Rev. 10/20/17 
                    Department of 
                    Taxation 
Ohio 

Scan Specifications for the 

          2017 Ohio IT 1140

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                              Important Note 

   The following document (2017 Ohio IT 1140) 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 1140 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 

     Department of 
     Taxation 
Ohio 

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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
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4                                                               Do not staple or paper clip. 
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6                                                                                                                                                                                 2017 Ohio IT 1140 
                                                                                             Rev. 8/17
7                                                                                                                                      Pass-Through Entity and 
8                                                                                                                               Trust Withholding Tax Return                                                                                                                  17170110
                                                             88 88 88 
9                                                                                                                                         Use only black ink and UPPERCASE letters. 
                                                                                                                                                                                   Placement of the tax year and 1D barcode is critical. 
                                                                                                            XX X Check here if amended return                                                 X X X Check here if final returnCheck here if final return
10                                                                                                                                                                                 Make sure to followChecktheheregrid positionsif final returnfor layout. Do                 For taxable year beginning in
11                                                                   This is the date the return was generated Check here if the federal extension was granted not forget to get your barcode(s) assignments for 
                                                                                                                     X                                                                                                                                                                88/2017 
12                                                           FEIN by the taxpayer (MM DD YY).                                                                                      every form, version and page.
13                                                                                                                                     Entity Type:                                              S corporation                                             Partnership
                                                             88 8888888                                                                (check only one)                                       X                                                         X 
14                                                                                                                                                                                            X  Limited liability company                              X  Trust
15                                                           Name of pass-through entity 
16                                                           JOHNXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 
17
18                                                           Address (if address change, check box)                             X 
19                                                           8888   CHERRY  LANEXXXXXXXXXXXXXXXXXXX 
20                                                           City                                                                                                                                          State          ZIP code 
22                                                           CITYXXXXXXXXXXXXXXXX                                                                                                                                    
21                                                                                                                                                                                                         OH             88888 
23                                                           Foreign State Code                       Country Code                    Foreign country (if the mailing address is outside the U.S.)                                                                            Foreign postal code 
24
                                                                          888                                 88                     88888888888888888888                                                                                                                8888888 
25
                                                                                                              Number of investors                                                   Ownership percentage 
26                                                           Total number of investors                        included on return                                                    of investors on return             Apportionment ratio, page 3, line 8 
27
                                                             888888                                           888888                                                                8 . 8888                        8 . 888888 
28                                                                                                                                                                                                                                Do not                 place spaces between  
29                                                                                                                                                                                                                                whole dollar numbers.                  There 
30                                                                                                                                                                                                                                is only a space between dollar               
31                                                           Schedule A – Reconciliation Tax and Payments                                                                                                                         amountsandcentsfields.                 
32                                                                                                                                                                                       Column (I) – Withholding Tax                                                   Column (II) – Entity Tax 
33                                                               1.Tax for each column (from Schedule B, line 11,                                                                   
34                                                                 columns A and B or from Schedule D, line 5)  .............. 1.                                                                   888888888 00                                                      888888888 00 
35                                                            2. Interest    penalty on underpayment of estimated tax 
36                              Do not staple or paper clip.       (include Ohio IT/SD 2210) ........................................... 2.                                                         888888888 00                                                      888888888 00 
37                                                             2a. Add lines 1 and 2 ......................................................2a.                                                      888888888 00                                                      888888888 00 
38                                                             3.  Ohio IT 1140ES and UPC payments the entity or trust 
39                                                                 made and/or 2016 overpaymentNEW!credited For statictotext2017use(see                                             Arial font (black ink) and 
40                                                                 Note 1 on page 7) ........................................................trytomatchsize.Fordataentryfields(       3.888888888888888888  shown88888888in 00008 00                                  888888888 00
41                                                             3a.   Payments transferred from Ohioredforidentificationpurposesonly IT 4708ES and                                  UPC        ), use Arial font 
                                                                                                                     (black ink).All   the data                                    entry fields must follow  
42                                                                 (include schedule if required;gridseelayout.1140 instructions)Never hard codeanda negative sign, and 
43                                                                 other payments previously madedo notforincludethis taxablethe negative year..... 3a.sign with the888888888amounts.                                             00 
44                                                            3b.  Payments transferred to OhioThisisnowaseparatefield.IT   4708 and   refunds,                                       
45                                                                 if any, previously claimed for this taxable year  ............ 3b.                                                               888888888 00 
46                                                            3c.  Net payments (sum of lines 3 and 3a minus line 3b) 
47                                                                 not less than zero ...................................................... 3c.                                                    888888888 00                                                      888888888888888888  0000 
48                                                              4. ForNumbereach column,of investorssubtract line 3c from line 2a ..............4.                                            -     888888888 00                                                -     888888888 00 
49                                                             NEW!5.  If theThesefieldsmaypossiblybeanegativevalue.includedsum of lineon return4, columns  (I)   and (II) is an overpayment, enter that sum here ..........YOUR REFUND5.                            888888888 00 
                                                               Include a “-“ sign here if this line has a negative value.
50                                                            6. If  the  888888sum of line 4, columns (I) and (II) is a balance due or zero, enter here ............................................6.                                                               888888888 00 
51                                                                 Interestandpenaltydueonlate-paidtaxand/orlate-filedreturn,ifany                                                                     .......................................................7.      888888888 00 
52                                                             8. Total amount due (add lines 6 and 7). Make check2D barcodepayableistoa requirement.Ohio Treasurer                                                  of State. 
53                                                                 Include  Ohio UPC and place FEIN on check ..................................................................Delete this box and replace it with                AMOUNT DUE8.                       888888888 00 
54                                                                                                                                         the 2D barcode.
55                                                                               If your refund is $1.00 or less, no refund will be issued. If you owe $1.00 or less, no payment is necessary. 
56                                                              Target marks or registration marks 
57                                                              must measure 6 mm X 6 mm. The 
58                                                              four target  marks or registration                    
59                                                              marks on every page must follow Software vendors: Place 2D barcode in this location                                                                                                            For Department Use Only 
                                                                grid layout. 
60                                                                           Do not place a box around the 2D barcode. The box                                                                                                                                        /       / 
61                                                                                                 is only here for placement purposes.                                                                                                                           Postmark date           Code 
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63                                                                                                                                                                                                                                           2017 IT 1140 – page  1of 6
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6                                                                 2017 Ohio IT 1140 
                                Rev. 8/17
7                                                            Pass-Through Entity and 
8                                                      Trust Withholding Tax Return                                                     17170210 
   FEIN 
9  88 8888888 
10

