payment of tax (see instructions) ...........................................................22.                  888888888 00
 23. TOTAL AMOUNT DUE (line 21 plus line 22). Include Ohio IT 40P (if original return) or IT 40XP
     (if amended return) and make check payable to “Ohio Treasurer of State” ........AMOUNT DUE23.                                                                    888888888 00

   24. Overpayment (line 20 minus line 13) ........................................................................................................24.                 888888888 00
 25. Original return only – amount of line 24 to be credited toward 2017 income tax liability .........................25.                                             888888888 00
  26. Amount of line 24 to be donated:
     a. Wildlife species             b. Military injury relief       c. Ohio History Fund

        8888 00                          8888 00                           8888 00
  
     d. State nature preserves       e. Breast / cervical cancer     f. Wishes for Sick Children
   8888 00                               8888 00                           8888 00                      Total.......26g.                                               888888888 00

 27. YOUR REFUND (line 24 minus lines 25 and 26g) ...................................................YOUR  REFUND27.                                                  888888888 00

   Sign Here (required): I have read this return. Under penalties of perjury, I declare that, to                            If your refund is $1.00 or less, no refund will be issued. 
   the best of my knowledge and belief, the return and all enclosures are true, correct and complete.                       If you owe $1.00 or less, no payment is necessary.
                                                                                                                                                      NO Payment Included   Mail–      to:
 Your signature                                                            Date (MM/DD/YY)                                                                    Ohio Department of Taxation
                                                                                                                                                               P.O. Box 2679
 Spouse’s signature (see instructions)                                     Phone number                                                                       Columbus, OH  43270-2679
                                                                                                                                                               Payment Included   Mail–to:
                                                                                                                                                               Ohio Department of Taxation
       Preparer’s printed name (see Instructions)       PTIN                Phone number                                                                       P.O. Box 2057
       Do you authorize your preparer to contact us regarding this return?        XXYes              No                                                        Columbus, OH  43270-2057

                                                                                                        2016 IT 1040 – page 2 of 2

- 11 -

General information 

regarding this form

- 12 -

              General Information (2016 IT 1040):

1) Dimensions: 
  
  Target or Registration Marks - 6 mm X 6 mm. Follow grid layout for positioning.

  1D barcode (2 of 5 interleaved) - .375”H x 1.5”W. Follow grid layout for positioning. Center the barcode  
  number directly under the barcode.

  2D barcode (PDF 417) - See 2D instructions and schema. Follow grid layout for positioning. There is one 
  2D barcode for the IT 1040 and Schedule A.

2) 1D barcode - The last two numbers of the 1D barcode represent the vendor number. Use the same vendor 
number as you did for last year’s return. If you have a question about your barcode assignment, e-mail the Forms 
Unit at Forms@tax.state.oh.us. The ﬁ rst six numbers are constant for this form (160001XX - 160002XX). 

  16 = tax year
  00 = IT 1040 
  01-02 = page number 
  XX = vendor number (assigned to you by the Ohio Dept. of Taxation, Forms Unit)

    NOTE: The vendor number also serves as the ﬁ rst two digits of the SSN in the test scenarios.

3) Use Arial font for the static text on the form.

4) Use monospaced Arial or similar monospaced san serif font for the variable data ﬁ elds on the form.

5) Follow the grid layout for the variable data ﬁ elds shown in red. Ensure that the tax year, target or reg-
istration marks, “For Department Use Only” area and the 1D and 2D barcodes follow grid layout.

6) Do not use commas, hyphens or decimals in the variable data ﬁ elds except where shown in specs.

7)  All monetary ﬁ elds must always show “00” in the cents ﬁ eld even though there may not be a value for that line.

8) When a variable data ﬁ eld reﬂ ects a negative amount, make sure there is no space between the negative sign 
and the amount (for example: -888888888 00). The possible negative ﬁ elds for this return are lines 1, 3 and 20. 
Do not hard-code negative signs.

9) Provide guidance to customers regarding duplex printing that instructs them to print pages 1 and 2 together. 
Taxpayers have ﬁ led returns with pages 2 and 3 duplexed or a worksheet or software receipt on the back of a 
page of the return. This slows the processing of the tax return.

10) Generate the following message for customers: “Do not enclose other documentation unless it is speciﬁ ed 
on the tax return or instructions.” Taxpayers often submit worksheets and receipts from the vendor product, 
which slows the processing of tax returns.

11) If the taxpayer is claiming dependents on the IT 1040, they must ﬁ le Schedule J. The Schedule J should be 
submitted with the IT 1040 income tax return; it should never be submitted by itself.

12) When the IT 1040 is ﬁ led as an amended return, please include the IT RE (Reason of Explanation and Correc-
tions), and if necessary, the IT NOL. Make sure that any barcodes on these returns represent your vendor number 
assignment. For example, if your last two digits of your 1D barcode are “05”, make sure that these are “05” also.

- 13 -

13) IMPORTANT NOTE: Add this statement to your software programs. It should print out with the taxpayer’s 
return. “Do not hand write in any corrections on the printed paper return. Hand writing in corrections will 
result in capturing incorrect data and delaying the processing of this income tax return. Make any cor-
rections to this income tax return within [the software program name], then print and mail.”

14) See the 2D barcode instructions for submission details.

- 14 -

                                            Rev. 11/4/16

Scan Speciﬁ cations for the 

2016 Ohio Schedule A

       Important Note

The following document (2016 Ohio Schedule A) contains grids for 
placement of information on this speciﬁ c tax form. To accurately print, 
do not reduce the size, rotate or center this document. Doing so will 
jeopardize the integrity of the grid. When printing from Adobe Reader, 
please select “None” for “Page Scaling,” which is under “Page Han-
dling.”

       Ohio Department of Taxation

                        4485 Northland Ridge Blvd.

                        Columbus, OH 43229

                        tax.ohio.gov

- 15 -

Grid layout 

with notations

- 16 -

123456789 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3
4                                                         Do not use staples. Use only black ink. 
5                      New! The date the return was gen-
                                                         2016 Ohio Schedule A
6                      erated by the taxpayer (MM DD YY).
7                          Rev. 9/16           Income Adjustments – Additions and Deductions
8                                                                           SSN of primary ﬁ ler                                                                                                 
        88 88 88
9                                                                888 88  8888
10
11                                                Additions                            Placement of the 1D bar code and tax year is critical. 
                                                                                       Make sure to follow the grid positions for layout. Do 
12                   (add income items only to the extent not included on Ohio IT 1040, line 1)not forget to get your bar code(s) assignments for 
                                                                                       every form, version and page.
13      1.  Non-Ohio state or local government interest and dividends ..................................................................... 1.                                                     888888888 00
14
15                                                                                                                                                                                                 888888888 00
        2.  Certain Ohio pass-through entity and ﬁ nancial institutions taxes paid ...................................................... 2.
16  
17      3.  Reimbursement of college tuition expenses and fees deducted in any previous year(s) and 
          noneducation expenditures from a college savings account ....................................................................3.                                                               888888 00
18
19                                                                                                                                                                                                 888888888 00
        4.  Losses from sale or disposition of Ohio public obligations ....................................................................... 4.
20                                                        For static text use Arial font (black ink) and try to 
21                                                        match size. For data entry ﬁ elds (shown in red 
        5.  Nonmedical withdrawals from a medical savings accountfor identiﬁ........................................................................cation purposes only), use Arial font 5.       888888888 00
22                                                        (black ink). All the data entry ﬁ elds must follow 
23      6.  Reimbursement of expenses previously deductedgridfor Ohiolayout.income tax purposes, but only if the                                                                                   888888888 00
          reimbursement is not in federal adjusted gross income ............................................................................ 6.
24
25      Federal
26                                                                                                                                                                                                 888888888 00
        7.  Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense .......................... 7.
27
28                                                                                                                                                                                                 888888888 00
        8.  Federal interest and dividends subject to state taxation ........................................................................... 8.
29
30                                                                                                                                                                                                 888888888 00
        9.  Miscellaneous federal income tax additions ............................................................................................. 9.
31
32                                                                                                                                                                                          88888888888 00
    10. Total additions (add lines 1 through 9 ONLY). Enter here and on Ohio IT 1040, line 2a) ........................ 10.
33
34
35                                                Deductions 
36                   (deduct income items only to the extent included on Ohio IT 1040, line 1)
37       
     11.  Business income deduction (include Ohio Schedule IT BUS, line 11) .................................................... 11.                                                                    888888 00
38
39  
     12.  Employee compensation earned in Ohio by residents of neighboring states ........................................... 12.                                                                  888888888 00
40
41   13.  State or municipal income tax overpayments shown on the federal 1040, line 10 ................................. 13.                                                                      888888888 00
42
43   14.  Qualifying Social Security beneﬁ ts and certain railroad retirement beneﬁ ts ........................................... 14.                                                             888888888 00
44
45   15.  Interest income from Ohio public obligations and from Ohio purchase obligations; gains from the 
46        sale or disposition of Ohio public obligations; public service payments received from the state of 
          Ohio; or income from a transfer agreement ............................................................................................ 15.                                               888888888 00
47                                                                                                                                                                                                 888888888 00
     16.  Amounts contributed to an individual development account ................................................................... 16.
48
49   17.  Amounts contributed to STABLE account: Ohio’s ABLE plan ................................................................. 17.                                                            888888888 00
50
51   Federal
52  
     18.  Federal interest and dividends exempt from state taxation .................................................................... 18.                                                       888888888 00
53
54     19.  Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense ........................ 19.                                                                         888888888 00
55
56   20.  Refund or reimbursements shown on the federal 1040, line 21 for itemized deductions claimed on a 
          prior year federal income tax return ........................................................................................................ 20.                                 Target marks888888888or registration00marks 
57                                                                                                                                                                                          must measure8888888886 mm X 6 mm.00The 
     21.  Repayment of income reported in a prior year ........................................................................................ 21.
58                                                                                                                                                                                          four target marks or registration 
                                                                                                                                                                                            marks on every page must follow 
     22.  Wage expense not deducted due to claiming the federal work opportunity tax credit ............................ 22.
59                                                                                                                                                                                          grid layout.888888888 00
60
61                                                                                                                                                                                                 888888888 00
     23.  Miscellaneous federal income tax deductions ........................................................................................ 23.
62  
63
                                               2016 Ohio Schedule A – page 1 of 2
64
65
66

