Rev. 10/20/17

Scan Specifications for the 

    2017 Ohio IT 1041

       Important Note

   The following document (2017 Ohio IT 1041) contains grids for place-
   ment of information on this specific tax form. To accurately print, do not 
   reduce the size, rotate or center this document. Doing so jeopardizes 
   the integrity of the grid. When printing from Adobe Reader, select 
   “None” for “Page Scaling,” which is under “Page Handling.”

   The 2017 Ohio IT 1041 test samples must be completed and sub-
   mitted for approval no later than Dec. 1, 2017. 

       Ohio Department of Taxation

                            4485 Northland Ridge Blvd.

                            Columbus, OH 43229

                            tax.ohio.gov

Grid layout 

with notations

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                                                                  Do not staple or paper clip.
5
6                                                                              The date the return was generated       2017 Ohio IT 1041 
                                                                               by the taxpayer (MM DD YY).
7                                                                                    Rev. 8/17            Fiduciary Income Tax Return
                                                                                                                                                                                                                                                                17180110
8                                                              88 88 88                                            Use only black ink and UPPERCASE letters. Placement of the tax year and 1D barcode is critical. 
9                                                                                                                                        Make sure to follow the grid positions for layout. Do 
                                                                                                                                                                                                                                                                For taxable year beginning in
10                                                                                             X Check here if amended return            not forget toXgetCheckyourherebarcode(s)if finalassignmentsreturnfor 
11                                                                                                   X    Check here if the federaleveryextensionform, versionwas grantedand page.                                                                                              88/2017
12                                                             FEIN                                         SSN of decedent (estates only)
13                                                             88 8888888                                   888 88 8888
14
15                                                             Name of trust or estate
16                                                             JOHNXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
17
18                                                             Name of trust or estate (second line)
19                                                             JANEXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
20
21                                                             Fiduciary name and title
22                                                             THE NAME AND TITLEXXXXXXXXXXXXXXXXX
23
24                                                             Address (if address change, check box)          X
25
                                                               8888 BERRY AVEXXXXXXXXXXXXXXXXXXXXX
26                                                             City                                                                                                        State         ZIP code
27
                                                               CITYXXXXXXXXXXXXXXXX                                                                                        OH            88888
28
29                                                             Foreign State Code             Country Code       Foreign country (if the mailing address is outside the U.S.)                                      Foreign postal code
30
                                                               ABC                               AB              ANYCOUNTRYXXXXXXXXXX                                                                              AB88888
31                                                                                                                                                                                                            Do not place spaces between 
32                                                             Check Applicable Box(es)                                                                                                                       whole dollar numbers. There 
                                                                                                               Number of investors                                                                            is only a space between dollar 
                                                                       X
33                                                                             Simple trust         ORNEW!Thesefieldsmaypossiblybeanegativevalue.includedX Complexon returntrust X    Irrevocable trust       amountsandcentsfields.X                                 Testamentary trust
34                                                                                                     Include a “-“ sign here if this line has a negative value.
35                                                                     X       Resident trust       OR         888888X Nonresident trust                                   X          Bankruptcy estate                                                         X     Decedent’s estate
36
37                                                                  1. Federal taxable income (from the federal 1041, line 22).Include page 1 of the federal 1041                      ..............................1.                                        -      888888888 00
38                                                            
39                                                            2. Net adjustments       from Schedule A, line 40   .........................................................................................................2.                                  -
                                                                                                                                                                                                                                                                      888888888 00
40                                                              
41                                                             3. Ohio  taxable income (line 1 plus or minus line 2). Estates should skip lines 4-7                         ...............................................3.                                  -      888888888 00
42                              Do not staple or paper clip.  
43                                                            4. Allocated     qualifying trust amount from Schedule F, line 59 (trusts only)                        ...........................................................4.                             -
                                                                                                                                                                                                                                                                      888888888 00
44                                                                                                         NEW! For static text use Arial font (black ink) and 
                                                                                                           trytomatchsize.Fordataentryfields(shown in 
45                                                             5. Apportioned   trust income from ScheduleredforidentificationpurposesonlyG, line 62 (trusts only)   ......................................................................5.), use Arial font -
                                                                                                                                                                                                                                                                      888888888 00
46                                                                                                         (black ink).All the data entry fields must follow
                                                                                                           grid layout. Never hard code a negative sign, and 
47                                                            6. Allocated     trust income from ScheduledoH,notlineinclude65 (truststhe negativeonly) ...........................................................................6.sign with the amounts.     -      888888888 00
48                                                                                                         Thisisnowaseparatefield.
49                                                            ModifiedOhiotaxableincome(trustsaddlines4,5and6;iflessthanzero,enter-0-)                                                 ....................................7.                                         888888888 00
50                                                            8.TaxonOhiotaxableincome(estates,line3)ortaxonmodifiedOhiotaxableincome(trusts,line7).
51                                                                 See tax table in the instructions .........................................................................................................................8.                                      888888888 00
52                                                            9. Credits from Schedule B, line 48 (estates only)2D barcode .................................................................................................9.required. Delete this                   888888888 00
53                                                                                                             box with text and replace it with 
                                                              10.Resident creditfromScheduleC(estates);nonresidentcreditfromScheduleD(estates);businesscreditfromthe 2D barcode.
54                                                                 ScheduleE(includeScheduleE)(estatesandtrusts);andtaxcreditfromScheduleI(residenttrusts)   .............10.
                                                                                                                                                                                                                                                                      888888888 00
55
56
57                                                                                                                                                                                                                 Target marks or registration marks 
58                                                                                                                                                                                                        For Department Use Onlymust measure 6 mm X 6 mm. The 
                                                                                                                                                                                                                   four target marks or registration 
59                                                                              Software vendors: Place 2D barcode in this location                                                                                marks on every page must follow 
60                                                                               Do not place a box around the 2D barcode. The box                                                                                 grid/                                       layout./
61                                                                                            is only here for placement purposes.                                                                                 Postmark date                                                  Code
62
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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
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5
6                                                            2017 Ohio IT 1041 
7                            Rev. 8/17            Fiduciary Income Tax Return
                                                                                                                                                                                     17180210
8   FEIN
9   88 8888888
10   11. Tax after nonrefundable credits (line 8 minus the amount on lines 9 and 10)  .....................................11.                                           888888888 00
11    
12       12. Interest penalty on underpayment of estimated tax (include Ohio IT/SD 2210) ......................................12.                                       888888888 00
13    13. Total Ohio tax (add lines 11 and 12)  ...................................................................................................13.                   888888888 00
14       14. Net payments  from line 78 on page 5 ......................14.        888888888 00
15
     15. Refundable business credits from line 85 on page 
16       5(includedocumentation/certificates)              ....................15. 888888888 00
17    16. Total  (add lines 14 and 15) .......................................16.  888888888 00
18       17. Overpayment, if any (line 16 minus line 13, but not less than -0-) ........................YOUR17.REFUND                                                   888888888 00
19
      18. 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-)  .............................................................................................................................................18.     888888888 00
21
      19.Interest andpenaltyonlate-paidand/orlate-filedreturn,if                    ..............................................................19.                    888888888 00
22
     20. Total amount due (add lines 18 and 19). Make check payable to Ohio Treasurer of State, include
23   20.    Ohio UPC and place FEIN on check ......................................................................AMOUNT DUE                                           888888888 00
24
25                    If your refund is $1.00 or less, no refund will be issued. If you owe $1.00 or less, no payment is necessary.

26                                                                                                                                                                       Do not staple or paper clip. 
   Sign Here (required): I have read this return. Under penalties of perjury, I declare that, to 
27 the best of my knowledge and belief, the return and all enclosures are true, correct and complete.                   Place any supporting documents, including 
28                                                                                                                      Ohio IT K-1(s), after the last page of this return.
29
   Signatureoffiduciaryortrustofficer                Preparer’sname(print)
30
                                                                                                                                                                                   Mail to: 
31 Title                     Date (MM/DD/YY)         Preparer’s address (include ZIP code)
32                                                                                                                      Ohio Department of Taxation 
33 Fiduciary’sortrustofficer’sphone        Preparer’sphonenumber                                                                                                         P.O. Box 2619 
34                                                                                                                      Columbus, OH 43216-2619
35 Preparer’s e-mail address                         PTIN
36 DoyouauthorizeyourpreparertocontactusregardingthisY           No                                                       Instructions for this form are on 
37                                                                                             X X                                                                       our website at tax.ohio.gov.

