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                                                                                                                                                                                     Rev. 8/15
                                                                                                                                                                            IT 1041
                                                                                                                                                     2015                   Fiduciary
        Check here if amended return                                                                                              15180102                                  Income Tax Return

        Check here if ﬁ nal return                                                                                                Use only black ink.
     Federal employer I.D. no. (FEIN)                                                     Social Security no. of decedent (estates only)                                             For taxable year beginning in
                                                                                                                                                                                     MM/ 2    0 15
     Use UPPERCASE letters.
 Name of trust or estate

 Name of trust or estate (second line)

 Fiduciary name and title

     Address (if address change, check box)

     City                                                                                                                                  State     ZIP code

     E-mail address

     Check Applicable Box(es)
                                                                                                                                                     Do not staple or otherwise attach. 
          Simple trust                                                      OR                       Complex trust                                   Place any supporting documents, including K-1’s, 
                                                                                                                                                     after the last page of this return. 
          Resident trust                                                    OR                       Nonresident trust
                                                                                                                                                                            Mail to: 
          Irrevocable trust                                                                          Testamentary trust                              Ohio Dept. of Taxation
                                                                                                                                                             P.O. Box 2619
                                                                                                                                                     Columbus, OH 43216-2619
          Bankruptcy estate                                                                          Decedent’s estate                     Instructions for this form are on our Web site at tax.ohio.gov. 

     INCOME AND TAX INFORMATION – If amount is negative, shade the negative sign (“–”) in the box provided. 

   1. Federal taxable income (from line 22 of IRS form 1041).Attach page 1 of IRS form 1041 ......                                                    ...1.                 ,        ,          . 00
 
    2.............................................................................. Net adjustments from Schedule A, line 42 ...2.                                          ,        ,          . 00
   
     3. Ohio taxable income (line 1 plus or minus line 2). Estates should skip lines 4-7 ...................                                          ...3.                 ,        ,          . 00
 
     4. Allocated qualifying trust amount from Schedule F, line 58 (trusts only) ................................                                     ...4.                 ,        ,          . 00

     5............................................ Apportioned trust income from...5.Schedule G, line 61 (trusts only)                                                      ,        ,          . 00

     ................................................ 6. Allocated trust income from Schedule...6.H, line 64 (trusts only)                                                  ,        ,          . 00
 
  7. Modiﬁ ed Ohio taxable income (trusts add lines 4, 5 and 6; if less than zero, enter -0-)                                                         ...................7. ,        ,          . 00
  8. Tax on Ohio taxable income (estates, line 3) or tax on modiﬁ ed Ohio taxable income (trusts, 
  .............................................................................................8.line 7). See tax table in the instructions                                 ,        ,          . 00
  
    ................................................................................9.9. Credits from Schedule B, line 47 (estates only)                                    ,        ,          . 00
 
 10. Resident credit from Schedule C (estates); nonresident credit from Schedule D (estates); busi-
        ness credit for estates and trusts from Schedule E (attach Schedule E); and Schedule I credit 
  ................................................................................................................................10.(resident trusts)                      ,        ,          . 00

          2015 IT 1041                                                                                                                     pg. 1 of 5
                                                                                                                                                                            2015 IT 1041

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                                                                                                                                                                   Rev. 8/15
                                                                                                                                                          IT 1041
                                                                                               2015                                                       Fiduciary
    FEIN                                                  15180202                                                                                        Income Tax Return

    INCOME AND TAX INFORMATION...cont.

    11. Tax after nonrefundable credits (line 8 minus the amount on lines 9 and 10)  .................................11.                                 ,        ,        .    00
 
    12. Interest penalty on underpayment of estimated tax (attach Ohio form IT/SD 2210) .............................12.                                  ,        ,        .    00
 
   13. Total Ohio tax (sum of lines 11 and 12)  ...........................................................................................13.            ,        ,        .    00

  14. Net payments from line 77 on page 5  ..................14.                 ,           ,   . 00
 15. Refundable business credits (attach documen-
   ...................................................................15.tation) ,           ,   .  00

 16. Total (sum of lines 14 and 15)  ..............................16.           ,           ,   .  00
    17. If line 16 is more than line 13, subtract line 13 from line 16. This is your overpayment  .................17.                                    ,        ,        .    00
 18. Amount of line 17 to be credited to 2016 estimated 
  18.tax liability .............................CREDIT TO 2016                   ,           ,   .  00
    19. Amount of line 17 to be refunded (subtract line 18 from line 17).................... YOUR REFUND  19.                                             ,        ,        .    00
 20. Net amount due, if any (if line 13 is more than line 16, subtract line 16 from line 13, but not less 
   ..........................................................................................................................................20.than -0-) ,        ,        .    00

 21. Interest and penalty on late-paid and/or late-ﬁ led return, if any   ...........................................................21.                  ,        ,        .    00
 22. Total amount due, if any (sum of lines 20 and 21). Make check payable to Ohio Treasurer of State,
     include Ohio form IT 1041P and place FEIN on check ......................     TOTAL AMOUNT DUE       22.                                             ,        ,        .    00
               If your refund is $1.00 or less, no refund will be issued. If you owe $1.00 or less, no payment is necessary.
    SIGN HERE (required)
    I declare under penalties of perjury that this report, including any accompanying schedules and 
    statements, has been examined by me and to the best of my knowledge and belief is a true, cor-                                                        For Department Use Only
    rect and complete return and report.