11 Sign Here (required): I have read this return. Under penalties of perjury, I declare that, to                                 Do not staple or paper clip. 
12 the best of my knowledge and belief, the return and all enclosures are true, correct and complete.                                                      
13                                                                                                                               Place any supporting documents, including  
                                                                                                                                 Ohio IT K-1’s, after the last page of this return. 
14
15 Pass-throughentityofficeroragent(print)       
16                                                                                                                                 Mail to: 
17 Titleofofficeroragent                                     Phonenumber                   
                                                                                                                                 Ohio Dept. of Taxation 
18                                                           Date(MM/DD/YY)                                                        P.O. Box 181140 
   Signatureofpass-throughofficeror
19
                                                                                                                                 Columbus, OH 43218-1140 
20 Preparer’s name (print)                                   Phone number 
21
22 Preparer’s e-mail address                                 PTIN                                                                Instructions for this form are on our 
                                                                                                                                 website at tax.ohio.gov. 
23 Do you authorize your preparer to contact us regarding this return?  Yes                   X      No  X                                               
24                                                                                                         
25 Schedule B – Qualifying Pass-Through Entities – Tax Due 
26 Use this schedule to calculate the adjusted qualifying amounts and tax due for all qualifying investors in qualifying pass-through entities. Include federal K-1(s)  
   and a listing of pass-through credits of participating investors. See “Special Notes” in the instructions, which are available on our website at tax.ohio.gov. 
27
28                                                               Number of investors                                                          (B) 
29                                                           NEW!Thesefieldsmaypossiblybeanegativevalue.included on return         Qualifying Investors Other 
                                                                                                     