38 Schedule A – Adjustments to Federal Taxable Income Net of Related Expenses
39  Additions
40    21. Federal and/or non-Ohio state or local government interest and dividends not distributed ...............21.                                                    888888888 00
41   Pass-throughentityandfinancialinstitutionstaxespaidandrelatedmemberadd-back                                ...................22.                                   888888888 00
42
     23. Income from an Electing Small Business Trust (ESBT) not shown in federal taxable income 
                                                 .....................................................................................................................23.
43       (include documentation)                                                                                                                                         888888888 00
44
45    24. Losses from sale or other disposition of Ohio public obligations .......................................................24.                                    888888888 00
46
47    25. Recovery of amount previously deducted or excluded .......................................................................25.                                  888888888 00
48
     26. Adjustment for Internal Revenue Code section 168(k) depreciation expense.
49      2/3, X         X 5/6 or      X 6/6 (check applicable box) ..........................................................................26.                          888888888 00
50   
51
      27. Federal personal exemption (estates only) and miscellaneous federal tax adjustments ...................27.                                                     888888888 00
52                                                   2D barcode required. Delete this 
      28. Expenses claimed on Ohio estate return (estates only) .....................................................................28.                                 888888888 00
53                                                   box with text and replace it with 
                                                     the 2D barcode.
54   29. Total additions (add lines 21 through 28) ...........................................................................................29.                        888888888 00
55
56
57
58
59                       Software vendors: Place 2D barcode in this location
60                       Do not place a box around the 2D barcode. The box 
61                               is only here for placement purposes.
62
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6                                                                          2017 Ohio IT 1041 
7                          Rev. 8/17                Fiduciary Income Tax Return
                                                                                                                                                                                                 17180310
8  FEIN
9  88 8888888
10
11 Schedule A – Adjustments to Federal Taxable Income Net of Related Expenses...cont.
12 Deductions – Note: Deduct income items described below only to the extent that those amounts 
13 are not already deducted or excluded from federal taxable income after distributions.
14  30. Federal interest and dividends exempt from state taxation net of related expenses .........................30.
                                                                                                                                                                                       888888888 00
15  
16   31. Certain state and municipal income tax overpayments ......................................................................31.
                                                                                                                                                                                       888888888 00
17   32.  Losses from an ESBT not shown in federal taxable income (include documentation).......................32.
                                                                                                                                                                                       888888888 00
18
    33.  Wage and salary expense not previously deducted due to the federal targeted jobs credit or 
19        the work opportunity credit .................................................................................................................33.
                                                                                                                                                                                       888888888 00
20
    34.  Interest income from Ohio public obligations and Ohio purchase obligations and gains from the 
21        sale or other disposition of Ohio public obligations ............................................................................34.
                                                                                                                                                                                       888888888 00
22
    35.Refunds orreimbursementsofprioryearfederalitemizeddeductionsandmiscellaneousfederal
23        tax adjustments ..................................................................................................................................35.
                                                                                                                                                                                       888888888 00
24   36.  Farm income from a farm of at least 10 acres (trusts only) ................................................................36.
                                                                                                                                                                                       888888888 00
25
    37.  Adjustment for Internal Revenue Code section 168(k) depreciation expense. Include a separate 
26        schedule showing calculations designatingNumber1/2, 1/5 or 1/6of investors  ..........................................................37.                                    888888888 00
                                        NEW!Thesefieldsmaypossiblybeanegativevalue.included on return 
27   38. Repayment of income reported in a prior year and not otherwise deductedInclude a “-“ sign here if this line has a negative value. ......................................38.   888888888 00
28                                                 888888
29    39. Total deductions (add lines 30 through 38)         .........................................................................................39.
                                                                                                                                                                                       888888888 00
30    .........................................40. 40. Net adjustments (subtract line 39 from line 29). Enter here and on line 2                                                     -
                                                                                                                                                                                       888888888 00
31
   Schedule B – Estate Credits
32    41. Retirement income credit (see instructions for credit table) (limit – $200).......................................... 41.
                                                                                                                                                                                                   888 00
33
34   42. Lump sum retirement credit (see instructions to calculate the credit) .................................................. 42.                                                  888888888 00
35
36  Seniorcitizen’scredit(       limit – $50 per return) .................................................................................... 43.
                                                                                                                                                                                                         88 00
37
38 44.Lumpsumdistributioncredit(mustbe65oroldertoclaimthiscredit;seeinstructionsto
          calculate this credit)  ............................................................................................................................. 44.                    888888888 00
39
                                                                                                                                                                                       888888888 00
40   45. Child and dependent care credit (see instructions and worksheet in Ohio IT 1040 booklet) ................... 45.
41
                                                                                                                                                                                       888888888 00
42     46. Ohio political contributions credit..... .................................................................................................... 46. 
43   47. Ohio adoption credit (limit $10,000) .................................................................................................... 47.
                                                                                                                                                                                       888888888 00
44
45  48. Total Schedule B credits (add lines 41 through 47) – enter here and on line 9 ..................................48.
                                                                                                                                                                                       888888888 00
46
   Schedule C – Estate Ohio Resident Credit
47
    49.  Enter the portion of Ohio taxable income (line 3) subjected to tax by other states or the 
48      District of Columbia while an Ohio resident  .......................................................................................49.                                      - 888888888 00
49  50. Enter Ohio taxable income (line 3)  .....................................................................................................50.                                 -
                                                                                                                                                                                       888888888 00
50  51.  Divide line 49 by line 50 and enter percentage here                       888.88 %. Multiply this percentage 
51        by the amount shown on line 8 reduced by any amount shown on line 9 ..........................................51.                                                            888888888 00
52                                                          2D barcode required. Delete this 
    52.  Enter the 2017 income tax, less all related credits other than withholding and estimated tax payments 
53        and carryforwards from previous years, paidboxtowithothertextstatesand replaceor theitDistrictwith of Columbia................................52.                            888888888 00
                                                            the 2D barcode.
54  
55  53.  Enter the smaller of line 51 or line 52. This is your Ohio resident tax credit. Enter here and on line 10 ........53.                                                         888888888 00
56
57
58
59                   Software vendors: Place 2D barcode in this location
60                   Do not place a box around the 2D barcode. The box 
61                               is only here for placement purposes.
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6                                                                        2017 Ohio IT 1041 
7                        Rev. 8/17             Fiduciary Income Tax Return
                                                                                                                                                                                              17180410
8    FEIN          Number of investors 
           NEW!Thesefieldsmaypossiblybeanegativevalue.included on return 
9    88 8888888Include a “-“ sign here if this line has a negative value.
10                 888888
11
    Schedule D – Estate Nonresident Credit
12
13   54.  Enter the portion of Ohio taxable income (line 3) not earned or received in Ohio (include 
        Ohio IT 2023) ......................................................................................................................................54.                 - 888888888 00
14
15                                                                                                                                                                              - 888888888 00
      55.  Enter Ohio taxable income (line 3) .....................................................................................................55.
16  56.   Divide line 54 by line 55 and enter percentage here                          888.88%. Multiply this percentage by the 
17
      amount shown on line 8 reduced by the amount shown on line 9. Enter here and on line 10 ...................56.                                                              888888888 00
18  
19  Schedule F – Allocated Qualifying Trust Amounts
20   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  ..........57.                                                        - 888888888 00
21
22   58. Enter the percentage of the closely held investee’s physical assets located within Ohio             .................58.                                                              
                                                                                                                                                                                              8.8888
23
24                                                                                                                                                                              -
     59. Multiply the amount on line 57 by the percentage on line 58. Enter here and on line 4 ....................59.
25                                                                                                                                                                                888888888 00
26  Schedule G – Apportioned Income for Trusts
27   60. Enter (i) the trust’s business income not included in line 57 and (ii) the trust’s qualifying investment 
         income not otherwise a part of business income and not included in line 57       ....................................60.                                               - 888888888 00
28
29   61. Enter the Ohio apportionment ratio from line 76 of the apportionment worksheet on page 5 ...........61.                                                                              8.888888
30
31   62. Multiply the amount on line 60 by the apportionment ratio on line 61. Enter here and on line 5  .......62.                                                             - 888888888 00
32
33  Schedule H – Allocated Nonbusiness Income for Trusts
34  If distributive share is business income from a pass-through entity, use Schedule G.
     63. Resident trusts: Enter the trust’s portion of Ohio taxable income (line 3) not reported on lines 57 or 60            ................63.                               - 888888888 00
35
36   64. Nonresident trusts: Enter the trust’s portion of Ohio taxable income (line 3) not reported on lines 57 
37       or 60 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 64)  ............................................................64.                                       - 888888888 00
38
39  65. Add lines 63 and 64 and enter here and on line 6  .............................................................................65.                                      - 888888888 00
40
    Schedule I – Tax Credit for Resident Trusts
41
     66. Enter the amount of allocated resident trust nonbusiness income (line 63, above) subject to tax in 
42       one or more states or in the District of Columbia                                                                                                                      - 888888888 00
                                                           ..............................................................................66.
43
44   67. Enter the amount from line 8  ..............................................................................................................67.                          888888888 00
45
46  EntertheamountofmodifiedOhiotaxableincomefromline                           .........................................................68.                                      888888888 00
47   
48  69.Divideline67byline68andenterthepercentagehere.                    Thisistheaverageeffectivetaxrate      ..................69.                                                          8.8888 
49
50   70. Multiply the amount on line 66 by the percentage reported on line 69          ..............................................70.                                        - 888888888 00
51   
     71. Enter the amount of tax actually paid by the resident trust to another state or the District of Columbia 
52       on the trust’s allocated nonbusiness income 2D barcode required. Delete this  .....................................................................................71.   888888888 00
53                                                 box with text and replace it with 
     72. Enter the smaller of the amount on lines 70theand2D71.barcode.This is the resident trust’s Ohio tax credit. Enter 
54       here and on line 10 ............................................................................................................................72.                      888888888 00
55
56
57
58
59                     Software vendors: Place 2D barcode in this location
60                     Do not place a box around the 2D barcode. The box 
61                                is only here for placement purposes.
62
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6                                                     2017 Ohio IT 1041 
7                 Rev. 8/17                 Fiduciary Income Tax Return
                                                                                                                             17180510
8  FEIN
9  88 8888888
10 Apportionment Worksheet
11
   Usethisworksheettocalculatetheapportionmentratioforthetrust’smodifiedbusinessincomeandqualifyinginvestmentincomeincluded
12 in Ohio taxable income. Note: All ratios are to be carried to six decimal places.
13  73.  Property                                           Within Ohio                                                      Total Everywhere
14     a) Owned (average cost)                        88888888888 00                                                   88888888888 00
15
16                                                          Within Ohio                                                      Total Everywhere
    
