Do not staple or paper clip.

2017 Ohio IT 1040 
Rev. 9/17
Individual Income Tax Return 17000102
Use only black ink and UPPERCASE letters. 1

 Check here if this is an amended return. Include the Ohio IT RE (do NOT include a copy of the previously filed return). 
 Check here if this is a Net Operating Loss (NOL) carryback. Include Ohio Schedule IT NOL.
Taxpayer's SSN (required)  If deceased Spouse’s SSN (if filing jointly)  If deceased Enter school district # for 
this return (see instructions).

check box check box SD#
First name M.I. Last name

Spouse's first name (only if married filing jointly) M.I. Last name

Address line 1 (number and street) or P.O. Box

Address line 2 (apartment number, suite number, etc.)

City State ZIP code Ohio county (first four letters)

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

Ohio Residency Status – Check applicable box Filing Status – Check one (as reported on federal income tax return)
Full-year Part-year Nonresident 
resident resident Indicate state Single, head of household or qualifying widow(er)
Check applicable box for spouse (only if married filing jointly) Married filing jointly
Full-year Part-year Nonresident
resident resident Indicate state Married filing separately
Ohio Political Party Fund
Check here if you want $1 to go to this fund. Check here if you filed the federal extension 4868.
Check here if your spouse wants $1 to go to this fund (if filing jointly). Check here if someone else is able to claim you (or your spouse if 
Do not staple or paper clip. Note: Checking this box will not increase your tax or decrease your refund. joint return) as a dependent.
 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). Include page 1 of your 
0 0
   federal return if the amount is zero or negative. Place a "-" in box at the right if negative ...... ..1. .
 
0 0
 2a. Additions – Ohio Schedule A, line 10 (include schedule) ............................................................... 2a. .
 
0 0
2b. Deductions – Ohio Schedule A, line 35 (include schedule)............................................................2b. .
 3. Ohio adjusted gross income (line 1 plus line 2a minus line 2b). Place a "-" in the box at 
0 0
   the right if the amount is less than zero...................................................................................       ..3. .
0 0
 4. Exemption amount (if claiming dependent(s), include Schedule J) ................................................. 4. .
      Number of exemptions claimed on your federal return:
 
0 0
 5. Ohio income tax base (line 3 minus line 4; if less than zero, enter zero) ......................................... 5. .
 
0 0
 6. Taxable business income – Ohio Schedule IT BUS, line 13 (include schedule) .............................. 6. .
0 0
 7. Line 5 minus line 6 (if less than zero, enter zero) ............................................................................7. .

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

2017 Ohio IT 1040 – page 1 of 2

                                                               2017 Ohio IT 1040 
                         Rev. 9/17
                                               Individual Income Tax Return                                                                                       17000202
                                                                                                                                                                                                        2
   SSN
                                                                                                                                                                                      0 0
 7a. Amount from line 7 on page 1 ........................................................................................................7a.                                        .
 
                                                                                                                                                                                      0 0
 8a. Nonbusiness income tax liability on line 7a (see instructions for tax tables)...............................................                     8a.                            .
 
                                                                                                                                                                                      0 0
 8b. Business income tax liability – Ohio Schedule IT BUS, line 14 (include schedule)           ....................................                  8b.                            .
                                                                                                                                                                                      0 0
 8c. Income tax liability before credits (line 8a plus line 8b) ..............................................................................        8c.                            .
                                                                                                                                                                                      0 0
 9. Ohio nonrefundable credits – Ohio Schedule of Credits, line 33 (include schedule) ....................................9.                                                         .
                                                                                                                                                                                      0 0
 10. Tax liability after nonrefundable credits (line 8c minus line 9; if less than zero, enter zero)........................10.                                                      .
 