                                                             Include a “-“ sign here if this line has a negative value.          Than Nonresident Individuals 
30                                                                888888
       1.Sum of all qualifying investors’ distributive       
31   shares of income, gain, expenses and losses  ............. 1.                      -    888888888 00                        - 888888888 00 
32  2a.  Add X  2/3,   X5/6 or X 6/6 (check applicable 
33       box) of the qualifying investors’ distributive 
         shares of Internal Revenue Code (I.R.C.) 
34       sections 168(k) and 179 depreciation expense 
35       and miscellaneous federal income tax adjust-
         ments, if any.  Include a separate schedule 
36       showing calculations  ................................................. 2a.         888888888 00                          888888888 00 
37  2b.  Subtract qualifying investors’   distributive shares 
         of other statutory adjustments and miscella-
38       neous federal income tax adjustments, if any .............2b.                       888888888 00                          888888888 00 
39  3. Qualifying investors’ distributive shares of ad-
         justed qualifying amount: Sum of lines 1 and 
40       2a minus line 2b ...........................................................3. -    888888888 00                        - 888888888 00 
41   4. Add all qualifying investors’    distributive shares 
42       of expenses and losses incurred in connection 
         with all direct and indirect transactions between  
43       the qualifying pass-through entity and its related 
44       members, including certain investors’ family 
         members (see Note 2 on page 7). However, do  
45       not add expenses or losses incurred in connec-
46       tion with sales of inventory to the extent that the 
47       cost of the inventory and the loss incurred were 
         calculated in accordance with I.R.C. sections  
48       263A and 482 (see Note 3 on page 7)  ......................... 4.              -    888888888 00                        - 888888888 00 
49   5. If the qualifying pass-through entity is either 
50       a partnership or a limited liability company 
51       treated as a partnership,  add all qualifying 
         investors’ distributive shares of guaranteed        
52       payments that the qualifying pass-through            2D barcode is a requirement.                  
53       entity made to any qualifying investor directly      Delete this box and replace it with 
         or indirectly owning at least 20% of the qualify-    the 2D barcode. 
54       ing pass-through entity  ................................................ 5.        888888888 00                          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.
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63                                                                                                           2017 IT 1140 – page  2of 6
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6                                                               2017 Ohio IT 1140 
                              Rev. 8/17
7                                                       Pass-Through Entity and 
8                                                    Trust Withholding Tax Return                                                                            17170310 
   FEIN 
9  88 8888888 
10
11
12 Schedule B – Qualifying Pass-Through Entities – Tax Due...cont. 
13                                                                                                                             (A)                                                (B) 
14     6.If the qualifying pass-through entity is an S corporation, add all                                      Qualifying Investors Who Are             Qualifying Investors Other
15       qualifying investors’  distributive shares of compensation that the                                     Nonresident Individuals              Than Nonresident Individuals 
         qualifying pass-through entity S corporation made to any qualifying 
16       investor directly or indirectly owning at least 20% of the qualifying 
         pass-through entity. Reciprocity agreements do not apply. (See 
17       Note 3 on page 7.)  ................................................................................ 6.        888888888 00                               888888888 00 
18
19    7.Qualifying investors’ adjusted distributive shares. Add lines           
         3, 4, 5 and 6, but not less than -0-.....................................................  7.                  888888888 00                               888888888 00 
20
     8. Apportionment ratio from Schedule C, line 4, below............................8. 
21                                                                                                                                  8.888888                                                  8.888888 
22  
23  9. Qualifying investors’ adjusted qualifying amount: Line 7 times 
         line 8. Complete the remainder of this schedule only if the sum 
24       of columns A and B on line 9 exceeds $1,000   .....................................9.                          888888888 00                               888888888 00 
     10. Tax rate (see Note 4 on page 7)  ........................................................ 10. 
25                                                                                                                                        X .05                                                        X .085 
26
27 11.  Tax due: Line 9 times line 10. Round tax to the nearest dollar. Enter  
         the column A  amount on page 1, line 1, column I; enter the column 
28       B amount on page 1, line 1, column II .................................................. 11.                   888888888 00                               888888888 00 
29
30 Schedule C – Qualifying Pass-Through Entities – Apportionment Worksheet 
31 Usethisscheduletocalculatetheapportionmentratioforaqualifyingpass-throughentitythatisnotafinancialinstitutionasdefinedinOhioRevisedCode                                                                   
32 section(R.C.)5725.01.Ifthepass-throughentityisafinancialinstitution,refertotheinstructions.                                       Note: All ratios are to be carried to six decimal places. 
33  1.  Property                                                    Within Ohio                                                                       Total Everywhere 
34     a) Owned (average cost)                          88888888888 00                                                                          88888888888 00 
35                                                                  Within Ohio                                                                       Total     Everywhere                                 
                                                                                                                                                Weightisavariabledatafieldand
36     b) Rented (annual rental X 8)                    88888888888This field requires00                            a leading zero,             88888888888mustTotalincludeEverywherea leading00zero. See 
37                                                                  Withine.g. .000026Ohio           should be displayed                        88888888888schemaTotalforEverywhereaccepted characters.00
38     c) Total (lines 1a and 1b)                       88888888888as 0.000026.00                                                   ÷           88888888888Total Everywhere00 
39
40                                                                                                                    Ratio                    Weight              Weighted Ratio 
41                                                                         =                                     8. 888888               x =8.88                           8. 888888 
42                                                                  Within Ohio                                                                       Total Everywhere 
43  2.  Payroll                                         88888888888 00                                                              ÷           88888888888 00 
44                                                                                                                    Ratio                    Weight              Weighted Ratio 
45                                                                         =                                     8. 888888               x      This field requires   a leading zero,                      
                                                                                                                                           =Weight8.88e.g. .000026 shouldWeighted8.be888888displayedRatio
46                                                                  Within Ohio                                                             8.88 as 0.000026. Total Everywhere 8. 888888 
47  3.  Sales                                           88888888888 00                                                              ÷           88888888888 00 
48                                                                                                                    Ratio                    Weight              Weighted Ratio 
49  
                                                                                                                 8. 888888                     8.88                        8. 888888 
50                                                                         =                                                             x = 
51                                                                                                                                                                         Weighted Ratio 
52  4.  Total weighted apportionment ratio (add lines 1c, 22Dandbarcode3). Enteris aratiorequirement.here and on        line 8, above (both columns)....................4. 8. 888888 
53                                                          Delete this box and replace it with 
   Note:If the denominator of any factor is zero, the weightthe 2Dgivenbarcode.to the other factors must be proportionately increased so that the total weight given to the 
54 combined number of factors used is 100%, i.e., if no property/payroll, use 25% and 75%; if no sales, use 50% property/payroll; if only one factor, use 100%. 
55
56
57
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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 1140 
                           Rev. 8/17
7                                                        Pass-Through Entity and 
8                                                     Trust Withholding Tax Return                                                                                                                   17170410 
   FEIN 
9  88 8888888 
10
11                                                    Number of investors 
   Schedule D – Trusts – Tax Due 
12 Use this schedule   to calculate the adjusted NEW!qualifying Thesefieldsmaypossiblybeanegativevalue.included amountson  return and  withholding     tax  due for  nonresident individuals    who are beneficiaries of trusts   that  
                                           Include a “-“ sign here if this line has a negative value. 
13 made distributions of either income or gain attributable888888to the trust’s ownership of or disposition of either tangible personal property located in Ohio or real 
14 property located in Ohio. 
15
16  1. Sum  of all distributions to nonresident individuals of income or gain attributable to the trust’s 
17      ownership of or disposition of either tangible personal property located in Ohio or real property 
        located in Ohio ........................................................................................................................................ 1.                           - 888888888 00 
18
    