                                                                                                                             Weight is now a variable data 
17     b) Rented (annual rental X 8)                  88888888888 00This field requires a leading zero,                88888888888 00field and must include a leading
18                                                          e.g. .000026 should be displayed                                 zero. See schema for accepted
19                                                          as 0.000026.Within Ohio                                          characters.Total Everywhere
20     c) Total (lines 73a and 73b)                   88888888888 00                                         ÷         88888888888 00
21                                                                                          Ratio               Weight                                             Weighted Ratio
22                                                                         = 8.888888                        x =8.88                                               8.888888
23
24                                                          Within Ohio                                                      Total Everywhere
25  74.  Payroll                                      88888888888 00                                         ÷         88888888888 00
26
27                                                                                          Ratio               Weight                                             Weighted Ratio
28
                                                                           = 8.888888                        x =8.88                                               8.888888
29
30                                                          Within Ohio                                           This field requiresTotal Everywherea leading zero,
                                                                                                                  e.g. .000026 should be displayed 
31  75.  Sales                                        88888888888 00                                         ÷    as 0.000026.88888888888 00
32
33                                                                                          Ratio               Weight                                             Weighted Ratio
34                                                                         = 8.888888                        x =8.88.                                              8.888888
35
36  76.  Total weighted apportionment ratio (add weighted ratio from lines 73c, 74 and 75). Enter ratio here and on
       Schedule G, line 61 (carry to six decimal places).......................................................................................................76. 8.888888
37
   Note: Ifthedenominatorofanyfactoriszero,theweightgiventotheotherfactorsmustbeproportionatelyincreasedsothatthetotalweightgiventothe
38 combinednumberoffactorsusedis100%,i.e.,ifnoproperty/payroll,use25%and75%;ifnosales,use50%property/payroll;ifonlyonefactor,use100%.
39
40 Net Payment Worksheet – Include 1099(s) and W-2(s)
41 77a. Estimated payments                                     77b. Prior year credit carryover                 77c. 1099 withholdings
42
        88888888 00                                   88888888 00                                               88888888 00
43
44 77d. W-2 withholdings                              77e. Refunds previously claimed                            78. Net payments (sum of lines 77a-d minus line 77e). 
                                                                                                                Enter here and on page 2, line 14.
45
        88888888 00                                   88888888 00
46
                                                                                                                888888888 00
47 Refundable Business Credits
48 Note:CertificatesfromtheOhioDevelopmentServices          Agencyand/orOhioIT K-1(s)mustbeincludedtoverifyeachrefundablecreditclaimed.
49 79.  Motion picture credit                                     80.  Business jobs credit                     81.  Pass-through entity credit
50
        88888888 00                                   88888888 00                                               88888888 00
51 82.  Venture capital credit                        83.  Historic preservation credit                          84. Financial Institutions Tax (FIT) credit
52                                                    2D barcode required. Delete this 
        88888888 00                                   box with text and replace it with 88888888 00             88888888 00
53 85. Total refundable business credits (add lines 79-84). the 2D barcode.Enter here and on page 2, line 15.
54
        888888888 00
55
56
57
58
59                Software vendors: Place 2D barcode in this location
60                Do not place a box around the 2D barcode. The box 
61                             is only here for placement purposes.
62
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6                                           2017 Ohio IT 1041 
7                    Rev. 8/17         Fiduciary Income Tax Return
                                                                                                        17180610
8  FEIN
9  88 8888888
10
   Beneficiary Schedule
11 Providebeneficiaryinformationfor all(residentandnonresident)beneficiariesintheestateortrust. Use an additional sheet, if necessary.
12
13 SSN                                 FEIN                  Amount distributed
14
   888 88 8888                         88 8888888            888888888 00
15
16 First name/entity                                       M.I. Last name
17
   JOHNXXXXXXXXXXX                                         Q PUBL I CXXXXXXXXXXXXXX
18 Address
19                    
   8888 CHERRY  LANEXXXXXXXXXXXXXXXXXXX
20 City                                                                       State             ZIP code
21
   CITYXXXXXXXXXXXXXXXX                                                       OH                88888
22
23
24 SSN                                 FEIN                  Amount distributed
25
   888 88 8888                         88 8888888            888888888 00
26
27 First name/entity                                       M.I. Last name
28
   JOHNXXXXXXXXXXX                                         Q PUBL I CXXXXXXXXXXXXXX
29 Address
30
   8888 CHERRY  LANEXXXXXXXXXXXXXXXXXXX 
31 City                                                                       State             ZIP code
32
   CITYXXXXXXXXXXXXXXXX                                                       OH                88888
33
34
35 SSN                                 FEIN                  Amount distributed
36
   888 88 8888                         88 8888888            888888888 00
37
38 First name/entity                                       M.I. Last name
39
   JOHNXXXXXXXXXXX                                         Q PUBL I CXXXXXXXXXXXXXX
40 Address
41
   8888 CHERRY  LANEXXXXXXXXXXXXXXXXXXX 
42 City                                                                       State             ZIP code
43
   CITYXXXXXXXXXXXXXXXX                                                       OH                88888
44
45
46 SSN                                 FEIN                  Amount distributed
47 888 88 8888                         88 8888888            888888888 00
48
49 First name/entity                                       M.I. Last name
50 JOHNXXXXXXXXXXX                                         Q PUBL I CXXXXXXXXXXXXXX
51 Address
52                                          2D barcode required. Delete this 
   8888 CHERRY  LANEXXXXXXXXXXXXXXXXXXX
53 City                                     box with text and replace it with State             ZIP code
                                            the 2D barcode.
54                                                                            OH                88888
   CITYXXXXXXXXXXXXXXXX
55
56
57
58
59              Software vendors: Place 2D barcode in this location
60              Do not place a box around the 2D barcode. The box 
61                    is only here for placement purposes.
62
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64                                                                                              2017 IT 1041 – page   of266
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Grid layout