- 17 -

123456789 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3
4
5
                                        2016 Ohio Schedule A
6
7           Rev. 9/16                   Income Adjustments – Additions and Deductions
8                                       SSN of primary ﬁ ler                                                                                                                   
9                                       888 88  8888
10  Uniformed Services
11                                                                                                                                                                             888888888 00
     24.  Military pay for Ohio residents received while the military member was stationed outside Ohio ............ 24.
12
13                                                                                                                                                                             888888888 00
     25.  Certain income earned by military nonresidents and civilian nonresident spouses .................................. 25.
14
15                                                                                                                                                                             888888888 00
     26.  Uniformed services retirement income ................................................................................................... 26.
16
17                                                                                                                                                                             888888888 00
    27.  Military injury relief fund ...................................................................................................................................... 27.
18
19                                                                                                                                                                             888888888 00
     28.  Certain Ohio National Guard reimbursements and beneﬁ ts ................................................................... 28.
20  
21 Education
22                                                                                                                                                                             888888 00
     29.  Ohio 529 contributions, tuition credit purchases ..................................................................................... 29.
23
24  
     30.  Pell/Ohio College Opportunity taxable grant amounts used to pay room and board .............................. 30.                                                    888888 00
25
26 Medical
27                                                                                                                                                                             888888888 00
     31.  Disability and survivorship beneﬁ ts (do not include pension continuation beneﬁ ts) ............................... 31.
28  
29   32.  Unreimbursed long-term care insurance premiums, unsubsidized health care insurance premiums
      and excess health care expenses (see instructions for worksheet) ........................................................ 32.                                            888888888 00
30
31   33.  Funds deposited into, and earnings of, a medical savings account for eligible health care expenses 
      (see instructions for worksheet) .............................................................................................................. 33.                      888888888 00
32
33  
    34.  Qualiﬁ ed organ donor expenses (maximum $10,000 per taxpayer) .................................................... 34.                                                88888 00
34
35                                                                                                                                                                             88888888888 00
    35. Total deductions (add lines 11 through 34 ONLY). Enter here and on Ohio IT 1040, line 2b ...........................35.
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
                                        2016 Ohio Schedule A – page 2 of 2
64
65
66

- 18 -

Grid layout

- 19 -

123456789 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3
4                                                         Do not use staples. Use only black ink. 
5
                                                 2016 Ohio Schedule A
6
7                          Rev. 9/16        Income Adjustments – Additions and Deductions
8                                                                    SSN of primary ﬁ ler                                                                   
        88 88 88
9                                                                888 88  8888
10
11                                               Additions 
12             (add income items only to the extent not included on Ohio IT 1040, line 1)
13      1.  Non-Ohio state or local government interest and dividends ..................................................................... 1.              888888888 00
14
15                                                                                                                                                          888888888 00
        2.  Certain Ohio pass-through entity and ﬁ nancial institutions taxes paid ...................................................... 2.
16  
17      3.  Reimbursement of college tuition expenses and fees deducted in any previous year(s) and 
          noneducation expenditures from a college savings account ....................................................................3.                   888888 00
18
19                                                                                                                                                          888888888 00
        4.  Losses from sale or disposition of Ohio public obligations ....................................................................... 4.
20
21  
        5.  Nonmedical withdrawals from a medical savings account ........................................................................ 5.               888888888 00
22
23      6.  Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if the 
          reimbursement is not in federal adjusted gross income ............................................................................ 6.             888888888 00
24
25      Federal
26                                                                                                                                                          888888888 00
        7.  Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense .......................... 7.
27
28                                                                                                                                                          888888888 00
        8.  Federal interest and dividends subject to state taxation ........................................................................... 8.
29
30                                                                                                                                                          888888888 00
        9.  Miscellaneous federal income tax additions ............................................................................................. 9.
31
32                                                                                                                                                          88888888888 00
    10. Total additions (add lines 1 through 9 ONLY). Enter here and on Ohio IT 1040, line 2a) ........................ 10.
33
34
35                                               Deductions 
36             (deduct income items only to the extent included on Ohio IT 1040, line 1)
37       
     11.  Business income deduction (include Ohio Schedule IT BUS, line 11) .................................................... 11.                        888888 00
38
39  
     12.  Employee compensation earned in Ohio by residents of neighboring states ........................................... 12.                           888888888 00
40
41   13.  State or municipal income tax overpayments shown on the federal 1040, line 10 ................................. 13.                               888888888 00
42
43   14.  Qualifying Social Security beneﬁ ts and certain railroad retirement beneﬁ ts ........................................... 14.                      888888888 00
44
45   15.  Interest income from Ohio public obligations and from Ohio purchase obligations; gains from the 
46        sale or disposition of Ohio public obligations; public service payments received from the state of 
          Ohio; or income from a transfer agreement ............................................................................................ 15.        888888888 00
47                                                                                                                                                          888888888 00
     16.  Amounts contributed to an individual development account ................................................................... 16.
48
49   17.  Amounts contributed to STABLE account: Ohio’s ABLE plan ................................................................. 17.                     888888888 00
50
51   Federal
52  
     18.  Federal interest and dividends exempt from state taxation .................................................................... 18.                888888888 00
53
54     19.  Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense ........................ 19.                                  888888888 00
55
56   20.  Refund or reimbursements shown on the federal 1040, line 21 for itemized deductions claimed on a 
          prior year federal income tax return ........................................................................................................ 20. 888888888 00
57                                                                                                                                                          888888888 00
     21.  Repayment of income reported in a prior year ........................................................................................ 21.
58
59                                                                                                                                                          888888888 00
     22.  Wage expense not deducted due to claiming the federal work opportunity tax credit ............................ 22.
60
61                                                                                                                                                          888888888 00
     23.  Miscellaneous federal income tax deductions ........................................................................................ 23.
62  
63
                                            2016 Ohio Schedule A – page 1 of 2
64
65
66

- 20 -

123456789 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3
4
5
                                        2016 Ohio Schedule A
6
7           Rev. 9/16                   Income Adjustments – Additions and Deductions
8                                       SSN of primary ﬁ ler                                                                                                                   
9                                       888 88  8888
10  Uniformed Services
11                                                                                                                                                                             888888888 00
     24.  Military pay for Ohio residents received while the military member was stationed outside Ohio ............ 24.
12
13                                                                                                                                                                             888888888 00
     25.  Certain income earned by military nonresidents and civilian nonresident spouses .................................. 25.
14
15                                                                                                                                                                             888888888 00
     26.  Uniformed services retirement income ................................................................................................... 26.
16
17                                                                                                                                                                             888888888 00
    27.  Military injury relief fund ...................................................................................................................................... 27.
18
19                                                                                                                                                                             888888888 00
     28.  Certain Ohio National Guard reimbursements and beneﬁ ts ................................................................... 28.
20  
21 Education
22                                                                                                                                                                             888888 00
     29.  Ohio 529 contributions, tuition credit purchases ..................................................................................... 29.
23
24  
     30.  Pell/Ohio College Opportunity taxable grant amounts used to pay room and board .............................. 30.                                                    888888 00
25
26 Medical
27                                                                                                                                                                             888888888 00
     31.  Disability and survivorship beneﬁ ts (do not include pension continuation beneﬁ ts) ............................... 31.
28  
29   32.  Unreimbursed long-term care insurance premiums, unsubsidized health care insurance premiums
      and excess health care expenses (see instructions for worksheet) ........................................................ 32.                                            888888888 00
30
31   33.  Funds deposited into, and earnings of, a medical savings account for eligible health care expenses 
      (see instructions for worksheet) .............................................................................................................. 33.                      888888888 00
32
33  
    34.  Qualiﬁ ed organ donor expenses (maximum $10,000 per taxpayer) .................................................... 34.                                                88888 00
34
35                                                                                                                                                                             88888888888 00
    35. Total deductions (add lines 11 through 34 ONLY). Enter here and on Ohio IT 1040, line 2b ...........................35.
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
                                        2016 Ohio Schedule A – page 2 of 2
64
65
66

- 21 -

Layout 

without grid

- 22 -

Do not use staples. Use only black ink.
2016 Ohio Schedule A
Rev. 9/16 Income Adjustments – Additions and Deductions
SSN of primary ﬁ ler 
88 88 88
888 88 8888
Additions
(add income items only to the extent not included on Ohio IT 1040, line 1)
1. Non-Ohio state or local government interest and dividends ..................................................................... 1. 888888888 00

2. Certain Ohio pass-through entity and ﬁ nancial institutions taxes paid ...................................................... 2. 888888888 00

3. Reimbursement of college tuition expenses and fees deducted in any previous year(s) and
noneducation expenditures from a college savings account ....................................................................3. 888888 00

4. Losses from sale or disposition of Ohio public obligations ....................................................................... 4. 888888888 00

5. Nonmedical withdrawals from a medical savings account ........................................................................ 5. 888888888 00
6. Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if the
reimbursement is not in federal adjusted gross income ............................................................................ 6. 888888888 00
Federal
7. Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense .......................... 7. 888888888 00

8. Federal interest and dividends subject to state taxation ........................................................................... 8. 888888888 00

9. Miscellaneous federal income tax additions ............................................................................................. 9. 888888888 00

10. Total additions (add lines 1 through 9 ONLY). Enter here and on Ohio IT 1040, line 2a) ........................ 10. 88888888888 00

Deductions
(deduct income items only to the extent included on Ohio IT 1040, line 1)

11. Business income deduction (include Ohio Schedule IT BUS, line 11) .................................................... 11. 888888 00

12. Employee compensation earned in Ohio by residents of neighboring states ........................................... 12. 888888888 00

13. State or municipal income tax overpayments shown on the federal 1040, line 10 ................................. 13. 888888888 00

14. Qualifying Social Security beneﬁ ts and certain railroad retirement beneﬁ ts ........................................... 14. 888888888 00
15. 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 state of
Ohio; or income from a transfer agreement ............................................................................................ 15. 888888888 00
16. Amounts contributed to an individual development account ................................................................... 16. 888888888 00

17. Amounts contributed to STABLE account: Ohio’s ABLE plan ................................................................. 17. 888888888 00
Federal

18. Federal interest and dividends exempt from state taxation .................................................................... 18. 888888888 00

19. Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense ........................ 19. 888888888 00
20. Refund or reimbursements shown on the federal 1040, line 21 for itemized deductions claimed on a
prior year federal income tax return ........................................................................................................ 20. 888888888 00
21. Repayment of income reported in a prior year ........................................................................................ 21. 888888888 00

22. Wage expense not deducted due to claiming the federal work opportunity tax credit ............................ 22. 888888888 00

23. Miscellaneous federal income tax deductions ........................................................................................ 23. 888888888 00

2016 Ohio Schedule A – page 1 of 2

- 23 -

2016 Ohio Schedule A
Rev. 9/16 Income Adjustments – Additions and Deductions
SSN of primary ﬁ ler 
888 88 8888
Uniformed Services
24. Military pay for Ohio residents received while the military member was stationed outside Ohio ............ 24. 888888888 00

25. Certain income earned by military nonresidents and civilian nonresident spouses .................................. 25. 888888888 00

26. Uniformed services retirement income ................................................................................................... 26. 888888888 00

27. Military injury relief fund ...................................................................................................................................... 27. 888888888 00

28. Certain Ohio National Guard reimbursements and beneﬁ ts ................................................................... 28. 888888888 00

Education
29. Ohio 529 contributions, tuition credit purchases ..................................................................................... 29. 888888 00

30. Pell/Ohio College Opportunity taxable grant amounts used to pay room and board .............................. 30. 888888 00
Medical
31. Disability and survivorship beneﬁ ts (do not include pension continuation beneﬁ ts) ............................... 31. 888888888 00

32. Unreimbursed long-term care insurance premiums, unsubsidized health care insurance premiums
and excess health care expenses (see instructions for worksheet) ........................................................ 32. 888888888 00
33. Funds deposited into, and earnings of, a medical savings account for eligible health care expenses
(see instructions for worksheet) .............................................................................................................. 33. 888888888 00

34. Qualiﬁ ed organ donor expenses (maximum $10,000 per taxpayer) .................................................... 34. 88888 00

35. Total deductions (add lines 11 through 34 ONLY). Enter here and on Ohio IT 1040, line 2b ...........................35. 88888888888 00

2016 Ohio Schedule A – page 2 of 2

- 24 -

General information 

regarding this form

- 25 -

          General Information (2016 Schedule A):

1) Dimensions: 
  
  Target or Registration Marks - 6 mm X 6 mm. Follow grid layout for positioning.