19 2a. Add    X2/3,    X  5/6 or      X6/6 (check applicable box) of I.R.C. section 168(k) depreciation                                                                    
20      expense and miscellaneous federal income tax adjustments attributed to nonresident individu-
        alswhoarebeneficiariesoftrusts.Includeaseparatescheduleshowing                                                                                             ...................... 2a.   888888888 00 
21  
22  2b. Other statutory adjustments and miscellaneous federal income tax adjustments attributed to 
        nonresidentindividualswhoarebeneficiariesof                           ......................................................................... 2b.                                     888888888 00 
23  
24  3. Adjusted qualifying amount: sum of lines 1 and 2a minus line 2b. Complete the remainder of 
        the worksheet only if line 3 exceeds $1,000  ........................................................................................... 3.                                           - 888888888 00 
25
26                                                                                                                                                                                                                 X .05
     4. Tax rate  ...................................................................................................................................................4. 
27  
28    5. Tax due: Line 3 times line 4. Round tax to the nearest dollar. Enter here and on page 1, line 1, 
        column I...................................................................................................................................................                       5.    888888888 00 
29
30 Schedule E – Investor Information 
31 Provide investor information forall (resident and nonresident) investorsValue isinthethenumericpass-throughequivalententity or trust. List investors by highest to lowest ownership percent-
32 age. Use an additional sheet, if necessary. See Note 5 on page 7offorthethepercentamountof ownershipof pass-throughand                                                  entity tax credits. 
33                                                                                          must include the leading zero, e.g. 
34   X    Check the box if the investor is included on the return.                          45.62% = 0.4562 

35 SSN                                      FEIN                                                                Percent of ownership                                                      Amount of PTE tax credit 
36
   888 88 8888                             88 8888888                                                            8.8888                                                                   888888888 00 
37 First name / entity                                                        M.I.              Last name 
38 JOHNXXXXXXXXXXX                                                            Q              PUBL I CXXXXXXXXXXXXXX 
39 Address 
40 8888 CHERRY              LANEXXXXXXXXXXXXXXXXXXX 
41 City                                                                                                         State                                                ZIP code 
42 CITYXXXXXXXXXXXXXXXX                                                                                   OH                                                         88888 
43
44   X    Check the box if the investor is included on the return. 
45        
46 SSN                                      FEIN                                                                Percent of ownership                                                      Amount of PTE tax credit 
47
   888 88 8888                             88 8888888                                                            8 . 8888                                                                 888888888 00 
48 First name / entity                                                        M.I.              Last name 
49
   JOHNXXXXXXXXXXX                                                            Q              PUBL I CXXXXXXXXXXXXXX 
50 Address 
51 8888 CHERRY LANEXXXXXXXXXXXXXXXXXXX 
                           
52 City                                                     2D barcode is a requirement.State                                                                        ZIP code 
53                                                          Delete this box and replace it with 
   CITYXXXXXXXXXXXXXXXX                                                                                OH                                                            88888 
54                                                          the 2D barcode. 
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.
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6                                                           2017 Ohio IT 1140 
                         Rev. 8/17
7                                                 Pass-Through Entity and 
8                                             Trust Withholding Tax Return                                             17170510 
   FEIN 
9  88 8888888 
10
11
   Schedule E – Investor Information...cont. 
12
13 Provide investor information for all  (resident and nonresident) investors in the pass-through entity or trust. List investors by highest to lowest ownership percent-
   age. Use an additional sheet, if necessary. See Note 5 on page 7 for the amount of pass-through entity tax credits. 
14
15
16 X    Check the box if the investor is included on the return. 

17 SSN                                   FEIN                                    Percent of ownership Amount of PTE tax credit 
18 888 88 8888                           88 8888888                              8 . 8888             888888888 00 
19 First name / entity                                           M.I.  Last name 
20 JOHNXXXXXXXXXXX                                               Q    PUBL I CXXXXXXXXXXXXXX 
21 Address 
22 8888 CHERRY LANEXXXXXXXXXXXXXXXXXXX 
                        
23 City                                                                          State       ZIP code 
24 CITYXXXXXXXXXXXXXXXX                                                      OH              88888 
25
26 X    Check the box if the investor is included on the return. 
27   
28 SSN                                   FEIN                                    Percent of ownership Amount of PTE tax credit 
29
   888 88 8888                           88 8888888                              8.8888               888888888 00 
30 First name / entity                                           M.I.  Last name 
31
   JOHNXXXXXXXXXXX                                               Q    PUBL I CXXXXXXXXXXXXXX 
32 Address 
                        
33 8888 CHERRY LANEXXXXXXXXXXXXXXXXXXX 
34 City                                                                          State       ZIP code 
35
   CITYXXXXXXXXXXXXXXXX                                                      OH              88888 
36
37
38 X    Check the box if the investor is included on the return. 

39 SSN                                   FEIN                                    Percent of ownership Amount of PTE tax credit 
40
   888 88 8888                           88 8888888                              8 . 8888             888888888 00 
41 First name / entity                                           M.I.  Last name 
42
43 JOHNXXXXXXXXXXX                                               Q  PUBL  I CXXXXXXXXXXXXXX 
                                                                  
   Address 
44
   8888 CHERRY            LANEXXXXXXXXXXXXXXXXXXX 
45
   City                                                                          State       ZIP code 
46
   CITYXXXXXXXXXXXXXXXX                                                      OH              88888 
47
48
49
50
51
52                                                       2D barcode is a requirement.  
53                                                       Delete this box and replace it with 
54                                                       the 2D barcode. 
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                                                                                           2017 IT 1140 – page  5of 6
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6                                                           2017 Ohio IT 1140 
                         Rev. 8/17
7                                                    Pass-Through Entity and 
8                                             Trust Withholding Tax Return                                             17170610 
   FEIN 
9  88 8888888 
10
11
   Schedule E – Investor Information...cont. 
12
13 Provide investor information for all  (resident and nonresident) investors in the pass-through entity or trust. List investors by highest to lowest ownership percent-
   age. Use an additional sheet, if necessary. See Note 5 on page 7 for the amount of pass-through entity tax credits. 
14
15
16 X    Check the box if the investor is included on the return. 