    Signature of ﬁ duciary or trust ofﬁ cer               Preparer’s name (please print)

    Title           Date                                  Preparer’s address (including ZIP code)

    Fiduciary’s or trust ofﬁ cer’s phone number           Preparer’s phone number
    Do you authorize your preparer to contact us regarding this return? Yes        No                                                                       Code

    SCHEDULE A – ADJUSTMENTS TO FEDERAL TAXABLE INCOME NET OF RELATED EXPENSES
  Additions
    23. Federal and/or non-Ohio state or local government interest and dividends not distributed ...........23.                                           ,        ,        .    00

    24. Pass-through entity and ﬁ nancial institutions taxes paid and related member add-back ...............24.                                          ,        ,        .    00

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

  26. Losses from sale or other disposition of Ohio public obligations  ....................................................26.                           ,        ,        .    00
  27. Recovery of amount previously deducted or excluded  ...................................................................27.                          ,        ,        .    00
  28. Adjustment for Internal Revenue Code section 168(k) depreciation expense.
    ........................................................................28. F 2/3, F 5/6 or F 6/6 (check applicable box)                              ,        ,        .    00
 29. Federal personal exemption (estates only), lump sum distribution add-back and miscellaneous
   ..................................................................................................................29.  federal tax adjustments         ,        ,        .    00

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

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

          2015 IT 1041                                                             pg. 2 of 5                                                             2015 IT 1041

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Rev. 8/15
IT 1041
2015 Fiduciary
FEIN 15180302 Income Tax Return

SCHEDULE A – ADJUSTMENTS TO FEDERAL TAXABLE INCOME NET OF RELATED EXPENSES...cont.
Deductions – Note: Deduct income items described below only to the extent that those
amounts are not already deducted or excluded from federal taxable income after distributions.
32. Federal interest and dividends exempt from state taxation net of related expenses ....................32. , , . 00

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

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

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

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

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

42. Net adjustments (subtract line 41 from line 31). Enter here and on line 2 ........................ ....42. , , . 00

SCHEDULE B – ESTATE CREDITS

43. Retirement income credit (see instructions for credit table) ( limit – $200) ....................................43. . 00

44. Senior citizen’s credit (limit – $50 per return) ..............................................................................44. . 00

45. Child and dependent care credit (see instructions and worksheet in Ohio form IT 1040 booklet) .....45. , , . 00

..................................................................................................46. 46. Ohio political contributions credit , , . 00

47. Total Schedule B credits (sum of lines 43 through 46) – enter here and on line 9 ........................47. , , . 00

SCHEDULE C – ESTATE OHIO RESIDENT CREDIT
48. Enter the portion of line 3 subjected to tax by other states or the District of Columbia
................................................... while an Ohio resident. New limitation...48.– see instructions , , . 00

49. ..................................................................................... Enter Ohio taxable income (line 3) ...49. , , . 00
50. Divide line 48 by line 49 and enter percentage here %. Multiply this percentage
by the amount shown on line 8 reduced by any amount shown on line 9 ....................................50. , , . 00
51. Enter the 2015 income tax, less all related credits other than withholding and estimated tax payments
and carryforwards from previous years, paid to other states or the District of Columbia. New limita-
...................................................................................................................51. tion – see instructions , , . 00
52. Enter the smaller of line 50 or line 51. This is your Ohio resident tax credit. Enter here and on
...........................................................................................................................................52.line 10 , , . 00

SCHEDULE D – ESTATE NONRESIDENT CREDIT
53. Enter the portion of Ohio taxable income (line 3) not earned or received in Ohio
.................................................................................................. (attach Ohio form IT 2023) ...53. , , . 00

54. ..................................................................................... Enter Ohio taxable income (line 3)...54. , , . 00
55. Divide line 53 by line 54 and enter percentage here %. Multiply this percentage
by the amount shown on line 8 reduced by the amount shown on line 9. Enter here and on
...........................................................................................................................................55.line 10 , , . 00

2015 IT 1041 pg. 3 of 5
2015 IT 1041

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IT 1041 Rev. 8/15
2015 Fiduciary
FEIN 15180402 Income Tax Return

SCHEDULE E – NONREFUNDABLE BUSINESS CREDITS
Note: Schedule E is not included in this return (see instructions).
SCHEDULE F, G, H AND I FOR TRUSTS ONLY
See instructions for a detailed explanation of “Matching, Against Income and Gain, Expense Amounts and Distribution Deduction.”
SCHEDULE F – ALLOCATED QUALIFYING TRUST AMOUNTS
This schedule is used to allocate qualifying trust amounts for trusts recognized gains or losses from the disposition of closely held investments.
56. Enter the trust’s portion of capital gains/losses recognized to the extent included in Ohio
taxable income (line 3) if the location of the physical assets of the closely held investee is
available................................................................................................................................. ..56. , , . 00