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                                                                  Do not staple or paper clip.
5
6                                                                                                                     2017 Ohio IT 1041 
7                                                                                    Rev. 8/17          Fiduciary Income Tax Return
                                                                                                                                                                                                                                  17180110
8                                                              88 88 88                                          Use only black ink and UPPERCASE letters. 
9
                                                                                                                                                                                                                                  For taxable year beginning in
10                                                                                             X Check here if amended return                 X  Check here if final return
11                                                                                                   X  Check here if the federal extension was granted                                                                                       88/2017
12                                                             FEIN                                        SSN of decedent (estates only)
13                                                             88 8888888                                  888 88 8888
14
15                                                             Name of trust or estate
16                                                             JOHNXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
17
18                                                             Name of trust or estate (second line)
19                                                             JANEXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
20
21                                                             Fiduciary name and title
22                                                             THE NAME AND TITLEXXXXXXXXXXXXXXXXX
23
24                                                             Address (if address change, check box)        X
25
                                                               8888 BERRY AVEXXXXXXXXXXXXXXXXXXXXX
26                                                             City                                                                                  State        ZIP code
27
                                                               CITYXXXXXXXXXXXXXXXX                                                                  OH           88888
28
29                                                             Foreign State Code           Country Code        Foreign country (if the mailing address is outside the U.S.)     Foreign postal code
30
                                                               ABC                               AB             ANYCOUNTRYXXXXXXXXXX                                             AB88888
31
32                                                             Check Applicable Box(es)
33                                                                             Simple trust         OR          X  Complex trust                             X Irrevocable trust                                                  X Testamentary trust
                                                                       X
34
35                                                                     X       Resident trust       OR          X  Nonresident trust                         X Bankruptcy estate                                                  X Decedent’s estate
36
37                                                                  1. Federal taxable income (from the federal 1041, line 22).Include page 1 of the federal 1041  ..............................1.                              -  888888888 00
38                                                            
39                                                            2. Net adjustments       from Schedule A, line 40  .........................................................................................................2.     -
                                                                                                                                                                                                                                    888888888 00
40                                                              
41                                                             3. Ohio  taxable income (line 1 plus or minus line 2). Estates should skip lines 4-7   ...............................................3.                          -  888888888 00
42                              Do not staple or paper clip.  
43                                                            4. Allocated     qualifying trust amount from Schedule F, line 59 (trusts only)     ...........................................................4.                  -
                                                                                                                                                                                                                                    888888888 00
44                                                             
45                                                             5. Apportioned   trust income from Schedule G, line 62 (trusts only)     ......................................................................5.                 -
                                                                                                                                                                                                                                    888888888 00
46
47                                                            6. Allocated     trust income from Schedule H, line 65 (trusts only) ...........................................................................6.                 -  888888888 00
48                                                            
49                                                            ModifiedOhiotaxableincome(trustsaddlines4,5and6;iflessthanzero,enter-0-)                             ....................................7.                           888888888 00
50                                                            8.TaxonOhiotaxableincome(estates,line3)ortaxonmodifiedOhiotaxableincome(trusts,line7).
51                                                                 See tax table in the instructions .........................................................................................................................8.    888888888 00
52                                                            9. Credits from Schedule B, line 48 (estates only)   .................................................................................................9.              888888888 00
53                                                            
                                                              10.Resident creditfromScheduleC(estates);nonresidentcreditfromScheduleD(estates);businesscreditfrom
54                                                                 ScheduleE(includeScheduleE)(estatesandtrusts);andtaxcreditfromScheduleI(residenttrusts)   .............10.
                                                                                                                                                                                                                                    888888888 00
55
56
57
58                                                                                                                                                                               For Department Use Only
59                                                                              Software vendors: Place 2D barcode in this location
60                                                                               Do not place a box around the 2D barcode. The box                                               /                                                  /
61                                                                                          is only here for placement purposes.                                                 Postmark date                                                  Code
62
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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
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4
5
6                                                            2017 Ohio IT 1041 
7                            Rev. 8/17            Fiduciary Income Tax Return
                                                                                                                                                                                     17180210
8   FEIN
9   88 8888888
10   11. Tax after nonrefundable credits (line 8 minus the amount on lines 9 and 10)  .....................................11.                                           888888888 00
11    
12       12. Interest penalty on underpayment of estimated tax (include Ohio IT/SD 2210) ......................................12.                                       888888888 00
13    13. Total Ohio tax (add lines 11 and 12)  ...................................................................................................13.                   888888888 00
14       14. Net payments  from line 78 on page 5 ......................14.        888888888 00
15
     15. Refundable business credits from line 85 on page 
16       5(includedocumentation/certificates)              ....................15. 888888888 00
17    16. Total  (add lines 14 and 15) .......................................16.  888888888 00
18       17. Overpayment, if any (line 16 minus line 13, but not less than -0-) ........................YOUR17.REFUND                                                   888888888 00
19
      18. 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-)  .............................................................................................................................................18.     888888888 00
21
      19.Interest andpenaltyonlate-paidand/orlate-filedreturn,if                    ..............................................................19.                    888888888 00
22
     20. Total amount due (add lines 18 and 19). Make check payable to Ohio Treasurer of State, include
23   20.    Ohio UPC and place FEIN on check ......................................................................AMOUNT DUE                                           888888888 00
24
25                    If your refund is $1.00 or less, no refund will be issued. If you owe $1.00 or less, no payment is necessary.

26                                                                                                                                                                       Do not staple or paper clip. 
   Sign Here (required): I have read this return. Under penalties of perjury, I declare that, to 
27 the best of my knowledge and belief, the return and all enclosures are true, correct and complete.                   Place any supporting documents, including 
28                                                                                                                      Ohio IT K-1(s), after the last page of this return.
29
   Signatureoffiduciaryortrustofficer                Preparer’sname(print)
30
                                                                                                                                                                                   Mail to: 
31 Title                     Date (MM/DD/YY)         Preparer’s address (include ZIP code)
32                                                                                                                      Ohio Department of Taxation 
33 Fiduciary’sortrustofficer’sphone        Preparer’sphonenumber                                                                                                         P.O. Box 2619 
34                                                                                                                      Columbus, OH 43216-2619
35 Preparer’s e-mail address                         PTIN
36 DoyouauthorizeyourpreparertocontactusregardingthisY           No                                                       Instructions for this form are on 
37                                                                                             X X                                                                       our website at tax.ohio.gov.

38 Schedule A – Adjustments to Federal Taxable Income Net of Related Expenses
39  Additions
40    21. Federal and/or non-Ohio state or local government interest and dividends not distributed ...............21.                                                    888888888 00
41   Pass-throughentityandfinancialinstitutionstaxespaidandrelatedmemberadd-back                                ...................22.                                   888888888 00
42
     23. Income from an Electing Small Business Trust (ESBT) not shown in federal taxable income 
                                                 .....................................................................................................................23.
43       (include documentation)                                                                                                                                         888888888 00
44
45    24. Losses from sale or other disposition of Ohio public obligations .......................................................24.                                    888888888 00
46
47    25. Recovery of amount previously deducted or excluded .......................................................................25.                                  888888888 00
48
     26. Adjustment for Internal Revenue Code section 168(k) depreciation expense.
49      2/3, X         X 5/6 or      X 6/6 (check applicable box) ..........................................................................26.                          888888888 00
50   
51
      27. Federal personal exemption (estates only) and miscellaneous federal tax adjustments ...................27.                                                     888888888 00
52
      28. Expenses claimed on Ohio estate return (estates only) .....................................................................28.                                 888888888 00
53
54   29. Total additions (add lines 21 through 28) ...........................................................................................29.                        888888888 00
55
56
57
58
59                       Software vendors: Place 2D barcode in this location
60                       Do not place a box around the 2D barcode. The box 
61                               is only here for placement purposes.
62
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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                                                        2017 Ohio IT 1041 
7                         Rev. 8/17                 Fiduciary Income Tax Return
                                                                                                                                                                      17180310
8  FEIN
9  88 8888888
10
11 Schedule A – Adjustments to Federal Taxable Income Net of Related Expenses...cont.
12 Deductions – Note: Deduct income items described below only to the extent that those amounts 
13 are not already deducted or excluded from federal taxable income after distributions.
14  30. Federal interest and dividends exempt from state taxation net of related expenses .........................30.
                                                                                                                                                                      888888888 00
15  
16   31. Certain state and municipal income tax overpayments ......................................................................31.
                                                                                                                                                                      888888888 00
17   32.  Losses from an ESBT not shown in federal taxable income (include documentation).......................32.
                                                                                                                                                                      888888888 00
18
    33.  Wage and salary expense not previously deducted due to the federal targeted jobs credit or 
19        the work opportunity credit .................................................................................................................33.
                                                                                                                                                                      888888888 00
20
    34.  Interest income from Ohio public obligations and Ohio purchase obligations and gains from the 
21        sale or other disposition of Ohio public obligations ............................................................................34.
                                                                                                                                                                      888888888 00
22
    35.Refunds orreimbursementsofprioryearfederalitemizeddeductionsandmiscellaneousfederal
23        tax adjustments ..................................................................................................................................35.
                                                                                                                                                                      888888888 00
24   36.  Farm income from a farm of at least 10 acres (trusts only) ................................................................36.
                                                                                                                                                                      888888888 00
25
    37.  Adjustment for Internal Revenue Code section 168(k) depreciation expense. Include a separate 
26        schedule showing calculations designating 1/2, 1/5 or 1/6 ..........................................................37.                                     888888888 00
27   38. Repayment of income reported in a prior year and not otherwise deducted ......................................38.                                            888888888 00
28
29    39. Total deductions (add lines 30 through 38) .........................................................................................39.
                                                                                                                                                                      888888888 00
30    .........................................40. 40. Net adjustments (subtract line 39 from line 29). Enter here and on line 2                                    -
                                                                                                                                                                      888888888 00
31
   Schedule B – Estate Credits
32    41. Retirement income credit (see instructions for credit table) (limit – $200).......................................... 41.
                                                                                                                                                                      888 00
33
34   42. Lump sum retirement credit (see instructions to calculate the credit) .................................................. 42.                                 888888888 00
35
36  Seniorcitizen’scredit(       limit – $50 per return) .................................................................................... 43.
                                                                                                                                                                              88 00
37
38 44.Lumpsumdistributioncredit(mustbe65oroldertoclaimthiscredit;seeinstructionsto
          calculate this credit)  ............................................................................................................................. 44.   888888888 00
39
                                                                                                                                                                      888888888 00
40   45. Child and dependent care credit (see instructions and worksheet in Ohio IT 1040 booklet) ................... 45.
41
                                                                                                                                                                      888888888 00
42     46. Ohio political contributions credit..... .................................................................................................... 46. 
43   47. Ohio adoption credit (limit $10,000) .................................................................................................... 47.
                                                                                                                                                                      888888888 00
44
45  48. Total Schedule B credits (add lines 41 through 47) – enter here and on line 9 ..................................48.
                                                                                                                                                                      888888888 00
46
   Schedule C – Estate Ohio Resident Credit
47
    49.  Enter the portion of Ohio taxable income (line 3) subjected to tax by other states or the 
48      District of Columbia while an Ohio resident  .......................................................................................49.                     - 888888888 00
49  50. Enter Ohio taxable income (line 3)  .....................................................................................................50.                -
                                                                                                                                                                      888888888 00
50  51.  Divide line 49 by line 50 and enter percentage here                       888.88 %. Multiply this percentage 
51        by the amount shown on line 8 reduced by any amount shown on line 9 ..........................................51.                                           888888888 00
52
    52.  Enter the 2017 income tax, less all related credits other than withholding and estimated tax payments 
53        and carryforwards from previous years, paid to other states or the District of Columbia................................52.                                  888888888 00
54  
55  53.  Enter the smaller of line 51 or line 52. This is your Ohio resident tax credit. Enter here and on line 10 ........53.                                        888888888 00
56
57
58
59                   Software vendors: Place 2D barcode in this location
60                   Do not place a box around the 2D barcode. The box 
61                               is only here for placement purposes.
62
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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                                                           2017 Ohio IT 1041 
7                        Rev. 8/17             Fiduciary Income Tax Return
                                                                                                                                                                              17180410
8    FEIN
9    88 8888888
10
11
    Schedule D – Estate Nonresident Credit
12
13   54.  Enter the portion of Ohio taxable income (line 3) not earned or received in Ohio (include 
        Ohio IT 2023) ......................................................................................................................................54. - 888888888 00
14
15                                                                                                                                                              - 888888888 00
      55.  Enter Ohio taxable income (line 3) .....................................................................................................55.
16  56.   Divide line 54 by line 55 and enter percentage here                          888.88%. Multiply this percentage by the 
17
      amount shown on line 8 reduced by the amount shown on line 9. Enter here and on line 10 ...................56.                                              888888888 00
18  
19  Schedule F – Allocated Qualifying Trust Amounts
20   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  ..........57.                                        - 888888888 00
21
22   58. Enter the percentage of the closely held investee’s physical assets located within Ohio             .................58.                                              
                                                                                                                                                                              8.8888
23
24                                                                                                                                                              -
     59. Multiply the amount on line 57 by the percentage on line 58. Enter here and on line 4 ....................59.
25                                                                                                                                                                888888888 00
26  Schedule G – Apportioned Income for Trusts
27   60. Enter (i) the trust’s business income not included in line 57 and (ii) the trust’s qualifying investment 
         income not otherwise a part of business income and not included in line 57       ....................................60.                               - 888888888 00
28
29   61. Enter the Ohio apportionment ratio from line 76 of the apportionment worksheet on page 5 ...........61.                                                              8.888888
30
31   62. Multiply the amount on line 60 by the apportionment ratio on line 61. Enter here and on line 5  .......62.                                             - 888888888 00
32
33  Schedule H – Allocated Nonbusiness Income for Trusts
34  If distributive share is business income from a pass-through entity, use Schedule G.
     63. Resident trusts: Enter the trust’s portion of Ohio taxable income (line 3) not reported on lines 57 or 60            ................63.               - 888888888 00
35
36   64. Nonresident trusts: Enter the trust’s portion of Ohio taxable income (line 3) not reported on lines 57 
37       or 60 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 64)  ............................................................64.                       - 888888888 00
38
39  65. Add lines 63 and 64 and enter here and on line 6  .............................................................................65.                      - 888888888 00
40
    Schedule I – Tax Credit for Resident Trusts
41
     66. Enter the amount of allocated resident trust nonbusiness income (line 63, above) subject to tax in 
42       one or more states or in the District of Columbia                                                                                                      - 888888888 00
                                                           ..............................................................................66.
43
44   67. Enter the amount from line 8  ..............................................................................................................67.          888888888 00
45
46  EntertheamountofmodifiedOhiotaxableincomefromline                     .........................................................68.                            888888888 00
47   
48  69.Divideline67byline68andenterthepercentagehere.          Thisistheaverageeffectivetaxrate                ..................69.                                          8.8888 
49
50   70. Multiply the amount on line 66 by the percentage reported on line 69    ..............................................70.                              - 888888888 00
51   
     71. Enter the amount of tax actually paid by the resident trust to another state or the District of Columbia 
52       on the trust’s allocated nonbusiness income  .....................................................................................71.                    888888888 00
53   
     72. Enter the smaller of the amount on lines 70 and 71. This is the resident trust’s Ohio tax credit. Enter 
54       here and on line 10 ............................................................................................................................72.      888888888 00
55
56
57
58
59                     Software vendors: Place 2D barcode in this location
60                     Do not place a box around the 2D barcode. The box 
61                               is only here for placement purposes.
62
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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                                                            2017 Ohio IT 1041 
7                       Rev. 8/17           Fiduciary Income Tax Return
                                                                                                                                                                       17180510
8  FEIN
9  88 8888888
10 Apportionment Worksheet
11
   Usethisworksheettocalculatetheapportionmentratioforthetrust’smodifiedbusinessincomeandqualifyinginvestmentincomeincluded
12 in Ohio taxable income. Note: All ratios are to be carried to six decimal places.
13  73.  Property                                                 Within Ohio                                       Total Everywhere
14     a) Owned (average cost)                        88888888888 00                                                88888888888 00
15
16                                                                Within Ohio                                       Total Everywhere
    