17 SSN                                   FEIN                                    Percent of ownership Amount of PTE tax credit 
18 888 88 8888                           88 8888888                              8 . 8888             888888888 00 
19 First name / entity                                           M.I.  Last name 
20 JOHNXXXXXXXXXXX                                               Q    PUBL I CXXXXXXXXXXXXXX 
21 Address 
22 8888 CHERRY LANEXXXXXXXXXXXXXXXXXXX 
                        
23 City                                                                          State       ZIP code 
24 CITYXXXXXXXXXXXXXXXX                                                      OH              88888 
25
26 X    Check the box if the investor is included on the return. 
27   
28 SSN                                   FEIN                                    Percent of ownership Amount of PTE tax credit 
29
   888 88 8888                           88 8888888                              8.8888               888888888 00 
30 First name / entity                                           M.I.  Last name 
31
   JOHNXXXXXXXXXXX                                               Q    PUBL I CXXXXXXXXXXXXXX 
32 Address 
                        
33 8888 CHERRY LANEXXXXXXXXXXXXXXXXXXX 
34 City                                                                          State       ZIP code 
35
   CITYXXXXXXXXXXXXXXXX                                                      OH              88888 
36
37
38 X    Check the box if the investor is included on the return. 

39 SSN                                   FEIN                                    Percent of ownership Amount of PTE tax credit 
40
   888 88 8888                           88 8888888                              8 . 8888             888888888 00 
41 First name / entity                                           M.I.  Last name 
42
43 JOHNXXXXXXXXXXX                                               Q  PUBL  I CXXXXXXXXXXXXXX 
                                                                  
   Address 
44
   8888 CHERRY            LANEXXXXXXXXXXXXXXXXXXX 
45
   City                                                                          State       ZIP code 
46
   CITYXXXXXXXXXXXXXXXX                                                      OH              88888 
47
48
49
50
51
52                                                       2D barcode is a requirement.  
53                                                       Delete this box and replace it with 
54                                                       the 2D barcode. 
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                                                                                           2017 IT 1140 – page  6of 6
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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 1140 
7                                                       Rev. 8/17                      Pass-Through Entity and 
8                                                                               Trust Withholding Tax Return                                                                            17170110
                                 88 88 88 
9                                                                                        Use only black ink and UPPERCASE letters. 
10                                                                 Check here if amended return                       X    Check here if final return                                   For taxable year beginning in 
                                                                X 
                                                                       X 
11                                                                           Check here if the federal extension was granted                                                                    88 / 2017 
12                               FEIN 
13                                                                                     Entity Type:                     S corporation              X     Partnership 
                                 88 8888888                                            (check only one)               X 
14                                                                                                                    X Limited liability company  X     Trust 
15                               Name of pass-through entity 
16                               JOHNXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 
17
18                               Address (if address change, check box)         X 
19                               8888   CHERRY  LANEXXXXXXXXXXXXXXXXXXX 
20                               City                                                                                      State         ZIP code 
22                               CITYXXXXXXXXXXXXXXXX                                                                                    
21                                                                                                                         OH            88888 
23                               Foreign State Code             Country Code           Foreign country (if the mailing address is outside the U.S.)                                     Foreign postal code 
24
                                            888                    88                88888888888888888888                                                                               8888888 
25
                                                                   Number of investors                           Ownership percentage 
26                               Total number of investors         included on return                            of investors on return  Apportionment ratio, page 3, line 8
27
                                 888888                            888888                                       8 . 8888                8 . 888888 
28
29
30
31                               Schedule A – Reconciliation Tax and Payments 
32                                                                                                               Column (I) – Withholding Tax                                           Column (II) – Entity Tax 
33                                   1.Tax for each column (from Schedule B, line 11,           
34                                     columns A and B or from Schedule D, line 5)  .............. 1.                      888888888 00                                               888888888 00 
35                                2. Interest   penalty on underpayment of estimated tax 
36  Do not staple or paper clip.       (include Ohio IT/SD 2210) ........................................... 2.            888888888 00                                               888888888 00 
37                                 2a. Add lines 1 and 2 ...................................................... 2a.        888888888 00                                               888888888 00 
38                                 3. Ohio IT 1140ES and UPC payments the entity or trust 
39                                     made and/or 2016 overpayment credited to 2017 (see  
40                                     Note 1 on page 7)  ........................................................ 3.      888888888 00                                               888888888 00 
41                                 3a. Payments transferred from Ohio IT 4708ES and UPC 
42                                     (include schedule if required; see IT  1140 instructions)  
43                                     and other payments previously made for this taxable year ..... 3a.                  888888888 00 
44                                3b.  Payments transferred to Ohio IT 4708 and refunds, 
45                                     if any, previously claimed for this taxable year ............ 3b.                   888888888 00 
46                                3c.  Net payments (sum of lines 3 and 3a minus line 3b) 
47                                     not less than zero ...................................................... 3c.       888888888 00                                               8888888888888888880000 
48                                  4. For each column, subtract line 3c from line 2a ..............4.                -    888888888 00                     -                         888888888 00 
49                                   5.  If the sum of line 4, columns (I) and (II) is an overpayment, enter that sum here..........     YOUR REFUND5.                               888888888 00 
50                                6. If     the sum of line 4, columns (I) and (II) is a balance due or zero, enter here............................................6.                888888888 00 
51                                     Interestandpenaltydueonlate-paidtaxand/orlate-filedreturn,ifany                      .......................................................7. 888888888 00 
52                                 8. Total amount due (add lines 6 and 7). Make check payable to Ohio Treasurer of State. 
53                                    Include Ohio  UPC and place FEIN on check.................................................................. AMOUNT DUE8.                       888888888 00 
54
55                                               If your refund is $1.00 or less, no refund will be issued. If you owe $1.00 or less, no payment is necessary. 
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
63                                                                                                                                                 2017 IT 1140 – page  1of 6
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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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5
6                                                                 2017 Ohio IT 1140 
7                               Rev. 8/17                    Pass-Through Entity and 
8                                                      Trust Withholding Tax Return                                               17170210 
   FEIN 
9  88 8888888 
10