                                                                                                                                                                                      0 0
  11. Interest penalty on underpayment of estimated tax (include Ohio IT/SD 2210)..........................................11.                                                       .
 12. Use tax due on Internet, mail order or other out-of-state purchases (see instructions). 
                                                                                                                                                                                      0 0
   Check here to certify that no use tax is due ....................................................................................          ....    12.                            .
                                                                                                                                                                                      0 0
 13. Total Ohio tax liability before withholding or estimated payments (add lines 10, 11 and 12) ...................                                  13.                            .
 14. Ohio income tax withheld (W-2, box 17; W-2G, box 15; 1099-R, box 12). Include W-2(s), W-2G(s) 
                                                                                                                                                                                      0 0
   and 1099-R(s) with the return .....................................................................................................................14.                            .
 15. Estimated (2017 Ohio IT 1040ES) and extension (2017 Ohio IT 40P) payments and credit
                                                                                                                                                                                      0 0
   carryforward from previous year return .......................................................................................................     15.                            .
                                                                                                                                                                                      0 0
 16. Refundable credits – Ohio Schedule of Credits, line 40 (include schedule) ...............................................                        16.                            .
                                                                                                                                                                                      0 0
 17. Amended return only – amount previously paid with original and/or amended return .............................17.                                                               .
                                                                                                                                                                                      0 0
 18. Total Ohio tax payments (add lines 14, 15, 16 and 17) ............................................................................               18.                            .
                                                                                                                                                                                      0 0
 19. Amended return only – overpayment previously requested on original and/or amended return ..............19.                                                                      .
                                                                                                                                                                                      0 0
 20. Line 18 minus line 19. Place a "-" in the box at the right if the amount is less than zero ...........................                   ....    20.                            .
 
            If line 20 is MORE THAN line 13, skip to line 24. OTHERWISE, continue to line 21.
                                                                                                                                                                                      0 0
 21. Tax liability (line 13 minus line 20). If line 20 is negative, ignore the "-" and add line 20 to line 13 .............                           21.                            .
                                                                                                                                                                                      0 0
 22. Interest and penalty due on late filing or late payment of tax (see instructions) ..............................................................22.                             .
 
23. Total amount due (line 21 plus line 22). Include Ohio IT 40P (if original return) or IT 40XP (if    
                                                                                                                                                                                      0 0
     amended return) and make check payable to “Ohio Treasurer of State” ........... AMOUNT DUE23.                                                                                  .
                                                                                                                                                                                      0 0
 24. Overpayment (line 20 minus line 13) ..........................................................................................................   24.                            .
 
                                                                                                                                                                                      0 0
 25. Original return only – amount of line 24 to be credited toward 2018 income tax liability ............................                            25.                            .
 26. Original return only – amount of line 24 to be donated:
      a. Wishes for Sick Children  b. Wildlife species                      c. Military injury relief

                         . 0 0                               0 0                               0 0
                                                             .                         .
      d. Ohio History Fund         e. State nature preserves                f. Breast / cervical cancer
                          0 0                                0 0                               0 0                                                                                    0 0
                         .                                   .                         .                      Total ....                      26g.                                   .
                                                                                                                                                                                      0 0
 27. REFUND (line 24 minus lines 25 and 26g) .................................................................YOUR  REFUND27.                                                       .
  Sign Here (required): I have read this return. Under penalties of perjury, I declare that, to the best of my knowledge                              If your refund is $1.00 or less, no refund will be issued. 
  and belief, the return and all enclosures are true, correct and complete.                                                                           If you owe $1.00 or less, no payment is necessary.
Your signature  Date (MM/DD/YY)                                                                                                                          NO Payment Included  –Mail to:
                                                                                                                                                          Ohio Department of Taxation
Spouse’s signature                                                              Phone number                                                                P.O. Box 2679
                                                                                                                                                          Columbus, OH  43270-2679
      Check here to authorize your preparer to discuss this  return with Taxation                                                                         Payment Included  –Mail to:
  Preparer's printed name                                                                                                                                 Ohio Department of Taxation
                                                                                                                                                             P.O. Box 2057
  Phone number                                           Preparer's TIN (PTIN)   P                                                                        Columbus, OH  43270-2057

                                                                                                              2017 Ohio IT 1040 – page 2 of 2