  1D barcode (2 of 5 interleaved) - .375”H x 1.5”W. Follow grid layout for positioning. Center the barcode  
  number directly under the barcode.

  2D barcode (PDF 417) - See 2D instructions and schema. Follow grid layout for positioning. There is one 
  2D barcode for the IT 1040 and Schedule A.

2) 1D barcode - The last two numbers of the 1D barcode represent the vendor number. Use the same vendor 
number as you did for last year’s return. If you have a question about your barcode assignment, e-mail the Forms 
Unit at Forms@tax.state.oh.us. The ﬁ rst six numbers are constant for this form (160003XX - 160004XX). 

  16 = tax year
  00 = Schedule A 
  03-04 = page number 
  XX = vendor number (assigned to you by the Ohio Dept. of Taxation, Forms Unit)

    NOTE: The vendor number also serves as the ﬁ rst two digits of the SSN in the test scenarios.

3) Use Arial font for the static text on the form.

4) Use monospaced Arial or similar monospaced san serif font for the variable data ﬁ elds on the form.

5) Follow the grid layout for the variable data ﬁ elds shown in red. Ensure that the tax year, target or reg-
istration marks, “For Department Use Only” area and the 1D and 2D barcodes follow grid layout.

6) Do not use commas, hyphens or decimals in the variable data ﬁ elds except where shown in specs.

7)  All monetary ﬁ elds must always show “00” in the cents ﬁ eld even though there may not be a value for that line.

8) Provide guidance to customers regarding duplex printing that instructs them to print pages 1 and 2 together. 
Taxpayers have ﬁ led returns with pages 2 and 3 duplexed or a worksheet or software receipt on the back of a 
page of the return. This slows the processing of the tax return.

9) Generate the following message for customers: “Do not enclose other documentation unless it is speciﬁ ed 
on the tax return or instructions.” Taxpayers often submit worksheets and receipts from the vendor product, 
which slows the processing of tax returns.

10) IMPORTANT NOTE: Add this statement to your software programs. It should print out with the taxpayer’s 
return. “Do not hand write in any corrections on the printed paper return. Hand writing in corrections will 
result in capturing incorrect data and delaying the processing of this income tax return. Make any cor-
rections to this income tax return within [the software program name], then print and mail.”

11) See the 2D barcode instructions for submission details.

- 26 -

                                          Rev. 11/4/16

Scan Speciﬁ cations for the 

2016 Ohio IT BUS – 

Business Income Schedule

Important Note

The following document (2016 Ohio IT BUS) contains grids for place-
ment of information on this speciﬁ c tax form. To accurately print, do not 
reduce the size, rotate or center this document. Doing so will jeopar-
dize the integrity of the grid. When printing from Adobe Reader, please 
select “None” for “Page Scaling,” which is under “Page Handling.”

       Ohio Department of Taxation

                        4485 Northland Ridge Blvd.

                        Columbus, OH 43229

                        tax.ohio.gov

- 27 -

Grid layout 

with notations

- 28 -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3
4
5              New! The date the return was gen-
6              erated by the taxpayer (MM DD YY).2016 Ohio Schedule IT BUS 
7                           Rev. 10/16                      Business Income
8                                                                                                                                                                                         
   88 88 88
9
   Include on this Ohio Schedule IT BUS any income included in federalPlacementadjustedof thegross1D barcodeincomeandthattax yearconstitutesis critical.                                business income. See Ohio 
10 Revised Code (R.C.) section 5747.01(B). On page 2 of this schedule,Make surelist theto followsourcesthe gridofpositionsbusinessforincomelayout. Doand your ownership percentage. 
11 Include the Ohio Schedule IT BUS with Ohio IT 1040 if ﬁ ling by papernot forget(seetoinstructionsget your barcode(s)if ﬁ lingassignmentselectronically).for 
12                          SSN of primary ﬁ ler                    every form, version and page. Check to indicate which taxpayer earned this income:
13                          888 88  8888                                                                                  X                                       Primary         New!X DoSpousenot place spaces be-
14                                                                                                                                                                  tween whole dollar numbers. There 
15 Part 1 – Business Income From IRS Schedules                                                                                                                      is only a space between dollar 
                                                                                                                                                                    amounts and cents ﬁ elds.
16
17 Note: Do not include amounts listed on these IRS schedules that are nonbusiness income. 
   See R.C. 5747.01(C).
18
19                                                                                                                                                                                        888888888 00
     1. Schedule B – Interest and Ordinary Dividends ........................................................................ 1.
20                                                      For static text use Arial font (black ink) and try to 
    
21                                                      match size. For data entry ﬁ elds (shown in red 
     2. Schedule C – Proﬁ t or Loss From Business (Sole Proprietorship)for identiﬁ cation purposes..........................................only), use Arial font 2.                      888888888 00
22                                                      (black ink). All the data entry ﬁ elds must follow 
    
23                                                      grid layout. When a  ﬁ eld  reﬂ ects a negative                                                                                   888888888 00
     3. Schedule D – Capital Gains and Losses.................................................................................. 3.
24                                                      amount, make sure there is                no space between 
                                                        the amount and the negative sign. Never hard 
25                                                      code a negative sign.                                                                                                             888888888 00
     4. Schedule E – Supplemental Income and Loss ........................................................................ 4.
26
     5. Guaranteed payments, compensation and/or wages from each pass-through entity in 
27
       which you have at least a 20% direct or indirect ownership interest.               Note: Reciprocity 
28                                                                                                                                                                                        888888888 00
       agreements do not apply.......................................................................................................... 5.
29
30                                                                                                                                                                                        888888888 00
     6. Schedule F – Proﬁ t or Loss From Farming .............................................................................. 6.
31
     7. Other items of income and gain separately stated on the federal Schedule K-1, gains 
32
       and/or losses reported on the federal 4797 and miscellaneous federal income tax 
33                                                                                                                                                                                        888888888 00
       adjustments, if any ................................................................................................................... 7.
34
35                                                                                                                                                                                        888888888 00
     8. Total of business income (add lines 1 through 7) ..................................................................... 8.
36
37 Part 2 – Business Income Deduction
38
     9. All business income (enter the lesser of line 8 above or Ohio IT 1040, line 1). If -0- 
39                                                                                                                                                                                        888888888 00
       or negative, stop here and do not complete Part 3 .................................................................. 9.
40  
41   10. Enter $250,000 if ﬁ ling status is single or married ﬁ ling jointly; OR
42                                                                                                                                                                                                  888888 00
       Enter $125,000 if ﬁ ling status is married ﬁ ling separately ...................................................... 10.
43
44                                                                                                                                                                                                  888888 00
    11. Enter lesser of line 9 or line 10. Enter here and on Ohio Schedule A, line 11 .........................11.
45
46 Part 3 – Taxable Business Income
47
48 Note: If Ohio IT 1040, line 5 equals -0-, do not complete Part 3.
    
49                                                                                                                                                                                        888888888 00
    12. Line 9 minus line 11 ................................................................................................................ 12. 
50  
    13. Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5). 
51                                                                                                                                                                                        888888888 00
       Enter here and on Ohio IT 1040, line 6 .................................................................................. 13.
52  
    14. Business income tax liability – multiply line 13 by 3% (.03). Enter here and on Ohio IT 1040, 
      line 8b ..................................................................................................................................... 14.
53             2D barcode required. Delete this                                                                                                                                               8888888 00
54             box with text and replace it with 
55             the 2D barcode.
56
57                                                                                                                                                                  Target marks or registration marks 
                                                                                                                                                                    must measure 6 mm X 6 mm. The 
58                                                                                                                                                                  four target marks or registration 
59         Do not write in this area; for department use only.                                                                                                      marks on every page must follow 
60                                                                                                                                                                  grid layout.
61
62
63                                     2016 Ohio Schedule IT BUS – pg. 1 of 2
64
65
66

- 29 -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3
4
5
6                                2016 Ohio Schedule IT BUS 
7                     Rev. 10/16 Business Income
8                                                                      
9                                SSN of primary ﬁ ler
10                               888 88  8888
11
                                                     New! The percentage of ownership 
12 Part 4 – Business Entity                          ﬁ eld now contains a decimal.
13
   If you have more than 18 entities, complete additional copies of this page and include with your income tax return.
14
15 1.  Name of entity            FEIN/SSN                              Percentage of ownership
16     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
17 2.  Name of entity            FEIN/SSN                              Percentage of ownership
18     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
19 3.  Name of entity            FEIN/SSN                              Percentage of ownership
20     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
21 4.  Name of entity            FEIN/SSN                              Percentage of ownership
22     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
23 5.  Name of entity            FEIN/SSN                              Percentage of ownership
24     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
25 6.  Name of entity            FEIN/SSN                              Percentage of ownership
26     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
27 7.  Name of entity            FEIN/SSN                              Percentage of ownership
28     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
29 8.  Name of entity            FEIN/SSN                              Percentage of ownership
30     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
31 9.  Name of entity            FEIN/SSN                              Percentage of ownership
32     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
33 10. Name of entity            FEIN/SSN                              Percentage of ownership
34     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
35 11. Name of entity            FEIN/SSN                              Percentage of ownership
36     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
37 12. Name of entity            FEIN/SSN                              Percentage of ownership
38     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
39 13. Name of entity            FEIN/SSN                              Percentage of ownership
40     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
41 14. Name of entity            FEIN/SSN                              Percentage of ownership
42     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
43 15. Name of entity            FEIN/SSN                              Percentage of ownership
44     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
45 16. Name of entity            FEIN/SSN                              Percentage of ownership
46     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
47 17. Name of entity            FEIN/SSN                              Percentage of ownership
48     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
49 18. Name of entity            FEIN/SSN                              Percentage of ownership
50     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
51
52
53
54
55
56
57
58
59
60
61
62                               2016 Ohio Schedule IT BUS – pg. 2 of 2
63
64
65
66

- 30 -

Grid layout

- 31 -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3
4
5
6                                    2016 Ohio Schedule IT BUS 
7                      Rev. 10/16                  Business Income
8                                                                                                                                                      
   88 88 88
9
   Include on this Ohio Schedule IT BUS any income included in federal adjusted gross income that constitutes business income. See Ohio 
10 Revised Code (R.C.) section 5747.01(B). On page 2 of this schedule, list the sources of business income and your ownership percentage. 
11 Include the Ohio Schedule IT BUS with Ohio IT 1040 if ﬁ ling by paper (see instructions if ﬁ ling electronically).
12                     SSN of primary ﬁ ler                                      Check to indicate which taxpayer earned this income:
13                     888 88  8888                                                                      X Primary         X                           Spouse
14
15 Part 1 – Business Income From IRS Schedules
16
17 Note: Do not include amounts listed on these IRS schedules that are nonbusiness income. 
   See R.C. 5747.01(C).
18
19                                                                                                                                                     888888888 00
    1. Schedule B – Interest and Ordinary Dividends ........................................................................ 1.
20
    