11 Sign Here (required): I have read this return. Under penalties of perjury, I declare that, to                             Do not staple or paper clip. 
12 the best of my knowledge and belief, the return and all enclosures are true, correct and complete.                                                  
13                                                                                                                   Place any supporting documents, including  
                                                                                                                     Ohio IT K-1’s, after the last page of this return. 
14
15 Pass-throughentityofficeroragent(print)       
16                                                                                                                                Mail to: 
17 Titleofofficeroragent                                     Phonenumber                   
                                                                                                                          Ohio Dept. of Taxation 
18                                                           Date(MM/DD/YY)                                                  P.O. Box 181140 
   Signatureofpass-throughofficeror
19
                                                                                                                          Columbus, OH 43218-1140 
20 Preparer’s name (print)                                   Phone number 
21
22 Preparer’s e-mail address                                 PTIN                                                         Instructions for this form are on our 
                                                                                                                             website at tax.ohio.gov. 
23 Do you authorize your preparer to contact us regarding this return?  Yes                 X No  X                                                  
24                                                                                                  
25 Schedule B – Qualifying Pass-Through Entities – Tax Due 
26 Use this schedule to calculate the adjusted qualifying amounts and tax due for all qualifying investors in qualifying pass-through entities. Include federal K-1(s)  
   and a listing of pass-through credits of participating investors. See “Special Notes” in the instructions, which are available on our website at tax.ohio.gov. 
27
28                                                                                            (A)                                       (B) 
29                                                                                      Qualifying Investors Who Are         Qualifying Investors Other 
                                                                                        Nonresident Individuals              Than Nonresident Individuals 
30
       1.Sum of all qualifying investors’ distributive       
31   shares of income, gain, expenses and losses  ............. 1.                      -  888888888 00                   -  888888888 00 
32  2a.  Add X  2/3,   X5/6 or X 6/6 (check applicable 
33       box) of the qualifying investors’ distributive 
         shares of Internal Revenue Code (I.R.C.) 
34       sections 168(k) and 179 depreciation expense 
35       and miscellaneous federal income tax adjust-
         ments, if any.  Include a separate schedule 
36       showing calculations  ................................................. 2a.       888888888 00                      888888888 00 
37  2b.  Subtract qualifying investors’    distributive shares 
         of other statutory adjustments and miscella-
38       neous federal income tax adjustments, if any .............2b.                     888888888 00                      888888888 00 
39  3. Qualifying investors’ distributive shares of ad-
         justed qualifying amount: Sum of lines 1 and 
40       2a minus line 2b ...........................................................3. -  888888888 00                   -  888888888 00 
41   4. Add all qualifying investors’ distributive shares 
42       of expenses and losses incurred in connection 
         with all direct and indirect transactions between  
43       the qualifying pass-through entity and its related 
44       members, including certain investors’ family 
         members (see Note 2 on page 7). However, do  
45       not add expenses or losses incurred in connec-
46       tion with sales of inventory to the extent that the 
47       cost of the inventory and the loss incurred were 
         calculated in accordance with I.R.C. sections  
48       263A and 482 (see Note 3 on page 7)  ......................... 4.              -  888888888 00                   -  888888888 00 
49   5. If the qualifying pass-through entity is either 
50       a partnership or a limited liability company 
51       treated as a partnership,  add all qualifying 
         investors’ distributive shares of guaranteed        
52       payments that the qualifying pass-through 
53       entity made to any qualifying investor directly 
         or indirectly owning at least 20% of the qualify-
54       ing pass-through entity  ................................................ 5.      888888888 00                      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
63                                                                                                                   2017 IT 1140 – page  2of 6
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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 1140 
7                             Rev. 8/17                 Pass-Through Entity and 
8                                                    Trust Withholding Tax Return                                                                        17170310 
   FEIN 
9  88 8888888 
10
11
12 Schedule B – Qualifying Pass-Through Entities – Tax Due...cont. 
13                                                                                                                          (A)                                     (B) 
14     6.If the qualifying pass-through entity is an S corporation, add all                                      Qualifying Investors Who Are         Qualifying Investors Other
15       qualifying investors’  distributive shares of compensation that the                                     Nonresident Individuals          Than Nonresident Individuals 
         qualifying pass-through entity S corporation made to any qualifying 
16       investor directly or indirectly owning at least 20% of the qualifying 
         pass-through entity. Reciprocity agreements do not apply. (See 
17       Note 3 on page 7.)  ................................................................................ 6.      888888888 00                          888888888 00 
18
19    7.Qualifying investors’ adjusted distributive shares. Add lines          
         3, 4, 5 and 6, but not less than -0-.....................................................  7.                888888888 00                          888888888 00 
20
     8. Apportionment ratio from Schedule C, line 4, below............................8. 
21                                                                                                                             8.888888                                8.888888 
22  
23  9. Qualifying investors’ adjusted qualifying amount: Line 7 times 
         line 8. Complete the remainder of this schedule only if the sum 
24       of columns A and B on line 9 exceeds $1,000   .....................................9.                        888888888 00                          888888888 00 
     10. Tax rate (see Note 4 on page 7)  ........................................................ 10. 
25                                                                                                                                    X .05                                 X .085 
26
27 11.  Tax due: Line 9 times line 10. Round tax to the nearest dollar. Enter  
         the column A  amount on page 1, line 1, column I; enter the column 
28       B amount on page 1, line 1, column II .................................................. 11.                 888888888 00                          888888888 00 
29
30 Schedule C – Qualifying Pass-Through Entities – Apportionment Worksheet 
31 Usethisscheduletocalculatetheapportionmentratioforaqualifyingpass-throughentitythatisnotafinancialinstitutionasdefinedinOhioRevisedCode                                           
32 section(R.C.)5725.01.Ifthepass-throughentityisafinancialinstitution,refertotheinstructions.                                   Note: All ratios are to be carried to six decimal places. 
33  1.  Property                                                    Within Ohio                                                                   Total Everywhere 
34                                                                                                                                          88888888888 00 
       a) Owned (average cost)                          88888888888 00 
35                                                                  Within Ohio                                                                   Total Everywhere 
36     b) Rented (annual rental X 8)                    88888888888 00                                                                      88888888888 00 
37                                                                  Within Ohio                                                                   Total Everywhere 
38     c) Total (lines 1a and 1b)                       88888888888 00                                                      ÷               88888888888 00 
39
40                                                                                                                  Ratio                  Weight           Weighted Ratio 
41                                                                         =                                     8. 888888          x =8.88                 8. 888888 
42                                                                  Within Ohio                                                                   Total Everywhere 
43  2.  Payroll                                         88888888888 00                                                      ÷               88888888888 00 
44                                                                                                                  Ratio                  Weight           Weighted Ratio 
45  
                                                                           =                                     8. 888888          x =8.88                 8. 888888 
46                                                                  Within Ohio                                                                   Total Everywhere 
47                                                      88888888888 00                                                      ÷               88888888888 00 
    3.  Sales 
48                                                                                                                  Ratio                  Weight           Weighted Ratio 
49  
50                                                                         =                                     8. 888888             =8.88                8. 888888 
                                                                                                                                    x 
51                                                                                                                                                          Weighted Ratio 
52  4.  Total weighted apportionment ratio (add lines 1c, 2 and 3). Enter ratio here and on line 8, above (both columns)....................4.              8. 888888 
53
   Note: If the denominator of any factor is zero, the weight given to the other factors must be proportionately increased so that the total weight given to the 
54 combined number of factors used is 100%, i.e., if no property/payroll, use 25% and 75%; if no sales, use 50% property/payroll; if only one factor, use 100%. 
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
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6                                                              2017 Ohio IT 1140 
7                           Rev. 8/17                  Pass-Through Entity and 
8                                                 Trust Withholding Tax Return                                                                                                  17170410 
   FEIN 
9  88 8888888 
10
11
   Schedule D – Trusts – Tax Due 
12
   Use this schedule   to calculate the adjusted qualifying amounts  and withholding  tax  due for nonresident individuals                                                 who are beneficiaries of trusts   that  
13 made distributions of either income or gain attributable to the trust’s ownership of or disposition of either tangible personal property located in Ohio or real 
14 property located in Ohio. 
15
16  1. Sum  of all distributions to nonresident individuals of income or gain attributable to the trust’s 
17      ownership of or disposition of either tangible personal property located in Ohio or real property 
        located in Ohio ........................................................................................................................................ 1.      - 888888888 00 
18
    