17     b) Rented (annual rental X 8)                  88888888888 00                                                88888888888 00
18
19                                                                Within Ohio                                       Total Everywhere
20     c) Total (lines 73a and 73b)                   88888888888 00                              ÷                 88888888888 00
21                                                                                          Ratio    Weight                                                            Weighted Ratio
22                                                                = 8.888888                      x =8.88                                                              8.888888
23
24                                                                Within Ohio                                       Total Everywhere
25  74.  Payroll                                      88888888888 00                              ÷                 88888888888 00
26
27                                                                                          Ratio    Weight                                                            Weighted Ratio
28
                                                                  = 8.888888                      x =8.88                                                              8.888888
29
30                                                                Within Ohio                                       Total Everywhere
31  75.  Sales                                        88888888888 00                              ÷                 88888888888 00
32
33                                                                                          Ratio    Weight                                                            Weighted Ratio
34                                                                = 8.888888                      x =8.88.                                                             8.888888
35
36  76.  Total weighted apportionment ratio (add weighted ratio from lines 73c, 74 and 75). Enter ratio here and on 
       Schedule G, line 61 (carry to six decimal places).    ..................................................................................................76..... 8.888888
37
   Note: Ifthedenominatorofanyfactoriszero,theweightgiventotheotherfactorsmustbeproportionatelyincreasedsothatthetotalweightgiventothe
38 combinednumberoffactorsusedis100%,i.e.,ifnoproperty/payroll,use25%and75%;ifnosales,use50%property/payroll;ifonlyonefactor,use100%.
39
40 Net Payment Worksheet – Include 1099(s) and W-2(s)
41 77a. Estimated payments                                     77b. Prior year credit carryover      77c. 1099 withholdings
42
        88888888 00                                          88888888 00                             88888888 00
43
44 77d. W-2 withholdings                              77e. Refunds previously claimed                 78. Net payments (sum of lines 77a-d minus line 77e). 
                                                                                                     Enter here and on page 2, line 14.
45
        88888888 00                                          88888888 00
46
                                                                                                     888888888 00
47 Refundable Business Credits
48 Note:CertificatesfromtheOhioDevelopmentServices           Agencyand/orOhioIT K-1(s)mustbeincludedtoverifyeachrefundablecreditclaimed.
49 79.  Motion picture credit                                     80.  Business jobs credit          81.  Pass-through entity credit
50
        88888888 00                                          88888888 00                             88888888 00
51 82.  Venture capital credit                        83.  Historic preservation credit               84. Financial Institutions Tax (FIT) credit
52
        88888888 00                                          88888888 00                             88888888 00
53 85. Total refundable business credits (add lines 79-84). Enter here and on page 2, line 15.
54
        888888888 00
55
56
57
58
59                 Software vendors: Place 2D barcode in this location
60                 Do not place a box around the 2D barcode. The box 
61                             is only here for placement purposes.
62
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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                                           2017 Ohio IT 1041 
7                    Rev. 8/17         Fiduciary Income Tax Return
                                                                                                        17180610
8  FEIN
9  88 8888888
10
   Beneficiary Schedule
11 Providebeneficiaryinformationfor all(residentandnonresident)beneficiariesintheestateortrust. Use an additional sheet, if necessary.
12
13 SSN                                 FEIN         Amount distributed
14
   888 88 8888                         88 8888888   888888888 00
15
16 First name/entity                              M.I. Last name
17
   JOHNXXXXXXXXXXX                                Q PUBL I CXXXXXXXXXXXXXX
18 Address
19                    
   8888 CHERRY  LANEXXXXXXXXXXXXXXXXXXX
20 City                                                         State                           ZIP code
21
   CITYXXXXXXXXXXXXXXXX                                         OH                              88888
22
23
24 SSN                                 FEIN         Amount distributed
25
   888 88 8888                         88 8888888   888888888 00
26
27 First name/entity                              M.I. Last name
28
   JOHNXXXXXXXXXXX                                Q PUBL I CXXXXXXXXXXXXXX
29 Address
30
   8888 CHERRY  LANEXXXXXXXXXXXXXXXXXXX 
31 City                                                         State                           ZIP code
32
   CITYXXXXXXXXXXXXXXXX                                         OH                              88888
33
34
35 SSN                                 FEIN         Amount distributed
36
   888 88 8888                         88 8888888   888888888 00
37
38 First name/entity                              M.I. Last name
39
   JOHNXXXXXXXXXXX                                Q PUBL I CXXXXXXXXXXXXXX
40 Address
41
   8888 CHERRY  LANEXXXXXXXXXXXXXXXXXXX 
42 City                                                         State                           ZIP code
43
   CITYXXXXXXXXXXXXXXXX                                         OH                              88888
44
45
46 SSN                                 FEIN         Amount distributed
47 888 88 8888                         88 8888888   888888888 00
48
49 First name/entity                              M.I. Last name
50 JOHNXXXXXXXXXXX                                Q PUBL I CXXXXXXXXXXXXXX
51 Address
52                    
   8888 CHERRY  LANEXXXXXXXXXXXXXXXXXXX
53 City                                                         State                           ZIP code
54                                                              OH                              88888
   CITYXXXXXXXXXXXXXXXX
55
56
57
58
59              Software vendors: Place 2D barcode in this location
60              Do not place a box around the 2D barcode. The box 
61                    is only here for placement purposes.
62
63
64                                                                                              2017 IT 1041 – page   of266
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Layout 