21                                                                                                                                                     888888888 00
     2. Schedule C – Proﬁ t or Loss From Business (Sole Proprietorship) .......................................... 2.
22
    
23                                                                                                                                                     888888888 00
     3. Schedule D – Capital Gains and Losses.................................................................................. 3.
24
    
25                                                                                                                                                     888888888 00
     4. Schedule E – Supplemental Income and Loss ........................................................................ 4.
26
     5. Guaranteed payments, compensation and/or wages from each pass-through entity in 
27
       which you have at least a 20% direct or indirect ownership interest.     Note: Reciprocity 
28                                                                                                                                                     888888888 00
       agreements do not apply.......................................................................................................... 5.
29
30                                                                                                                                                     888888888 00
     6. Schedule F – Proﬁ t or Loss From Farming .............................................................................. 6.
31
     7. Other items of income and gain separately stated on the federal Schedule K-1, gains 
32
       and/or losses reported on the federal 4797 and miscellaneous federal income tax 
33                                                                                                                                                     888888888 00
       adjustments, if any ................................................................................................................... 7.
34
35                                                                                                                                                     888888888 00
     8. Total of business income (add lines 1 through 7) ..................................................................... 8.
36
37 Part 2 – Business Income Deduction
38
     9. All business income (enter the lesser of line 8 above or Ohio IT 1040, line 1). If -0- 
39                                                                                                                                                     888888888 00
       or negative, stop here and do not complete Part 3 .................................................................. 9.
40  
41   10. Enter $250,000 if ﬁ ling status is single or married ﬁ ling jointly; OR
42                                                                                                                                                           888888 00
       Enter $125,000 if ﬁ ling status is married ﬁ ling separately ...................................................... 10.
43
44                                                                                                                                                           888888 00
    11. Enter lesser of line 9 or line 10. Enter here and on Ohio Schedule A, line 11 .........................11.
45
46 Part 3 – Taxable Business Income
47
48 Note: If Ohio IT 1040, line 5 equals -0-, do not complete Part 3.
    
49                                                                                                                                                     888888888 00
    12. Line 9 minus line 11 ................................................................................................................ 12. 
50  
    13. Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5). 
51                                                                                                                                                     888888888 00
       Enter here and on Ohio IT 1040, line 6 .................................................................................. 13.
52  
    14. Business income tax liability – multiply line 13 by 3% (.03). Enter here and on Ohio IT 1040, 
53                                                                                                                                                     8888888 00
      line 8b ..................................................................................................................................... 14.
54
55
56
57
58
59      Do not write in this area; for department use only.
60
61
62
63                                2016 Ohio Schedule IT BUS – pg. 1 of 2
64
65
66

- 32 -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3
4
5
6                                2016 Ohio Schedule IT BUS 
7                     Rev. 10/16 Business Income
8                                                                      
9                                SSN of primary ﬁ ler
10                               888 88  8888
11
12 Part 4 – Business Entity
13
   If you have more than 18 entities, complete additional copies of this page and include with your income tax return.
14
15 1.  Name of entity            FEIN/SSN                              Percentage of ownership
16     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
17 2.  Name of entity            FEIN/SSN                              Percentage of ownership
18     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
19 3.  Name of entity            FEIN/SSN                              Percentage of ownership
20     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
21 4.  Name of entity            FEIN/SSN                              Percentage of ownership
22     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
23 5.  Name of entity            FEIN/SSN                              Percentage of ownership
24     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
25 6.  Name of entity            FEIN/SSN                              Percentage of ownership
26     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
27 7.  Name of entity            FEIN/SSN                              Percentage of ownership
28     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
29 8.  Name of entity            FEIN/SSN                              Percentage of ownership
30     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
31 9.  Name of entity            FEIN/SSN                              Percentage of ownership
32     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
33 10. Name of entity            FEIN/SSN                              Percentage of ownership
34     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
35 11. Name of entity            FEIN/SSN                              Percentage of ownership
36     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
37 12. Name of entity            FEIN/SSN                              Percentage of ownership
38     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
39 13. Name of entity            FEIN/SSN                              Percentage of ownership
40     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
41 14. Name of entity            FEIN/SSN                              Percentage of ownership
42     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
43 15. Name of entity            FEIN/SSN                              Percentage of ownership
44     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
45 16. Name of entity            FEIN/SSN                              Percentage of ownership
46     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
47 17. Name of entity            FEIN/SSN                              Percentage of ownership
48     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
49 18. Name of entity            FEIN/SSN                              Percentage of ownership
50     JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
51
52
53
54
55
56
57
58
59
60
61
62                               2016 Ohio Schedule IT BUS – pg. 2 of 2
63
64
65
66

- 33 -

Layout 

without grid

- 34 -

2016 Ohio Schedule IT BUS
Rev. 10/16 Business Income

88 88 88
Include on this Ohio Schedule IT BUS any income included in federal adjusted gross income that constitutes business income. See Ohio
Revised Code (R.C.) section 5747.01(B). On page 2 of this schedule, list the sources of business income and your ownership percentage.
Include the Ohio Schedule IT BUS with Ohio IT 1040 if ﬁ ling by paper (see instructions if ﬁ ling electronically).
SSN of primary ﬁ ler Check to indicate which taxpayer earned this income:
888 88 8888 X Primary X Spouse

Part 1 – Business Income From IRS Schedules
Note: Do not include amounts listed on these IRS schedules that are nonbusiness income.
See R.C. 5747.01(C).

1. Schedule B – Interest and Ordinary Dividends ........................................................................ 1. 888888888 00

2. Schedule C – Proﬁ t or Loss From Business (Sole Proprietorship) .......................................... 2. 888888888 00

3. Schedule D – Capital Gains and Losses.................................................................................. 3. 888888888 00

4. Schedule E – Supplemental Income and Loss ........................................................................ 4. 888888888 00
5. Guaranteed payments, compensation and/or wages from each pass-through entity in
which you have at least a 20% direct or indirect ownership interest. Note: Reciprocity
agreements do not apply.......................................................................................................... 5. 888888888 00

6. Schedule F – Proﬁ t or Loss From Farming .............................................................................. 6. 888888888 00
7. Other items of income and gain separately stated on the federal Schedule K-1, gains
and/or losses reported on the federal 4797 and miscellaneous federal income tax
adjustments, if any ................................................................................................................... 7. 888888888 00

8. Total of business income (add lines 1 through 7) ..................................................................... 8. 888888888 00

Part 2 – Business Income Deduction
9. All business income (enter the lesser of line 8 above or Ohio IT 1040, line 1). If -0-
or negative, stop here and do not complete Part 3 .................................................................. 9. 888888888 00

10. Enter $250,000 if ﬁ ling status is single or married ﬁ ling jointly; OR
Enter $125,000 if ﬁ ling status is married ﬁ ling separately ...................................................... 10. 888888 00

11. Enter lesser of line 9 or line 10. Enter here and on Ohio Schedule A, line 11 .........................11. 888888 00

Part 3 – Taxable Business Income
Note: If Ohio IT 1040, line 5 equals -0-, do not complete Part 3.

12. Line 9 minus line 11 ................................................................................................................ 12. 888888888 00
13. Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5).
Enter here and on Ohio IT 1040, line 6 .................................................................................. 13. 888888888 00
14. Business income tax liability – multiply line 13 by 3% (.03). Enter here and on Ohio IT 1040,
line 8b ..................................................................................................................................... 14. 8888888 00

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

2016 Ohio Schedule IT BUS – pg. 1 of 2

- 35 -

                              2016 Ohio Schedule IT BUS 
                   Rev. 10/16 Business Income
                                                                    
                              SSN of primary ﬁ ler
                              888 88  8888

Part 4 – Business Entity
If you have more than 18 entities, complete additional copies of this page and include with your income tax return.

1.  Name of entity            FEIN/SSN                              Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
2.  Name of entity            FEIN/SSN                              Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
3.  Name of entity            FEIN/SSN                              Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
4.  Name of entity            FEIN/SSN                              Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
5.  Name of entity            FEIN/SSN                              Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
6.  Name of entity            FEIN/SSN                              Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
7.  Name of entity            FEIN/SSN                              Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
8.  Name of entity            FEIN/SSN                              Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
9.  Name of entity            FEIN/SSN                              Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
10. Name of entity            FEIN/SSN                              Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
11. Name of entity            FEIN/SSN                              Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
12. Name of entity            FEIN/SSN                              Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
13. Name of entity            FEIN/SSN                              Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
14. Name of entity            FEIN/SSN                              Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
15. Name of entity            FEIN/SSN                              Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
16. Name of entity            FEIN/SSN                              Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
17. Name of entity            FEIN/SSN                              Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX      888888888                             888.88
18. Name of entity            FEIN/SSN                              Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX      888888888                             888.88

                              2016 Ohio Schedule IT BUS – pg. 2 of 2

- 36 -

General information 

regarding this form

- 37 -

              General Information (2016 IT BUS):

1) Dimensions: 
  
  Target or Registration Marks - 6 mm X 6 mm. Follow grid layout for positioning.

  1D barcode (2 of 5 interleaved) - .375”H x 1.5”W. Follow grid layout for positioning. Center the barcode  
  number directly under the barcode.

  2D barcode (PDF 417) - See 2D instructions and schema. Follow grid layout for positioning. There is one 
  2D barcode for the IT BUS.

2) 1D barcode - The last two numbers of the 1D barcode represent the vendor number. Use the same vendor 
number as you did for last year’s return. If you have a question about your barcode assignment, e-mail the Forms 
Unit at Forms@tax.state.oh.us. The ﬁ rst six numbers are constant for this form (162601XX - 162602XX). 

  16 = tax year
  26 = IT BUS 
  01-02 = page number 
  XX = vendor number (assigned to you by the Ohio Dept. of Taxation, Forms Unit)

    NOTE: The vendor number also serves as the ﬁ rst two digits of the SSN in the test scenarios.

3) Use Arial font for the static text on the form.

4) Use monospaced Arial or similar monospaced san serif font for the variable data ﬁ elds on the form.

5) Follow the grid layout for the variable data ﬁ elds shown in red. Ensure that the tax year, target or reg-
istration marks, “For Department Use Only” area and the 1D and 2D barcodes follow grid layout.

6) Do not use commas, hyphens or decimals in the variable data ﬁ elds except where shown in specs.

7)  All monetary ﬁ elds must always show “00” in the cents ﬁ eld even though there may not be a value for that line.

8) When a variable data ﬁ eld reﬂ ects a negative amount, make sure there is no space between the negative sign 
and the amount (for example: -888888888 00). The possible negative ﬁ elds for this return are lines 2, 3, 4, 6, 7, 
8 and 9. Do not hard-code negative signs.

9) Provide guidance to customers regarding duplex printing that instructs them to print pages 1 and 2 together. 
Taxpayers have ﬁ led returns with pages 2 and 3 duplexed or a worksheet or software receipt on the back of a 
page of the return. This slows the processing of the tax return.

10) Generate the following message for customers: “Do not enclose other documentation unless it is speciﬁ ed 
on the tax return or instructions.” Taxpayers often submit worksheets and receipts from the vendor product, 
which slows the processing of tax returns.