57. Enter the percentage of the closely held investee’s physical assets located within Ohio ..............57. .
58. Multiply the amount on line 56 by the percentage on line 57. Enter here and on line 4 ......... ..58. , , . 00

....................................................26.SCHEDULE G – APPORTIONED INCOME FOR TRUSTS

investment income not otherwise a part of business income and not included in line 56 , , .
59. Enter (i) the trust’s business income not included in line 56 and (ii) the trust’s qualifying ...... ..59. 00

60. Enter the Ohio apportionment ratio from line 75 of the apportionment worksheet on page 5 .........60. .
61. Multiply the amount on line 59 by the apportionment ratio on line 60. Enter here and on
line 5 ....................................................................................................................................... ..61. , , . 00
SCHEDULE H – ALLOCATED NONBUSINESS INCOME FOR TRUSTS
If distributive share is business income from a pass-through entity, please use Schedule G.
62. Resident trusts: Enter the trust’s portion of Ohio taxable income (line 3) not reported on lines
................................................................................................................................... 56 or 59 ..62. , , . 00
63. Nonresident trusts: Enter the trust’s portion of Ohio taxable income (line 3) not reported
on lines 56 or 59 to the extent such income (i) was derived from real or tangible property
located in or based in Ohio or (ii) was sitused to Ohio (see instructions for line 63) or (iii)
was described in Ohio Revised Code section 5747.212 ........................................................ ..63. , , . 00

64. Add lines 62 and 63 and enter here and on line 6 .................................................................. ..64. , , . 00

SCHEDULE I – TAX CREDIT FOR RESIDENT TRUSTS
65. Enter the amount of allocated resident trust nonbusiness income (line 62, above) subject
...................................................... to tax in one or more states or in..65.the District of Columbia , , . 00

66. Enter the amount from line 8 ..........................................................................................................66. , , . 00

67. Enter the amount of modiﬁ ed Ohio taxable income from line 7 ......................................................67. , , . 00
68. Divide line 66 by line 67 and enter the percentage here. This is the average effective tax
rate .................................................................................................................................................68. .
69. Multiply the amount on line 65 by the percentage reported on line 68 ................................... ..69. , , . 00
70. Enter the amount of tax actually paid by the resident trust to another state or the District of
..................................................................70. Columbia on the trust’s allocated nonbusiness income , , . 00
71. Enter the smaller of the amount on lines 69 and 70. This is the resident trust’s Ohio tax
credit. Enter here and on line 10....................................................................................................71. , , . 00

2015 IT 1041 pg. 4 of 5
2015 IT 1041

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                                                                                                      IT 1041                 Rev. 8/15
                                                                                              2015    Fiduciary
  FEIN                                                  15180502                                      Income Tax Return

  APPORTIONMENT WORKSHEET
  Use this worksheet to calculate the apportionment ratio for the trust’s modiﬁ ed business income and qualifying investment income included in Ohio tax-
  able income. Note: All ratios are to be carried to six decimal places.
 72.  Property                                               Within Ohio                                           Total Everywhere
    a) Owned (average cost)                            ,          ,           .               00                 ,          ,          .  00
 
                                                             Within Ohio                                           Total Everywhere
    b) Rented (annual rental X 8)                      ,          ,           .               00                 ,          ,          .  00

                                                             Within Ohio                                           Total Everywhere
    c) Total (lines 72a and 72b)                       ,          ,           .               00    ÷            ,          ,          .  00

                                                                                              Ratio   Weight                Weighted Ratio
                                                                  =      .                            x  .20   =   .

                                                             Within Ohio                                           Total Everywhere
 
 73.  Payroll                                          ,          ,           .               00    ÷            ,          ,          .  00

                                                                                              Ratio   Weight                Weighted Ratio
                                                                  =      .                            x  .20   =   .

                                                             Within Ohio                                           Total Everywhere
 74.  Sales                                            ,          ,           .               00    ÷            ,          ,          .  00

                                                                                              Ratio   Weight                Weighted Ratio
                                                                  =      .                            x  .60   =   .

                                                                                                                            Weighted Ratio
 75.  Total weighted apportionment ratio (add weighted ratio from lines 72c, 73 and 74). Enter ratio here and on 
    Schedule G, line 60 (carry to six decimal places).                                                             .

  Note: If the denominator of any factor is zero, the weight given to the other factors must be proportionately increased so that the total weight given to 
  the combined number of factors used is 100%, i.e., if no property/payroll, use 25% and 75%; if no sales, use 50% property/payroll.

  NET PAYMENT WORKSHEET – INCLUDE 1099(s) and W-2(s)
 76a. Estimated payments                                     76b. Prior year credit carryover         76c. 1099 withholdings
              ,        ,                 . 00                ,           ,                    . 00               ,          ,       . 00
 76d. W-2 withholdings                             76e. Refunds previously claimed
                                                        
              ,        ,                 . 00                ,           ,                    . 00
 77. Net payments (sum of lines 76a-d minus line 76e). Enter here and on page 2, line 14.
                ,         ,                .       00

        2015 IT 1041                                                    pg. 5 of 5
                                                                                                      2015 IT 1041

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