19 2a. Add    X2/3,    X  5/6 or      X6/6 (check applicable box) of I.R.C. section 168(k) depreciation    
20      expense and miscellaneous federal income tax adjustments attributed to nonresident individu-
        alswhoarebeneficiariesoftrusts.Includeaseparatescheduleshowing                             ...................... 2a.                                              888888888 00 
21  
22   2b.  Other statutory adjustments and miscellaneous federal income tax adjustments attributed to 
        nonresidentindividualswhoarebeneficiariesof             ......................................................................... 2b.                              888888888 00 
23  
24  3. Adjusted  qualifying amount: sum of lines 1 and 2a minus line 2b. Complete the remainder of 
        the worksheet only if line 3 exceeds $1,000  ........................................................................................... 3.                      - 888888888 00 
25
26                                                                                                                                                                                  X .05
     4. Tax rate  ...................................................................................................................................................4. 
27  
28    5. Tax due: Line 3 times line 4. Round tax to the nearest dollar. Enter here and on page 1, line 1, 
        column I...................................................................................................................................................   5.   888888888 00 
29
30 Schedule E – Investor Information 
31 Provide investor information for all  (resident and nonresident) investors in the pass-through entity or trust. List investors by highest to lowest ownership percent-
32 age. Use an additional sheet, if necessary. See Note 5 on page 7 for the amount of pass-through entity tax credits. 
33
34   X    Check the box if the investor is included on the return. 