11) IMPORTANT NOTE: Add this statement to your software programs. It should print out with the taxpayer’s 
return. “Do not hand write in any corrections on the printed paper return. Hand writing in corrections will 
result in capturing incorrect data and delaying the processing of this income tax return. Make any cor-
rections to this income tax return within [the software program name], then print and mail.”

12) See the 2D barcode instructions for submission details.

- 38 -

                                                     Rev. 11/4/16

Scan Speciﬁ cations for the 

2016 Ohio Schedule 

                of Credits

                Important Note

The following document (2016 Ohio Schedule of Credits) contains 
grids for placement of information on this speciﬁ c tax form. To ac-
curately print, do not reduce the size, rotate or center this document. 
Doing so will jeopardize the integrity of the grid. When printing from 
Adobe Reader, please select “None” for “Page Scaling,” which is under 
“Page Handling.”

       Ohio Department of Taxation

                        4485 Northland Ridge Blvd.

                        Columbus, OH 43229

                        tax.ohio.gov

- 39 -

Grid layout 

with notations

- 40 -

123456789 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3
4                                                                     Do not use staples. Use only black ink. 
5
6                                                2016 Ohio Schedule of Credits
          New! The date the return was gen-
7         erated by the taxpayerRev. 11/16(MM DD YY).                 Nonrefundable and Refundable
8                                                                               SSN of primary ﬁ ler                                                                                                      16280110

9    88 88 88                                                                888 88  8888
10
                                                                                     Placement of the 1D barcode and tax year is critical. 
11                                               Nonrefundable Credits Make sure to follow the grid positions for layout. Do 
12   1. Tax liability before credits (from Ohio IT 1040, line 8c) ............................................................................... 1.not forget to get your barcode(s) assignments for     888888888 00
13                                                                                   every form, version and page.
14   2.  Retirement income credit (limit $200 per return). See the table in the instructions ................................... 2.                                                                                   888 00
15
16   3.  Lump sum retirement credit (include Ohio LS WKS, line 6)… ..................................................................3.                                                                               888888 00
17   4.  Senior citizen credit (must be 65 or older to claim this credit;       limit $50 per return) ................................ 4.                                                                             88 00
18  
19   5.  Lump sum distribution credit (must be 65 or older to claim this credit; include Ohio LS WKS, line 3)… .. 5.                                                                                                  8888 00
20
21                                                                                                                                                                                                                    8888 00
     6.  Child care and dependent care credit (see the worksheet in the instructions)… ...................................... 6.
22  
     7.  If Ohio IT 1040, line 5 is $10,000 or less, enter $88; otherwise, enter -0- (low income credit) ................. 7.                                                                                         88 00
23   
24   8.  Displaced worker training credit (see the worksheet in the instructions) (limit $500 per taxpayer) ........ 8.                                                                                               8888 00
25
                                                                                For static text use Arial font (black ink) and try to 
26   9.  Campaign contribution credit for Ohio statewide ofﬁ ce or GeneralmatchAssemblysize. For(limitdata entry$50 perﬁ eldstaxpayer)(shown in..red9.                                                                888 00
27                                                                              for identiﬁ cation purposes only), use Arial font                                                                                     888 00
     10.  Income-based exemption credit ($20 personal/dependent exemption credit) ........................................ 10.
28                                                                              (black ink). All the data entry ﬁ elds must follow 
                                                                                grid layout.
29   11.  Total (add lines 2 through 10) ................................................................................................................. 11.                                            888888888 00
30
31   12.  Tax less credits (line 1 minus line 11; if less than -0-, enter -0-) ............................................................. 12.                                                          888888888 00
32  
    13.  Joint ﬁ ling credit. See the instructions for eligibility and documentation requirements. This credit is for 
33        married ﬁ ling jointly status only.              88 % times amount on line 12(limit $650) ................................................13.                                                               888 00
34
35   14.  Earned income credit .............................................................................................................................. 14.                                                     888 00
36
37   15.  Ohio adoption credit (limit $10,000 per adopted child) ........................................................................ 15.                                                                         88888 00
38
39   16.  Job retention credit, nonrefundable portion (include a copy of the credit certiﬁ cate) .............................. 16.                                                                                   8888888 00
40
41   17.  Credit for eligible new employees in an enterprise zone (include a copy of the credit certiﬁ cate) .......... 17.                                                                                           8888888 00
42
43   18.  Credit for purchases of grape production property ................................................................................. 18.                                                                     8888888 00
44
45   19.  Invest Ohio credit (include a copy of the credit certiﬁ cate) ..................................................................... 19.                                                                     8888888 00
46
47                                                                                                                                                                                                                    8888888 00
     20.  Technology investment credit carryforward (include a copy of the credit certiﬁ cate) .............................. 20.
48   21.  Enterprise zone day care and training credits (include a copy of the credit certiﬁ cate) .......................... 21.                                                                                     8888888 00
49                                                                                                                                                                                                                    8888888 00
     22.  Research and development credit (include a copy of the credit certiﬁ cate) ............................................ 22.
50
     23.  Ohio historic preservation credit, nonrefundable carryforward portion (include a copy of the credit 
51        certiﬁ cate) ...............................................................................................................................................2D barcode required. Delete this 23.            8888888 00
52   24.  Total (add lines 13 through 23) ...............................................................................................................box with text and replace it with             24.            8888888 00
53                                                                                            the 2D barcode.
54   25. Tax less additional credits (line 12 minus line 24; if less than -0-, enter -0-) ........................................... 25.                                                                 888888888 00
55
56
57                                                                                                                                                                                                        Target marks or registration marks 
                                                                                                                                                                                                          must measure 6 mm X 6 mm. The 
58                                                                                                                                                                                                        four target marks or registration 
59                  Do not write in this area; for department use only.                                                                                                                                   marks on every page must follow 
60                                                                                                                                                                                                        grid layout.
61
62
63
                                              2016 Ohio Schedule of Credits – page 1 of 2
64
65
66

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123456789 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3
4                                                               Do not use staples. Use only black ink. 
5
                                    2016 Ohio Schedule of Credits
6
7                      Rev. 11/16                      Nonrefundable and Refundable
8                                                                                                       SSN of primary ﬁ ler                     16280210

9                                                                                                       888 88  8888
10 Nonresident Credit  
11 Date of nonresidency  88 88 88                   to          88 88 88                                State of residency   XX
12  
13  26.  Enter the portion of Ohio adjusted gross income (Ohio 
14    IT 1040, line 3) that was not earned or received in 
      Ohio. Include Ohio IT NRC if required ...............................26.                          888888888 00
15
16  27.  Enter the Ohio adjusted gross income (Ohio IT 1040, 
        line 3) ....................................................................................27. 888888888 00
17
18                                                                                                      .8888
19  28.  Divide line 26 by line 27 and enter the result here (four digits; do not round).
      Multiply this factor by the amount on line 25 to calculate your nonresident credit .................................... 28.                888888888 00
20
21 Resident Credit
22   29.  Enter the portion of Ohio adjusted gross income (Ohio 
23    IT 1040, line 3) subjected to tax by other states or the 
24      District of Columbia while you were an Ohio resident 
        (limits apply) ..................................................................... 29.        888888888 00
25
26   30.  Enter the Ohio adjusted gross income (Ohio IT 1040, 
        line 3) .............................................................................30.        888888888 00
27  
28  31.  Divide line 29 by line 30 and enter the result here (four digits; do not round).
29    Multiply this factor by the amount on line 25                                                     .8888
      and enter the result here ................................................31.                     888888888 00
30  
31   32.  Enter the 2016 income tax, less all credits other than
32    withholding and estimated tax payments and overpayment 
33    carryforwards from previous years, paid to other states or 
      the District of Columbia (limits apply) ............................. 32.
34                                                                                                      888888888 00
35   33.  Enter the smaller of line 31 or line 32. This is your Ohio resident tax credit. If you ﬁ led a return for 
      2016 with a state(s) other than Ohio, enter the two-letter state abbreviation in the box(es) below ........ 33.                            888888888 00
36
37      XX XX XX XX      XX XX
38
39                                                                                                                                               888888888 00
    34. Total nonrefundable credits (add lines 11, 24, 28 and 33; enter here and on Ohio IT 1040, line 9) .... 34.
40
41
42                                  Refundable Credits
43   35.  Historic preservation credit (include a copy of the credit certiﬁ cate) ....................................................... 35.    88888888 00
44
45  
    36.  Business jobs credit (include a copy of the credit certiﬁ cate) ................................................................... 36. 88888888 00
46
47                                                                                                                                               88888888 00
     37.  Pass-through entity credit (include a copy of the federal K-1) ................................................................ 37.
48
    
49                                                                                                                                               88888888 00
     38.  Motion picture production credit (include a copy of the credit certiﬁ cate) ............................................... 38.
50
51                                                                                                                                               88888888 00
     39.  Financial Institutions Tax (FIT) credit (include a copy of the federal K-1) ............................................... 39.
52
53                                                                                                                                               88888888 00
     40.  Venture capital credit (include a copy of the credit certiﬁ cate) ................................................................ 40.
54
55  41. Total refundable credits (add lines 35 through 40; enter here and on Ohio IT 1040, line 16) .............. 41.                           888888888 00
56
57
58
59
60
61
62
63
                                  2016 Ohio Schedule of Credits – page 2 of 2
64
65
66

- 42 -

Grid layout

- 43 -

123456789 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3
4                                                               Do not use staples. Use only black ink. 
5
6                                    2016 Ohio Schedule of Credits
7                  Rev. 11/16                                   Nonrefundable and Refundable
8                                                                         SSN of primary ﬁ ler                                                                       16280110