without grid

Do not staple or paper clip.
2017 Ohio IT 1041 
Rev. 8/17 Fiduciary Income Tax Return
17180110
88 88 88 Use only black ink and UPPERCASE letters. 
For taxable year beginning in
X Check here if amended return X Check here if final return
X Check here if the federal extension was granted 88/2017
FEIN SSN of decedent (estates only)
88 8888888 888 88 8888
Name of trust or estate
JOHNXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
Name of trust or estate (second line)
JANEXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
Fiduciary name and title
THE NAME AND TITLEXXXXXXXXXXXXXXXXX

Address (if address change, check box) X
8888 BERRY AVEXXXXXXXXXXXXXXXXXXXXX
City State ZIP code
CITYXXXXXXXXXXXXXXXX OH 88888
Foreign State Code Country Code Foreign country (if the mailing address is outside the U.S.) Foreign postal code
ABC AB ANYCOUNTRYXXXXXXXXXX AB88888
Check Applicable Box(es)
X Simple trust OR X Complex trust X Irrevocable trust X Testamentary trust

X Resident trust OR X Nonresident trust X Bankruptcy estate X Decedent’s estate

       1. Federal taxable income (from the federal 1041, line 22).Include page 1 of the federal 1041  ..............................1. - 888888888 00
 
 2. Net adjustments from Schedule A, line 40 .........................................................................................................2. - 888888888 00
   
  3. Ohio taxable income (line 1 plus or minus line 2). Estates should skip lines 4-7  ...............................................3. - 888888888 00
Do not staple or paper clip.  
 4. Allocated qualifying trust amount from Schedule F, line 59 (trusts only) ...........................................................4. - 888888888 00
  
  5. Apportioned trust income from Schedule G, line 62 (trusts only)   ......................................................................5. - 888888888 00

 6. Allocated trust income from Schedule H, line 65 (trusts only) ...........................................................................6. - 888888888 00
 
 ModifiedOhiotaxableincome(trustsaddlines4,5and6;iflessthanzero,enter-0-)  ....................................7. 888888888 00
 8.TaxonOhiotaxableincome(estates,line3)ortaxonmodifiedOhiotaxableincome(trusts,line7).
      See tax table in the instructions .........................................................................................................................8. 888888888 00
 9. Credits from Schedule B, line 48 (estates only)  .................................................................................................9. 888888888 00
 
 10.Resident creditfromScheduleC(estates);nonresidentcreditfromScheduleD(estates);businesscreditfrom
ScheduleE(includeScheduleE)(estatesandtrusts);andtaxcreditfromScheduleI(residenttrusts)   .............10. 888888888 00

For Department Use Only
Software vendors: Place 2D barcode in this location
Do not place a box around the 2D barcode. The box / /
is only here for placement purposes. Postmark date Code

2017 IT 1041 – page   of216

                                                          2017 Ohio IT 1041 
                          Rev. 8/17            Fiduciary Income Tax Return
                                                                                                                                                                                                          17180210
 FEIN
 88 8888888
  11. Tax after nonrefundable credits (line 8 minus the amount on lines 9 and 10)  .....................................11.                                                                   888888888 00
   
      12. Interest penalty on underpayment of estimated tax (include Ohio IT/SD 2210) ......................................12.                                                               888888888 00
   13. Total Ohio tax (add lines 11 and 12)  ...................................................................................................13.                                           888888888 00
      14. Net payments  from line 78 on page 5 ......................14.        888888888 00
  15. Refundable business credits from line 85 on page 
      5(includedocumentation/certificates)              ....................15. 888888888 00
   16. Total  (add lines 14 and 15) .......................................16.  888888888 00
      17. Overpayment, if any (line 16 minus line 13, but not less than -0-) ........................YOUR17.REFUND                                                                           888888888 00
   18. Net amount due, if any (if line 13 is more than line 16, subtract line 16 from line 13, but not less 
      than -0-)  .............................................................................................................................................18.                             888888888 00
   19.Interest andpenaltyonlate-paidand/orlate-filedreturn,if                    ..............................................................19.                                            888888888 00
  20. Total amount due (add lines 18 and 19). Make check payable to Ohio Treasurer of State, include
  20.    Ohio UPC and place FEIN on check ......................................................................AMOUNT DUE                                                                   888888888 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 have read this return. Under penalties of perjury, I declare that, to                                                                                                 Do not staple or paper clip. 
the best of my knowledge and belief, the return and all enclosures are true, correct and complete.                   Place any supporting documents, including 
                                                                                                                     Ohio IT K-1(s), after the last page of this return.
Signatureoffiduciaryortrustofficer                Preparer’sname(print)
                                                                                                                                                                                                        Mail to: 
Title                     Date (MM/DD/YY)         Preparer’s address (include ZIP code)
                                                                                                                     Ohio Department of Taxation 
Fiduciary’sortrustofficer’sphone        Preparer’sphonenumber                                                                                                                                 P.O. Box 2619 
                                                                                                                     Columbus, OH 43216-2619
Preparer’s e-mail address                         PTIN
DoyouauthorizeyourpreparertocontactusregardingthisY           No                                                       Instructions for this form are on 
                                                                                            X X                                                                                               our website at tax.ohio.gov.

Schedule A – Adjustments to Federal Taxable Income Net of Related Expenses
 Additions
   21. Federal and/or non-Ohio state or local government interest and dividends not distributed ...............21.                                                                            888888888 00
  Pass-throughentityandfinancialinstitutionstaxespaidandrelatedmemberadd-back                                ...................22.                                                           888888888 00
  23. Income from an Electing Small Business Trust (ESBT) not shown in federal taxable income 
                                              .....................................................................................................................23.(include documentation) 888888888 00

   24. Losses from sale or other disposition of Ohio public obligations .......................................................24.                                                            888888888 00

   25. Recovery of amount previously deducted or excluded .......................................................................25.                                                          888888888 00
  26. Adjustment for Internal Revenue Code section 168(k) depreciation expense.
     2/3, X         X 5/6 or      X 6/6 (check applicable box) ..........................................................................26.                                                  888888888 00
  
   27. Federal personal exemption (estates only) and miscellaneous federal tax adjustments ...................27.                                                                             888888888 00
   28. Expenses claimed on Ohio estate return (estates only) .....................................................................28.                                                         888888888 00

  29. Total additions (add lines 21 through 28) ...........................................................................................29.                                                888888888 00

                      Software vendors: Place 2D barcode in this location
                      Do not place a box around the 2D barcode. The box 
                              is only here for placement purposes.

                                                                                                                     2017 IT 1041 – page   of22                                                                   6

                                                      2017 Ohio IT 1041 
                       Rev. 8/17                 Fiduciary Income Tax Return
                                                                                                                                                                             17180310
FEIN
88 8888888

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.
 30. Federal interest and dividends exempt from state taxation net of related expenses .........................30.                                                888888888 00
 
  31. Certain state and municipal income tax overpayments ......................................................................31.                                888888888 00
  32.  Losses from an ESBT not shown in federal taxable income (include documentation).......................32.                                                   888888888 00
 33.  Wage and salary expense not previously deducted due to the federal targeted jobs credit or 
       the work opportunity credit .................................................................................................................33.            888888888 00
 34.  Interest income from Ohio public obligations and Ohio purchase obligations and gains from the 
       sale or other disposition of Ohio public obligations ............................................................................34.                        888888888 00
 35.Refunds orreimbursementsofprioryearfederalitemizeddeductionsandmiscellaneousfederal
       tax adjustments ..................................................................................................................................35.       888888888 00
  36.  Farm income from a farm of at least 10 acres (trusts only) ................................................................36.                              888888888 00
 37.  Adjustment for Internal Revenue Code section 168(k) depreciation expense. Include a separate 
       schedule showing calculations designating 1/2, 1/5 or 1/6 ..........................................................37.                                     888888888 00
  38. Repayment of income reported in a prior year and not otherwise deducted ......................................38.                                            888888888 00

   39. Total deductions (add lines 30 through 38) .........................................................................................39.                     888888888 00
   .........................................40. 40. Net adjustments (subtract line 39 from line 29). Enter here and on line 2                                    - 888888888 00
Schedule B – Estate Credits
   41. Retirement income credit (see instructions for credit table) (limit – $200).......................................... 41.                                               888 00

  42. Lump sum retirement credit (see instructions to calculate the credit) .................................................. 42.                                 888888888 00

 Seniorcitizen’scredit(       limit – $50 per return) .................................................................................... 43.                                       88 00
44.Lumpsumdistributioncredit(mustbe65oroldertoclaimthiscredit;seeinstructionsto
       calculate this credit)  ............................................................................................................................. 44.   888888888 00

  45. Child and dependent care credit (see instructions and worksheet in Ohio IT 1040 booklet) ................... 45.                                             888888888 00

    46. Ohio political contributions credit..... .................................................................................................... 46.          888888888 00
  47. Ohio adoption credit (limit $10,000) .................................................................................................... 47.                888888888 00

 48. Total Schedule B credits (add lines 41 through 47) – enter here and on line 9 ..................................48.                                           888888888 00
Schedule C – Estate Ohio Resident Credit
 49.  Enter the portion of Ohio taxable income (line 3) subjected to tax by other states or the 
     District of Columbia while an Ohio resident  .......................................................................................49.                     - 888888888 00
 50. Enter Ohio taxable income (line 3)  .....................................................................................................50.                - 888888888 00
 51.  Divide line 49 by line 50 and enter percentage here                       888.88 %. Multiply this percentage 
       by the amount shown on line 8 reduced by any amount shown on line 9 ..........................................51.                                           888888888 00
 52.  Enter the 2017 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................................52.                                  888888888 00
 
 53.  Enter the smaller of line 51 or line 52. This is your Ohio resident tax credit. Enter here and on line 10 ........53.                                        888888888 00

                  Software vendors: Place 2D barcode in this location
                  Do not place a box around the 2D barcode. The box 
                              is only here for placement purposes.

                                                                                                                   2017 IT 1041 – page   of23                                        6

                                                          2017 Ohio IT 1041 
                      Rev. 8/17              Fiduciary Income Tax Return
                                                                                                                                                                           17180410
  FEIN
  88 8888888

 Schedule D – Estate Nonresident Credit
  54.  Enter the portion of Ohio taxable income (line 3) not earned or received in Ohio (include 
     Ohio IT 2023) ......................................................................................................................................54. - 888888888 00

   55.  Enter Ohio taxable income (line 3) .....................................................................................................55.          - 888888888 00
 56.   Divide line 54 by line 55 and enter percentage here                          888.88%. Multiply this percentage by the 
   amount shown on line 8 reduced by the amount shown on line 9. Enter here and on line 10 ...................56.                                              888888888 00
 
 Schedule F – Allocated Qualifying Trust Amounts
  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  ..........57.                                       - 888888888 00

  58. Enter the percentage of the closely held investee’s physical assets located within Ohio            .................58.                                              8.8888 

   59. Multiply the amount on line 57 by the percentage on line 58. Enter here and on line 4                ....................59.                          - 888888888 00
 Schedule G – Apportioned Income for Trusts
  60.  Enter (i) the trust’s business income not included in line 57 and (ii) the trust’s qualifying investment 
       income not otherwise a part of business income and not included in line 57       ....................................60.                              - 888888888 00

  61. Enter the Ohio apportionment ratio from line 76 of the apportionment worksheet on page 5 ...........61.                                                              8.888888

  62. Multiply the amount on line 60 by the apportionment ratio on line 61. Enter here and on line 5  .......62.                                             - 888888888 00
 Schedule H – Allocated Nonbusiness Income for Trusts
 If distributive share is business income from a pass-through entity, use Schedule G.
  63. Resident trusts: Enter the trust’s portion of Ohio taxable income (line 3) not reported on lines 57 or 60            ................63.               - 888888888 00
  64. Nonresident trusts: Enter the trust’s portion of Ohio taxable income (line 3) not reported on lines 57 
       or 60 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 64)  ............................................................64.                      - 888888888 00

 65. Add lines 63 and 64 and enter here and on line 6  .............................................................................65.                      - 888888888 00
 Schedule I – Tax Credit for Resident Trusts
  66. Enter the amount of allocated resident trust nonbusiness income (line 63, above) subject to tax in 
       one or more states or in the District of Columbia ..............................................................................66.                   - 888888888 00

  67. Enter the amount from line 8  ..............................................................................................................67.          888888888 00

 EntertheamountofmodifiedOhiotaxableincomefromline                         .........................................................68.                        888888888 00
  
 69.Divideline67byline68andenterthepercentagehere.           Thisistheaverageeffectivetaxrate               ..................69.                                          8.8888 

  70. Multiply the amount on line 66 by the percentage reported on line 69      ..............................................70.                            - 888888888 00
  
  71. Enter the amount of tax actually paid by the resident trust to another state or the District of Columbia 
       on the trust’s allocated nonbusiness income  .....................................................................................71.                   888888888 00
  
  72. Enter the smaller of the amount on lines 70 and 71. This is the resident trust’s Ohio tax credit. Enter 
       here and on line 10 ............................................................................................................................72.     888888888 00

                     Software vendors: Place 2D barcode in this location
                     Do not place a box around the 2D barcode. The box 
                              is only here for placement purposes.

                                                                                                           2017 IT 1041 – page   of24                                              6

                                                          2017 Ohio IT 1041 
                     Rev. 8/17           Fiduciary Income Tax Return
                                                                                                                                                                    17180510
FEIN
88 8888888
Apportionment Worksheet
Usethisworksheettocalculatetheapportionmentratioforthetrust’smodifiedbusinessincomeandqualifyinginvestmentincomeincluded
in Ohio taxable income. Note: All ratios are to be carried to six decimal places.
 73.  Property                                                 Within Ohio                                       Total Everywhere
    a) Owned (average cost)                        88888888888 00                                                88888888888 00
                                                               Within Ohio                                       Total Everywhere
    b) Rented (annual rental X 8)                  88888888888 00                                                88888888888 00

                                                               Within Ohio                                       Total Everywhere
    c) Total (lines 73a and 73b)                   88888888888 00                              ÷                 88888888888 00
                                                                                         Ratio    Weight                                                            Weighted Ratio
                                                               = 8.888888                      x =8.88                                                              8.888888
                                                               Within Ohio                                       Total Everywhere
 74.  Payroll                                      88888888888 00                              ÷                 88888888888 00

                                                                                         Ratio    Weight                                                            Weighted Ratio
                                                               = 8.888888                      x =8.88                                                              8.888888
                                                               Within Ohio                                       Total Everywhere
 75.  Sales                                        88888888888 00                              ÷                 88888888888 00
                                                                                         Ratio    Weight                                                            Weighted Ratio
                                                               = 8.888888                      x =8.88.                                                             8.888888
 76.  Total weighted apportionment ratio (add weighted ratio from lines 73c, 74 and 75). Enter ratio here and on 
    Schedule G, line 61 (carry to six decimal places).    ..................................................................................................76..... 8.888888
Note: Ifthedenominatorofanyfactoriszero,theweightgiventotheotherfactorsmustbeproportionatelyincreasedsothatthetotalweightgiventothe
combinednumberoffactorsusedis100%,i.e.,ifnoproperty/payroll,use25%and75%;ifnosales,use50%property/payroll;ifonlyonefactor,use100%.
Net Payment Worksheet – Include 1099(s) and W-2(s)
77a. Estimated payments                                     77b. Prior year credit carryover      77c. 1099 withholdings

     88888888 00                                          88888888 00                             88888888 00
77d. W-2 withholdings                              77e. Refunds previously claimed                 78. Net payments (sum of lines 77a-d minus line 77e). 
                                                                                                  Enter here and on page 2, line 14.
     88888888 00                                          88888888 00
                                                                                                  888888888 00
Refundable Business Credits
Note:CertificatesfromtheOhioDevelopmentServices           Agencyand/orOhioIT K-1(s)mustbeincludedtoverifyeachrefundablecreditclaimed.
79.  Motion picture credit                                     80.  Business jobs credit          81.  Pass-through entity credit
     88888888 00                                          88888888 00                             88888888 00
82.  Venture capital credit                        83.  Historic preservation credit               84. Financial Institutions Tax (FIT) credit
     88888888 00                                          88888888 00                             88888888 00
85. Total refundable business credits (add lines 79-84). Enter here and on page 2, line 15.
     888888888 00

                Software vendors: Place 2D barcode in this location
                Do not place a box around the 2D barcode. The box 
                            is only here for placement purposes.

                                                                                               2017 IT 1041 – page   of25                                                   6

                                         2017 Ohio IT 1041 
                  Rev. 8/17         Fiduciary Income Tax Return
                                                                                                     17180610
FEIN
88 8888888
Beneficiary Schedule
Providebeneficiaryinformationfor all(residentandnonresident)beneficiariesintheestateortrust. Use an additional sheet, if necessary.