9   88 88 88                                                           888 88  8888
10
11                                Nonrefundable Credits
12  1. Tax liability before credits (from Ohio IT 1040, line 8c) ............................................................................... 1.                  888888888 00
13
14  2.  Retirement income credit (limit $200 per return). See the table in the instructions ................................... 2.                                           888 00
15
16  3.  Lump sum retirement credit (include Ohio LS WKS, line 6)… ..................................................................3.                               888888 00
17  4.  Senior citizen credit (must be 65 or older to claim this credit;  limit $50 per return) ................................ 4.                                          88 00
18  
19  5.  Lump sum distribution credit (must be 65 or older to claim this credit; include Ohio LS WKS, line 3)… .. 5.                                                  8888 00
20
21                                                                                                                                                                   8888 00
    6.  Child care and dependent care credit (see the worksheet in the instructions)… ...................................... 6.
22  
    7.  If Ohio IT 1040, line 5 is $10,000 or less, enter $88; otherwise, enter -0- (low income credit) ................. 7.                                                 88 00
23   
24  8.  Displaced worker training credit (see the worksheet in the instructions) (limit $500 per taxpayer) ........ 8.                                               8888 00
25
26  9.  Campaign contribution credit for Ohio statewide ofﬁ ce or General Assembly (limit $50 per taxpayer) .. 9.                                                            888 00
27                                                                                                                                                                           888 00
    10.  Income-based exemption credit ($20 personal/dependent exemption credit) ........................................ 10.
28
29   11.  Total (add lines 2 through 10) ................................................................................................................. 11.       888888888 00
30
31   12.  Tax less credits (line 1 minus line 11; if less than -0-, enter -0-) ............................................................. 12.                     888888888 00
32  
    13.  Joint ﬁ ling credit. See the instructions for eligibility and documentation requirements. This credit is for 
33  married ﬁ ling jointly status only.              88 % times amount on line 12(limit $650) ................................................13.                            888 00
34
35   14.  Earned income credit .............................................................................................................................. 14.            888 00
36
37   15.  Ohio adoption credit (limit $10,000 per adopted child) ........................................................................ 15.                        88888 00
38
39   16.  Job retention credit, nonrefundable portion (include a copy of the credit certiﬁ cate) .............................. 16.                                  8888888 00
40
41   17.  Credit for eligible new employees in an enterprise zone (include a copy of the credit certiﬁ cate) .......... 17.                                          8888888 00
42
43   18.  Credit for purchases of grape production property ................................................................................. 18.                    8888888 00
44
45   19.  Invest Ohio credit (include a copy of the credit certiﬁ cate) ..................................................................... 19.                    8888888 00
46
47                                                                                                                                                                   8888888 00
     20.  Technology investment credit carryforward (include a copy of the credit certiﬁ cate) .............................. 20.
48   21.  Enterprise zone day care and training credits (include a copy of the credit certiﬁ cate) .......................... 21.                                    8888888 00
49                                                                                                                                                                   8888888 00
     22.  Research and development credit (include a copy of the credit certiﬁ cate) ............................................ 22.
50
     23.  Ohio historic preservation credit, nonrefundable carryforward portion (include a copy of the credit 
51  certiﬁ cate) ............................................................................................................................................... 23. 8888888 00
52   24.  Total (add lines 13 through 23) ............................................................................................................... 24.        8888888 00
53
54   25. Tax less additional credits (line 12 minus line 24; if less than -0-, enter -0-) ........................................... 25.                            888888888 00
55
56
57
58
59            Do not write in this area; for department use only.
60
61
62
63
                                  2016 Ohio Schedule of Credits – page 1 of 2
64
65
66

- 44 -

123456789 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3
4                                                               Do not use staples. Use only black ink. 
5
                                    2016 Ohio Schedule of Credits
6
7                      Rev. 11/16                      Nonrefundable and Refundable
8                                                                                                       SSN of primary ﬁ ler                     16280210

9                                                                                                       888 88  8888
10 Nonresident Credit  
11 Date of nonresidency  88 88 88                   to          88 88 88                                State of residency   XX
12  
13  26.  Enter the portion of Ohio adjusted gross income (Ohio 
14    IT 1040, line 3) that was not earned or received in 
      Ohio. Include Ohio IT NRC if required ...............................26.                          888888888 00
15
16  27.  Enter the Ohio adjusted gross income (Ohio IT 1040, 
        line 3) ....................................................................................27. 888888888 00
17
18                                                                                                      .8888
19  28.  Divide line 26 by line 27 and enter the result here (four digits; do not round).
      Multiply this factor by the amount on line 25 to calculate your nonresident credit .................................... 28.                888888888 00
20
21 Resident Credit
22   29.  Enter the portion of Ohio adjusted gross income (Ohio 
23    IT 1040, line 3) subjected to tax by other states or the 
24      District of Columbia while you were an Ohio resident 
        (limits apply) ..................................................................... 29.        888888888 00
25
26   30.  Enter the Ohio adjusted gross income (Ohio IT 1040, 
        line 3) .............................................................................30.        888888888 00
27  
28  31.  Divide line 29 by line 30 and enter the result here (four digits; do not round).
29    Multiply this factor by the amount on line 25                                                     .8888
      and enter the result here ................................................31.                     888888888 00
30  
31   32.  Enter the 2016 income tax, less all credits other than
32    withholding and estimated tax payments and overpayment 
33    carryforwards from previous years, paid to other states or 
      the District of Columbia (limits apply) ............................. 32.
34                                                                                                      888888888 00
35   33.  Enter the smaller of line 31 or line 32. This is your Ohio resident tax credit. If you ﬁ led a return for 
      2016 with a state(s) other than Ohio, enter the two-letter state abbreviation in the box(es) below ........ 33.                            888888888 00
36
37      XX XX XX XX      XX XX
38
39                                                                                                                                               888888888 00
    34. Total nonrefundable credits (add lines 11, 24, 28 and 33; enter here and on Ohio IT 1040, line 9) .... 34.
40
41
42                                  Refundable Credits
43   35.  Historic preservation credit (include a copy of the credit certiﬁ cate) ....................................................... 35.    88888888 00
44
45  
    36.  Business jobs credit (include a copy of the credit certiﬁ cate) ................................................................... 36. 88888888 00
46
47                                                                                                                                               88888888 00
     37.  Pass-through entity credit (include a copy of the federal K-1) ................................................................ 37.
48
    
49                                                                                                                                               88888888 00
     38.  Motion picture production credit (include a copy of the credit certiﬁ cate) ............................................... 38.
50
51                                                                                                                                               88888888 00
     39.  Financial Institutions Tax (FIT) credit (include a copy of the federal K-1) ............................................... 39.
52
53                                                                                                                                               88888888 00
     40.  Venture capital credit (include a copy of the credit certiﬁ cate) ................................................................ 40.
54
55  41. Total refundable credits (add lines 35 through 40; enter here and on Ohio IT 1040, line 16) .............. 41.                           888888888 00
56
57
58
59
60
61
62
63
                                  2016 Ohio Schedule of Credits – page 2 of 2
64
65
66

- 45 -

Layout 

without grid

- 46 -

                                                              Do not use staples. Use only black ink. 

                                   2016 Ohio Schedule of Credits
                 Rev. 11/16                                   Nonrefundable and Refundable
                                                                        SSN of primary ﬁ ler                                                                       16280110

  88 88 88                                                           888 88  8888

                                Nonrefundable Credits
  1. Tax liability before credits (from Ohio IT 1040, line 8c) ............................................................................... 1.                  888888888 00

  2.  Retirement income credit (limit $200 per return). See the table in the instructions ................................... 2.                                           888 00

  3.  Lump sum retirement credit (include Ohio LS WKS, line 6)… ..................................................................3.                               888888 00
  4.  Senior citizen credit (must be 65 or older to claim this credit;  limit $50 per return) ................................ 4.                                          88 00
 
  5.  Lump sum distribution credit (must be 65 or older to claim this credit; include Ohio LS WKS, line 3)… .. 5.                                                  8888 00

  6.  Child care and dependent care credit (see the worksheet in the instructions)… ...................................... 6.                                      8888 00
  7.  If Ohio IT 1040, line 5 is $10,000 or less, enter $88; otherwise, enter -0- (low income credit) ................. 7.                                                 88 00
  
  8.  Displaced worker training credit (see the worksheet in the instructions) (limit $500 per taxpayer) ........ 8.                                               8888 00

  9.  Campaign contribution credit for Ohio statewide ofﬁ ce or General Assembly (limit $50 per taxpayer) .. 9.                                                            888 00
  10.  Income-based exemption credit ($20 personal/dependent exemption credit) ........................................ 10.                                                888 00

  11.  Total (add lines 2 through 10) ................................................................................................................. 11.        888888888 00

  12.  Tax less credits (line 1 minus line 11; if less than -0-, enter -0-) ............................................................. 12.                      888888888 00
 
 13.  Joint ﬁ ling credit. See the instructions for eligibility and documentation requirements. This credit is for 
  married ﬁ ling jointly status only.              88 % times amount on line 12(limit $650) ................................................13.                            888 00

  14.  Earned income credit .............................................................................................................................. 14.             888 00

  15.  Ohio adoption credit (limit $10,000 per adopted child) ........................................................................ 15.                         88888 00

  16.  Job retention credit, nonrefundable portion (include a copy of the credit certiﬁ cate) .............................. 16.                                   8888888 00

  17.  Credit for eligible new employees in an enterprise zone (include a copy of the credit certiﬁ cate) .......... 17.                                           8888888 00

  18.  Credit for purchases of grape production property ................................................................................. 18.                     8888888 00

  19.  Invest Ohio credit (include a copy of the credit certiﬁ cate) ..................................................................... 19.                     8888888 00

  20.  Technology investment credit carryforward (include a copy of the credit certiﬁ cate) .............................. 20.                                     8888888 00
  21.  Enterprise zone day care and training credits (include a copy of the credit certiﬁ cate) .......................... 21.                                     8888888 00
  22.  Research and development credit (include a copy of the credit certiﬁ cate) ............................................ 22.                                 8888888 00
  23.  Ohio historic preservation credit, nonrefundable carryforward portion (include a copy of the credit 
  certiﬁ cate) ............................................................................................................................................... 23. 8888888 00
  24.  Total (add lines 13 through 23) ............................................................................................................... 24.         8888888 00

  25. Tax less additional credits (line 12 minus line 24; if less than -0-, enter -0-) ........................................... 25.                             888888888 00

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

                                2016 Ohio Schedule of Credits – page 1 of 2

- 47 -

                                                             Do not use staples. Use only black ink. 
                                 2016 Ohio Schedule of Credits
                    Rev. 11/16                      Nonrefundable and Refundable
                                                                                                     SSN of primary ﬁ ler                     16280210

                                                                                                     888 88  8888
Nonresident Credit  
Date of nonresidency  88 88 88                   to          88 88 88                                State of residency   XX
 
 26.  Enter the portion of Ohio adjusted gross income (Ohio 
   IT 1040, line 3) that was not earned or received in 
   Ohio. Include Ohio IT NRC if required ...............................26.                          888888888 00
 27.  Enter the Ohio adjusted gross income (Ohio IT 1040, 
     line 3) ....................................................................................27. 888888888 00

 28.  Divide line 26 by line 27 and enter the result here (four digits; do not round).               .8888
   Multiply this factor by the amount on line 25 to calculate your nonresident credit .................................... 28.                888888888 00
Resident Credit
  29.  Enter the portion of Ohio adjusted gross income (Ohio 
   IT 1040, line 3) subjected to tax by other states or the 
     District of Columbia while you were an Ohio resident 
     (limits apply) ..................................................................... 29.        888888888 00
  30.  Enter the Ohio adjusted gross income (Ohio IT 1040, 
     line 3) .............................................................................30.        888888888 00
 
 31.  Divide line 29 by line 30 and enter the result here (four digits; do not round).
   Multiply this factor by the amount on line 25                                                     .8888
   and enter the result here ................................................31.                     888888888 00
 
  32.  Enter the 2016 income tax, less all credits other than
   withholding and estimated tax payments and overpayment 
   carryforwards from previous years, paid to other states or 
   the District of Columbia (limits apply) ............................. 32.                         888888888 00
 
  33.  Enter the smaller of line 31 or line 32. This is your Ohio resident tax credit. If you ﬁ led a return for 
   2016 with a state(s) other than Ohio, enter the two-letter state abbreviation in the box(es) below ........ 33.                            888888888 00

     XX XX XX XX      XX XX

 34. Total nonrefundable credits (add lines 11, 24, 28 and 33; enter here and on Ohio IT 1040, line 9) .... 34.                               888888888 00

                                 Refundable Credits
  35.  Historic preservation credit (include a copy of the credit certiﬁ cate) ....................................................... 35.    88888888 00
 
 36.  Business jobs credit (include a copy of the credit certiﬁ cate) ................................................................... 36. 88888888 00

  37.  Pass-through entity credit (include a copy of the federal K-1) ................................................................ 37.    88888888 00
 
  38.  Motion picture production credit (include a copy of the credit certiﬁ cate) ............................................... 38.        88888888 00

  39.  Financial Institutions Tax (FIT) credit (include a copy of the federal K-1) ............................................... 39.        88888888 00

  40.  Venture capital credit (include a copy of the credit certiﬁ cate) ................................................................ 40. 88888888 00

 41. Total refundable credits (add lines 35 through 40; enter here and on Ohio IT 1040, line 16) .............. 41.                           888888888 00

                               2016 Ohio Schedule of Credits – page 2 of 2

- 48 -

General information 

regarding this form

- 49 -

General Information (2016 Schedule of Credits):

1) Dimensions: 
  
  Target or Registration Marks - 6 mm X 6 mm. Follow grid layout for positioning.