SSN                                 FEIN         Amount distributed
888 88 8888                         88 8888888   888888888 00

First name/entity                              M.I. Last name
JOHNXXXXXXXXXXX                                Q PUBL I CXXXXXXXXXXXXXX
Address
8888 CHERRY  LANEXXXXXXXXXXXXXXXXXXX 
City                                                         State                           ZIP code
CITYXXXXXXXXXXXXXXXX                                         OH                              88888

SSN                                 FEIN         Amount distributed
888 88 8888                         88 8888888   888888888 00

First name/entity                              M.I. Last name
JOHNXXXXXXXXXXX                                Q PUBL I CXXXXXXXXXXXXXX
Address
8888 CHERRY  LANEXXXXXXXXXXXXXXXXXXX 
City                                                         State                           ZIP code
CITYXXXXXXXXXXXXXXXX                                         OH                              88888

SSN                                 FEIN         Amount distributed
888 88 8888                         88 8888888   888888888 00

First name/entity                              M.I. Last name
JOHNXXXXXXXXXXX                                Q PUBL I CXXXXXXXXXXXXXX
Address
8888 CHERRY  LANEXXXXXXXXXXXXXXXXXXX 
City                                                         State                           ZIP code
CITYXXXXXXXXXXXXXXXX                                         OH                              88888

SSN                                 FEIN         Amount distributed
888 88 8888                         88 8888888   888888888 00

First name/entity                              M.I. Last name
JOHNXXXXXXXXXXX                                Q PUBL I CXXXXXXXXXXXXXX
Address
8888 CHERRY  LANEXXXXXXXXXXXXXXXXXXX 
City                                                         State                           ZIP code
CITYXXXXXXXXXXXXXXXX                                         OH                              88888

             Software vendors: Place 2D barcode in this location
             Do not place a box around the 2D barcode. The box 
                  is only here for placement purposes.

                                                                                             2017 IT 1041 – page   of266

General information 

regarding this form

       General Information (2017 Ohio IT 1041):
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 on each page of the Ohio IT 1041.

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 first six numbers are constant for this form (171801XX - 171806XX). 

  17 = tax year
  18 = IT 1041 
  01-06 = page number 
  XX = vendor number (assigned to you by the Ohio Dept. of Taxation, Forms Unit).

   NOTE: The vendor number also serves as the first two digits of the SSN and FEIN fields in the test 
   scenarios.

3) New! Use Arial font for the static text on the form. The static text for all target marks and header information 
(target marks, logo, title and 1D barcode) must match grid.

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

5) Follow the grid layout for the variable data fields 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 fields except where shown in specs.

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

8) You must include a leading zero on ratio fields. For example, if the ratio is .000026, it should display as 0.000026.

9) The possible negative fields for this return are lines 1, 2, 3, 4, 5 and 6; Schedule A, line 40; Schedule C, lines 
49 and 50; Schedule D, lines 54 and 55; Schedule F, lines 57 and 59; Schedule G, lines 60 and 62; Schedule H, 
lines 63, 64 and 65 and Schedule I, lines 66 and 70. Do not hard-code negative signs.

10) Provide guidance to customers regarding duplex printing that instructs them to print pages 1 and 2 together 
and pages 3 and 4 together. Taxpayers have filed 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.

11) New! Generate the following message for customers: “Do not enclose other documentation unless it is 
specified on the tax return or instructions.” Taxpayers often submit worksheets and receipts from the vendor 
product, which slows the processing of tax returns. Any other documentation generated from the software must 
include a 1D barcode identifying it as an additional information. The preferred placement is centered on the top 
edge of the page within the print area, however placement at any location on the page will be accepted. Always 
use the following 1D barcode (2 of 5 interleaved):

                                                           10211411

12) 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.”

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

 Additional Instructions 

 for the 2D barcode and 

 regarding submissions, 

 testing and notifications 

 for the 2017 Ohio IT 1041

               Important Note

 It is required that vendors program the Ohio IT 1041 to include 2D barcodes.

                     2017 Ohio IT 1041 

               Fiduciary Income Tax Return 

                    2D Barcode Instructions 
 
 General Information 
 • The Ohio IT 1041 must be enabled for 2D barcode decoding 
 • A form enabled for 2D barcode should not allow users or practitioners the option to turn 
   off/on the 2D barcode function 
 • The minimum error correction code level is 4 
 • Products must not print a 2D barcode prior to being approved in Ohio 
 
 2D Barcode Size and Placement on the Form 
 • 2D barcode must be placed on each page of form in the designated area indicated in the 
   grid layout 
 • The maximum size of the 2D barcode is 3.5 inches wide by 1 inch in height and must fit 
   within the designated space in the grid layout 
 • 2D barcode must not be bigger than the allocated area 
 
 2D Barcode Layout 
 • Each field in the barcode is delimited by a single carriage return 
   o    <CR> equals single carriage return character 
   o    This separates each piece of data so it may be identified and processed. 
 • Data included in the 2D barcode can be broken down into three general sections 
 
 Header 
   Header Version Number 
        • Static for all barcodes, value is T1 
   Developer Code 
        • A four-digit vendor code identifying the software developer whose application 
          produced the barcode 
   Jurisdiction 
        • Static for all barcodes, value is OH 
   Description 
        • A four-digit form identifier, specific to each form 
   Spec Version 
        • A one-digit specification version control number starting with the number zero 
        • This number identifies the version of the specifications used to produce the form 
          barcode 
   Form Version 
        • A one-digit form version control number starting with the number one (1) 
        • This number will only be incremented when there are changes made that would 
          affect the content of the barcode 
   Date Generated 
        • Included on page 1 only 
        • Indicates date return was generated from the product 
 
 Form Specific Data – Please see encoding schemas for form specific data 
   •    All fields on form are required and must be included in the 2D barcode 
   •    Fields with values are represented by the data followed by a carriage return 

   •     Fields with no values are represented by a carriage return only; this results in two 
         adjacent carriage returns 
   •     Note that the data format within the 2D barcode for the Weight, Ratio and Weighted 
         Ratio differs from the print version. Do not include the decimal point in the 2D data. 
 
 Trailer 
   •     The last field in the barcode data stream is the trailer 
   •     The trailer is used to indicate the end of data has been reached 
   •     A static string of *EOD* is used as the trailer value 
 
 Examples of 2D Barcode data streams 
   Header Version Number           T1<CR> 
   Developer Code                  1111<CR> 
   Jurisdiction                    OH<CR> 
   Description                     1718<CR> 
   Spec Version                    0<CR> 
   Form Version                    1<CR> 
   Date Generated                  011517<CR> 
   Line Item Specific Data         IN<CR> 
   Line Item Specific Data         IT40<CR> 
   Line Item Specific Data         0<CR> 
   Trailer                         *EOD* <CR> 
 
 Submission Process 
 • The deadline for submitting Ohio IT 1041 test packets is December 1, 2017 
 • Test packets may be submitted by email to  Forms@tax.state.oh.us 
 • The email subject line must include the vendor number, product name, tax year and form 
   number in that order e.g. 12_ABCTax_ 17_1041 
 • Submissions must include 
   •     Ohio form STF- Approval Request for Scannable Tax Forms 
   •     One (1) full field sample in a PDF format 
   •     Eight (8) test scenarios for the Ohio IT 1041 provided by the Ohio Department of 
         Taxation 
         • Each test scenario must be in a separate PDF using the following naming 
           convention: vendor number, product name, tax year, form number, test number 
           e.g.12_ABCTax_17_1041_Test 1 
 • An emailed confirmation is sent to the vendor indicating the packet was received 
 • Submissions found to be missing any of the items above are rejected 
 
 Testing Process 
 • Testing of Ohio IT 1041 packets commences on November 17, 2017 
 • Test packets are reviewed in two (2) content areas- printed forms and 2D barcode data 
 • A submission is approved in its entirety once all sample documents pass in both areas 
 
 Printed forms 
         • Vendor full field matches template provided in the specifications 
         • All fields are present, are formatted properly and align with grid layout 
         • Test scenarios contain values specified by Ohio Department of Taxation 
 
 2D Barcode Data 
         • Barcodes read as valid 
         • All test scenarios can be decoded 
         • 2D barcode data matches data on printed forms 
 

 Additional instructions 
   • The static text for all target marks and header information (target marks, logo, title and 
     1D barcode) must match grid. 
   • Any other documentation generated from the software must include a 1D barcode 
     identifying it as an additional information. The preferred placement is centered on the top 
     edge of the page within the print area, however placement at any location on the page 
     will be accepted. Always use the following 1D barcode (2 of 5 interleaved): 

 Notifications 
 • Communications from the Ohio Department of Taxation regarding submissions are sent 
    from  Forms@tax.state.oh.us  to the vendor email address(es) on file for the product 
 •  Vendor contact information is compiled from STF- Approval Request for Scannable Tax 
    Forms but may also be submitted by email to the address above. 
 • If unapproved forms are released in software packages, vendors must include a visual 
    indicator signifying the return cannot be filed. 
 • If unapproved forms are released in software packages, vendors must ensure that 
    taxpayers cannot print returns containing 2D barcodes. 
 • An emailed confirmation is sent to the vendor indicating the packet was approved, at 
    which point the product is authorized to print with a 2D barcode. 
 • An emailed confirmation is sent to the vendor for packets that are rejected 
     •   Feedback is provided regarding the errors found 
     •   Resubmit packets must include all test scenarios and the full field return 
     •   After the third submission of test materials, the department cannot guarantee 
         timeliness of the review 
 • If a tax form changes before January 1, 2018 vendors will be notified and required to 
    submit revised test packets.