  1D barcode (2 of 5 interleaved) - .375”H x 1.5”W. Follow grid layout for positioning. Center the barcode  
  number directly under the barcode.

  2D barcode (PDF 417) - See 2D instructions and schema. Follow grid layout for positioning. There is one 
  2D barcode for the Schedule of Credits.

2) 1D barcode - The last two numbers of the 1D barcode represent the vendor number. Use the same vendor 
number as you did for last year’s return. If you have a question about your barcode assignment, e-mail the Forms 
Unit at Forms@tax.state.oh.us. The ﬁ rst six numbers are constant for this form (162801XX - 162802XX). 

  16 = tax year
  28 = Schedule of Credits 
  01-02 = page number 
  XX = vendor number (assigned to you by the Ohio Dept. of Taxation, Forms Unit)

    NOTE: The vendor number also serves as the ﬁ rst two digits of the SSN in the test scenarios.

3) Use Arial font for the static text on the form.

4) Use monospaced Arial or similar monospaced san serif font for the variable data ﬁ elds on the form.

5) Follow the grid layout for the variable data ﬁ elds shown in red. Ensure that the tax year, target or reg-
istration marks, “For Department Use Only” area and the 1D and 2D barcodes follow grid layout.

6) Do not use commas, hyphens or decimals in the variable data ﬁ elds except where shown in specs.

7)  All monetary ﬁ elds must always show “00” in the cents ﬁ eld even though there may not be a value for that line.

8) Provide guidance to customers regarding duplex printing that instructs them to print pages 1 and 2 together. 
Taxpayers have ﬁ led returns with pages 2 and 3 duplexed or a worksheet or software receipt on the back of a 
page of the return. This slows the processing of the tax return.

9) Generate the following message for customers: “Do not enclose other documentation unless it is speciﬁ ed 
on the tax return or instructions.” Taxpayers often submit worksheets and receipts from the vendor product, 
which slows the processing of tax returns.

10) IMPORTANT NOTE: Add this statement to your software programs. It should print out with the taxpayer’s 
return. “Do not hand write in any corrections on the printed paper return. Hand writing in corrections will 
result in capturing incorrect data and delaying the processing of this income tax return. Make any cor-
rections to this income tax return within [the software program name], then print and mail.”

11) See the 2D barcode instructions for submission details.

- 50 -

                                                          Rev. 11/4/16

Scan Speciﬁ cations for the 

2016 Ohio Schedule J

                        Important Note

The following document (2016 Ohio Schedule J) contains grids for place-
ment of information on this speciﬁ c tax form. To accurately print, do not 
reduce the size, rotate or center this document. Doing so will jeopardize 
the integrity of the grid. When printing from Adobe Reader, please select 
“None” for “Page Scaling,” which is under “Page Handling.”

       Ohio Department of Taxation

                        4485 Northland Ridge Blvd.

                        Columbus, OH 43229

                        tax.ohio.gov

- 51 -

Grid layout 

with notations

- 52 -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3                                               Do not use staples. Use only black ink and uppercase letters. 
4
5                                                          2016 Ohio Schedule J
6                      New! The date the return was gen-
7                      Rev. 9/16                Dependents Claimed on the Ohio IT 1040 Return
                       erated by the taxpayer (MM DD YY).
                                                                                                                                               16230110
8                                                                       SSN of primary ﬁ ler
9  88 88 88                                                Placement888of the88 tax year8888and 1D barcode is critical. 
10                                                         Make sure to follow the grid positions for layout. Do 
11 Do not list below the primary ﬁ ler and/or spouse reported on Ohio IT 1040.not forget to get your barcode(s) assignments for  Use this schedule to claim dependents. If you have more than 15 dependents, 
12 complete additional copies of this schedule and include themeverywithform,yourversionincomeand page.tax return. Abbreviate the “Dependent’s relationship to you” below if there are 
   not enough boxes to spell it out completely. 
13
14  1. Dependent’s SSN (required)                  Dependent's date of birth (MM DD YYYY)                                   Dependent’s relationship to you (required)
15 888 88  8888                                    88 88 8888                                                               XXXXXXXXXXXXXXX
16 Dependent’s ﬁ rst name (required)                       M.I.     Last name (required)
17 JOHNXXXXXXXXXXX                                         Q        PUBL I               CXXXXXXXXXXXXXX
18
19  2. Dependent’s SSN (required)                  Dependent's date of birth (MM DD YYYY)                                   Dependent’s relationship to you (required)
                                                   For static text use Arial font (black ink) and try to 
20 888 88  8888                                    88 88 8888match size. For data entry ﬁ elds (shown in red XXXXXXXXXXXXXXX
21 Dependent’s ﬁ rst name (required)               for identiﬁM.I.cationLastpurposesname (required)only        ), use Arial font 
22 JOHNXXXXXXXXXXX                                 (blackQink).     PUBLAll the dataI    entryCXXXXXXXXXXXXXXﬁ elds must follow 
23                                                 grid layout.
24  3. Dependent’s SSN (required)                  Dependent's date of birth (MM DD YYYY)                                   Dependent’s relationship to you (required)
25 888 88  8888                                    88 88 8888                                                               XXXXXXXXXXXXXXX
26 Dependent’s ﬁ rst name (required)                       M.I.     Last name (required)
27 JOHNXXXXXXXXXXX                                         Q        PUBL I               CXXXXXXXXXXXXXX
28
29  4. Dependent’s SSN (required)                  Dependent's date of birth (MM DD YYYY)                                   Dependent’s relationship to you (required)
30 888 88  8888                                    88 88 8888                                                               XXXXXXXXXXXXXXX
31 Dependent’s ﬁ rst name (required)                       M.I.     Last name (required)
32 JOHNXXXXXXXXXXX                                         Q        PUBL I               CXXXXXXXXXXXXXX
33
34  5. Dependent’s SSN (required)                  Dependent's date of birth (MM DD YYYY)                                   Dependent’s relationship to you (required)
35 888 88  8888                                    88 88 8888                                                               XXXXXXXXXXXXXXX
36 Dependent’s ﬁ rst name (required)                       M.I.     Last name (required)
37 JOHNXXXXXXXXXXX                                         Q        PUBL I               CXXXXXXXXXXXXXX
38
39  6. Dependent’s SSN (required)                  Dependent's date of birth (MM DD YYYY)                                   Dependent’s relationship to you (required)
40 888 88  8888                                    88 88 8888                                                               XXXXXXXXXXXXXXX
41 Dependent’s ﬁ rst name (required)                       M.I.     Last name (required)
42                                                                                       
   JOHNXXXXXXXXXXX                                         Q        PUBL I CXXXXXXXXXXXXXX
43
44  7. Dependent’s SSN (required)                  Dependent's date of birth (MM DD YYYY)                                   Dependent’s relationship to you (required)
45 888 88  8888                                    88 88 8888                                                               XXXXXXXXXXXXXXX
46 Dependent’s ﬁ rst name (required)                       M.I.     Last name (required)
47 JOHNXXXXXXXXXXX                                         Q        PUBL I               CXXXXXXXXXXXXXX
48
49                                                                                                                          2D barcode required. Delete this 
50                                                                                                                          box with text and replace it with 
51                                                                                                                          the 2D barcode.
52
53
54
55
56
57                                    Do not write in this area; for department use only.                                                  Target marks or registration marks 
                                                                                                                                           must measure 6 mm X 6 mm. The 
58                                                                                                                                         four target marks or registration 
59                                                                                                                                         marks on every page must follow 
60                                                                                                                                         grid layout.
61
62
63
                                                2016 Ohio Schedule J – pg. 1 of 2
64
65
66

- 53 -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3
4
5                                               2016 Ohio Schedule J
6
7  Rev. 9/16                                    Dependents Claimed on the Ohio IT 1040 Return
                                                                                             16230210
8                                                    SSN of primary ﬁ ler
9                                                    888 88  8888
10
11 Do not list below the primary ﬁ ler and/or spouse reported on Ohio IT 1040. Use this schedule to claim dependents. If you have more than 15 dependents, 
12 complete additional copies of this schedule and include them with your income tax return. Abbreviate the “Dependent’s relationship to you” below if there are 
   not enough boxes to spell it out completely. 
13
14  8. Dependent’s SSN (required)               Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
15 888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
16 Dependent’s ﬁ rst name (required)            M.I. Last name (required)
17 JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX
18
19  9. Dependent’s SSN (required)               Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
20 888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
21 Dependent’s ﬁ rst name (required)            M.I. Last name (required)
22 JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX
23
24   10. Dependent’s SSN (required)             Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
25 888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
26 Dependent’s ﬁ rst name (required)            M.I. Last name (required)
27 JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX
28
29   11. Dependent’s SSN (required)             Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
30 888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
31 Dependent’s ﬁ rst name (required)            M.I. Last name (required)
32 JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX
33
34   12. Dependent’s SSN (required)             Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
35 888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
36 Dependent’s ﬁ rst name (required)            M.I. Last name (required)
37 JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX
38
39   13. Dependent’s SSN (required)             Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
40 888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
41 Dependent’s ﬁ rst name (required)            M.I. Last name (required)
42                                                          
   JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX
43
44   14. Dependent’s SSN (required)             Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
45 888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
46 Dependent’s ﬁ rst name (required)            M.I. Last name (required)
47 JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX
48
49 15. Dependent’s SSN (required)               Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
50 888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
51 Dependent’s ﬁ rst name (required)            M.I. Last name (required)
52                                                          
   JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX
53
54
55
56
57
58
59
60
61
62
63
                                                2016 Ohio Schedule J – pg. 2 of 2
64
65
66

- 54 -

Grid layout

- 55 -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3                                               Do not use staples. Use only black ink and uppercase letters. 
4
5                                               2016 Ohio Schedule J
6
7           Rev. 9/16                           Dependents Claimed on the Ohio IT 1040 Return
                                                                                                              16230110
8                                                    SSN of primary ﬁ ler
9  88 88 88                                          888 88  8888
10
11 Do not list below the primary ﬁ ler and/or spouse reported on Ohio IT 1040. Use this schedule to claim dependents. If you have more than 15 dependents, 
12 complete additional copies of this schedule and include them with your income tax return. Abbreviate the “Dependent’s relationship to you” below if there are 
   not enough boxes to spell it out completely. 
13
14  1. Dependent’s SSN (required)               Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
15 888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
16 Dependent’s ﬁ rst name (required)            M.I. Last name (required)
17 JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX
18
19  2. Dependent’s SSN (required)               Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
20 888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
21 Dependent’s ﬁ rst name (required)            M.I. Last name (required)
22 JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX
23
24  3. Dependent’s SSN (required)               Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
25 888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
26 Dependent’s ﬁ rst name (required)            M.I. Last name (required)
27 JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX
28
29  4. Dependent’s SSN (required)               Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
30 888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
31 Dependent’s ﬁ rst name (required)            M.I. Last name (required)
32 JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX
33
34  5. Dependent’s SSN (required)               Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
35 888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
36 Dependent’s ﬁ rst name (required)            M.I. Last name (required)
37 JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX
38
39  6. Dependent’s SSN (required)               Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
40 888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
41 Dependent’s ﬁ rst name (required)            M.I. Last name (required)
42                                                          
   JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX
43
44  7. Dependent’s SSN (required)               Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
45 888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
46 Dependent’s ﬁ rst name (required)            M.I. Last name (required)
47 JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX
48
49
50
51
52
53
54
55
56
57                                   Do not write in this area; for department use only.
58
59
60
61
62
63
                                                2016 Ohio Schedule J – pg. 1 of 2
64
65
66

- 56 -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3
4
5                                               2016 Ohio Schedule J
6
7  Rev. 9/16                                    Dependents Claimed on the Ohio IT 1040 Return
                                                                                             16230210
8                                                    SSN of primary ﬁ ler
9                                                    888 88  8888
10
11 Do not list below the primary ﬁ ler and/or spouse reported on Ohio IT 1040. Use this schedule to claim dependents. If you have more than 15 dependents, 
12 complete additional copies of this schedule and include them with your income tax return. Abbreviate the “Dependent’s relationship to you” below if there are 
   not enough boxes to spell it out completely. 
13
14  8. Dependent’s SSN (required)               Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
15 888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
16 Dependent’s ﬁ rst name (required)            M.I. Last name (required)
17 JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX
18
19  9. Dependent’s SSN (required)               Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
20 888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
21 Dependent’s ﬁ rst name (required)            M.I. Last name (required)
22 JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX
23
24   10. Dependent’s SSN (required)             Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
25 888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
26 Dependent’s ﬁ rst name (required)            M.I. Last name (required)
27 JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX
28
29   11. Dependent’s SSN (required)             Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
30 888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
31 Dependent’s ﬁ rst name (required)            M.I. Last name (required)
32 JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX
33
34   12. Dependent’s SSN (required)             Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
35 888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
36 Dependent’s ﬁ rst name (required)            M.I. Last name (required)
37 JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX
38
39   13. Dependent’s SSN (required)             Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
40 888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
41 Dependent’s ﬁ rst name (required)            M.I. Last name (required)
42                                                          
   JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX
43
44   14. Dependent’s SSN (required)             Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
45 888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
46 Dependent’s ﬁ rst name (required)            M.I. Last name (required)
47 JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX
48
49 15. Dependent’s SSN (required)               Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
50 888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
51 Dependent’s ﬁ rst name (required)            M.I. Last name (required)
52                                                          
   JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX
53
54
55
56
57
58
59
60
61
62
63
                                                2016 Ohio Schedule J – pg. 2 of 2
64
65
66

- 57 -

 Layout 

without grid

- 58 -

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

                                             2016 Ohio Schedule J
         Rev. 9/16                           Dependents Claimed on the Ohio IT 1040 Return
                                                                                                           16230110
                                                  SSN of primary ﬁ ler
88 88 88                                          888 88  8888
Do not list below the primary ﬁ ler and/or spouse reported on Ohio IT 1040. Use this schedule to claim dependents. If you have more than 15 dependents, 
complete additional copies of this schedule and include them with your income tax return. Abbreviate the “Dependent’s relationship to you” below if there are 
not enough boxes to spell it out completely. 
 1. Dependent’s SSN (required)               Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
Dependent’s ﬁ rst name (required)            M.I. Last name (required)
JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX

 2. Dependent’s SSN (required)               Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
Dependent’s ﬁ rst name (required)            M.I. Last name (required)
JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX

 3. Dependent’s SSN (required)               Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
Dependent’s ﬁ rst name (required)            M.I. Last name (required)
JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX

 4. Dependent’s SSN (required)               Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
Dependent’s ﬁ rst name (required)            M.I. Last name (required)
JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX

 5. Dependent’s SSN (required)               Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
Dependent’s ﬁ rst name (required)            M.I. Last name (required)
JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX

 6. Dependent’s SSN (required)               Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
Dependent’s ﬁ rst name (required)            M.I. Last name (required)
JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX

 7. Dependent’s SSN (required)               Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
Dependent’s ﬁ rst name (required)            M.I. Last name (required)
JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX

                                             2016 Ohio Schedule J – pg. 1 of 2

- 59 -

                                             2016 Ohio Schedule J
Rev. 9/16                                    Dependents Claimed on the Ohio IT 1040 Return
                                                                                          16230210
                                                  SSN of primary ﬁ ler
                                                  888 88  8888
Do not list below the primary ﬁ ler and/or spouse reported on Ohio IT 1040. Use this schedule to claim dependents. If you have more than 15 dependents, 
complete additional copies of this schedule and include them with your income tax return. Abbreviate the “Dependent’s relationship to you” below if there are 
not enough boxes to spell it out completely. 
 8. Dependent’s SSN (required)               Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
Dependent’s ﬁ rst name (required)            M.I. Last name (required)
JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX

 9. Dependent’s SSN (required)               Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
Dependent’s ﬁ rst name (required)            M.I. Last name (required)
JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX

  10. Dependent’s SSN (required)             Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
Dependent’s ﬁ rst name (required)            M.I. Last name (required)
JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX

  11. Dependent’s SSN (required)             Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
Dependent’s ﬁ rst name (required)            M.I. Last name (required)
JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX

  12. Dependent’s SSN (required)             Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
Dependent’s ﬁ rst name (required)            M.I. Last name (required)
JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX

  13. Dependent’s SSN (required)             Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
Dependent’s ﬁ rst name (required)            M.I. Last name (required)
JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX

  14. Dependent’s SSN (required)             Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
Dependent’s ﬁ rst name (required)            M.I. Last name (required)
JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX

15. Dependent’s SSN (required)               Dependent's date of birth (MM DD YYYY) Dependent’s relationship to you (required)
888 88  8888                                 88 88 8888                             XXXXXXXXXXXXXXX
Dependent’s ﬁ rst name (required)            M.I. Last name (required)
JOHNXXXXXXXXXXX                              Q    PUBL I CXXXXXXXXXXXXXX

                                             2016 Ohio Schedule J – pg. 2 of 2

- 60 -

General information 

regarding this form

- 61 -

          General Information (2016 Schedule J):

1) Dimensions: 
  
  Target or Registration Marks - 6 mm X 6 mm. Follow grid layout for positioning.

  1D barcode (2 of 5 interleaved) - .375”H x 1.5”W. Follow grid layout for positioning. Center the barcode  
  number directly under the barcode.

  2D barcode (PDF 417) - See 2D instructions and schema. Follow grid layout for positioning. There is one 2D 
  barcode for the Schedule J.

2) 1D barcode - The last two numbers of the 1D barcode represent the vendor number. Use the same vendor 
number as you did for last year’s return. If you have a question about your barcode assignment, e-mail the Forms 
Unit at Forms@tax.state.oh.us. The ﬁ rst six numbers are constant for this form (162301XX - 162302XX). 

  16 = tax year
  23 = Schedule J 
  01-02 = page number 
  XX = vendor number (assigned to you by the Ohio Dept. of Taxation, Forms Unit)

    NOTE: The vendor number also serves as the ﬁ rst two digits of the SSN in the test scenarios.

3) Use Arial font for the static text on the form.

4) Use monospaced Arial or similar monospaced san serif font for the variable data ﬁ elds on the form.

5) Follow the grid layout for the variable data ﬁ elds shown in red. Ensure that the tax year, target or reg-
istration marks, “For Department Use Only” area and the 1D and 2D barcodes follow grid layout.

6) Do not use commas, hyphens or decimals in the variable data ﬁ elds except where shown in specs.

7) Provide guidance to customers regarding duplex printing that instructs them to print pages 1 and 2 together. 
Taxpayers have ﬁ led returns with pages 2 and 3 duplexed or a worksheet or software receipt on the back of a 
page of the return. This slows the processing of the tax return.

8) Generate the following message for customers: “Do not enclose other documentation unless it is speciﬁ ed 
on the tax return or instructions.” Taxpayers often submit worksheets and receipts from the vendor product, 
which slows the processing of tax returns.

9) IMPORTANT NOTE: Add this statement to your software programs. It should print out with the taxpayer’s return. 
“Do not hand write in any corrections on the printed paper return. Hand writing in corrections will result 
in capturing incorrect data and delaying the processing of this income tax return. Make any corrections 
to this income tax return within [the software program name], then print and mail.”

10) See the 2D barcode instructions for submission details.

- 62 -

                                                                                                                          IT RE
                                                                                                                          Rev. 10/16

                                                           16270101

               2016 Ohio IT RE – Reason and Explanation of Corrections
                                      Note: For amended individual return only
                               Complete the IT 1040 (checking the amended return box) and include 
                          this form with documentation to support any adjustments to line items on the return. 
Taxpayer's SSN (required) 

First name                                        M.I. Last name

Reason(s):
 Net operating loss carryback (IMPORTANT: Be sure to complete      Ohio Schedule of Credits, resident credit increased
 and include Ohio IT NOL, Net Operating Loss Carryback Schedule    Ohio     Schedule of Credits, resident credit decreased
 [available at tax.ohio.gov] and check the box on the front of the 
 Ohio IT 1040 indicating that you are amending for a NOL.)         Ohio Schedule of Credits, refundable credit(s) increased
 Federal adjusted gross income increased                           Ohio Schedule of Credits, refundable credit(s) decreased
 Federal adjusted gross income decreased*                          Ohio IT/SD 2210 interest penalty amount increased
 Filing status changed*                                            Ohio     IT/SD 2210 interest penalty amount decreased
 Residency status changed                                          Ohio sales and use tax increased
 Exemptions increased (include Schedule J)*                        Ohio sales and use tax decreased
 Exemptions decreased (include Schedule J)                         Ohio withholding increased
 Ohio Schedule A, additions to income                              Ohio     withholding decreased
 Ohio Schedule A, deductions from income                           Estimated and/or Ohio IT 40P amount or previous year 
                                                                   carryforward overpayment increased
 Ohio Schedule of Credits, nonrefundable credit(s) increased
                                                                   Estimated and/or Ohio IT 40P amount or previous year 
 Ohio Schedule of Credits, nonrefundable credit(s) decreased       carryforward overpayment decreased
 Ohio Schedule of Credits, nonresident credit increased            Amount paid with original ﬁ ling did not equal amount reported as 
 Ohio Schedule of Credits, nonresident credit decreased            paid with the original ﬁ ling
*To avoid delays you must include a copy of your federal account transcript OR a copy of your federal amended income tax return with a 
copy of the IRS acceptance letter or refund check.
Detailed explanation of adjusted items (include additional sheet(s) if necessary):

E-mail address                                                     Telephone number

                                                  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 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. 

                                                             - 1 -

PDF file checksum: 2649614119

(Plugin #1/9.12/13.0)