35 SSN                                      FEIN                                      Percent of ownership                                Amount of PTE tax credit 
36
   888 88 8888                             88 8888888                                 8.8888                                                                          888888888 00 
37 First name / entity                                              M.I. Last name 
38 JOHNXXXXXXXXXXX                                                  Q    PUBL I CXXXXXXXXXXXXXX 
39 Address 
40 8888 CHERRY               LANEXXXXXXXXXXXXXXXXXXX 
41 City                                                                               State        ZIP code 
42 CITYXXXXXXXXXXXXXXXX                                                               OH           88888 
43
44   X    Check the box if the investor is included on the return. 
45        
46 SSN                                      FEIN                                      Percent of ownership                                Amount of PTE tax credit 
47
   888 88 8888                             88 8888888                                 8.8888                                                                          888888888 00 
48 First name / entity                                              M.I. Last name 
49
   JOHNXXXXXXXXXXX                                                  Q    PUBL I CXXXXXXXXXXXXXX 
50 Address 
                           
51 8888 CHERRY LANEXXXXXXXXXXXXXXXXXXX 
52 City                                                                               State        ZIP code 
53
   CITYXXXXXXXXXXXXXXXX                                                               OH           88888 
54
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                                                                                                         2017 IT 1140 – page  4of 6
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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 1140 
7                        Rev. 8/17                Pass-Through Entity and 
8                                             Trust Withholding Tax Return                                             17170510 
   FEIN 
9  88 8888888 
10
11
   Schedule E – Investor Information...cont. 
12
13 Provide investor information for all  (resident and nonresident) investors in the pass-through entity or trust. List investors by highest to lowest ownership percent-
   age. Use an additional sheet, if necessary. See Note 5 on page 7 for the amount of pass-through entity tax credits. 
14
15
16 X    Check the box if the investor is included on the return. 

17 SSN                                   FEIN                                   Percent of ownership Amount of PTE tax credit 
18 888 88 8888                           88 8888888                             8 . 8888             888888888 00 
19 First name / entity                                           M.I. Last name 
20 JOHNXXXXXXXXXXX                                               Q    PUBL I CXXXXXXXXXXXXXX 
21 Address 
22 8888 CHERRY LANEXXXXXXXXXXXXXXXXXXX 
                        
23 City                                                                         State ZIP code 
24 CITYXXXXXXXXXXXXXXXX                                                      OH       88888 
25
26 X    Check the box if the investor is included on the return. 
27   
28 SSN                                   FEIN                                   Percent of ownership Amount of PTE tax credit 
29
   888 88 8888                           88 8888888                             8.8888               888888888 00 
30 First name / entity                                           M.I. Last name 
31
   JOHNXXXXXXXXXXX                                               Q    PUBL I CXXXXXXXXXXXXXX 
32 Address 
                        
33 8888 CHERRY LANEXXXXXXXXXXXXXXXXXXX 
34 City                                                                         State ZIP code 
35
   CITYXXXXXXXXXXXXXXXX                                                      OH       88888 
36
37
38 X    Check the box if the investor is included on the return. 

39 SSN                                   FEIN                                   Percent of ownership Amount of PTE tax credit 
40
   888 88 8888                           88 8888888                             8 . 8888             888888888 00 
41 First name / entity                                           M.I. Last name 
42
43 JOHNXXXXXXXXXXX                                               Q  PUBL  I CXXXXXXXXXXXXXX 
                                                                  
   Address 
44
   8888 CHERRY            LANEXXXXXXXXXXXXXXXXXXX 
45
   City                                                                         State ZIP code 
46
   CITYXXXXXXXXXXXXXXXX                                                      OH       88888 
47
48
49
50
51
52
53
54
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                                                                                       2017 IT 1140 – page  5of 6
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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 1140 
7                        Rev. 8/17                   Pass-Through Entity and 
8                                             Trust Withholding Tax Return                                             17170610 
   FEIN 
9  88 8888888 
10
11
   Schedule E – Investor Information...cont. 
12
13 Provide investor information for all  (resident and nonresident) investors in the pass-through entity or trust. List investors by highest to lowest ownership percent-
   age. Use an additional sheet, if necessary. See Note 5 on page 7 for the amount of pass-through entity tax credits. 
14
15
16 X    Check the box if the investor is included on the return. 

17 SSN                                   FEIN                                   Percent of ownership Amount of PTE tax credit 
18 888 88 8888                           88 8888888                             8 . 8888             888888888 00 
19 First name / entity                                           M.I. Last name 
20 JOHNXXXXXXXXXXX                                               Q    PUBL I CXXXXXXXXXXXXXX 
21 Address 
22 8888 CHERRY LANEXXXXXXXXXXXXXXXXXXX 
                        
23 City                                                                         State ZIP code 
24 CITYXXXXXXXXXXXXXXXX                                                      OH       88888 
25
26 X    Check the box if the investor is included on the return. 
27   
28 SSN                                   FEIN                                   Percent of ownership Amount of PTE tax credit 
29
   888 88 8888                           88 8888888                             8.8888               888888888 00 
30 First name / entity                                           M.I. Last name 
31
   JOHNXXXXXXXXXXX                                               Q    PUBL I CXXXXXXXXXXXXXX 
32 Address 
                        
33 8888 CHERRY LANEXXXXXXXXXXXXXXXXXXX 
34 City                                                                         State ZIP code 
35
   CITYXXXXXXXXXXXXXXXX                                                      OH       88888 
36
37
38 X    Check the box if the investor is included on the return. 

39 SSN                                   FEIN                                   Percent of ownership Amount of PTE tax credit 
40
   888 88 8888                           88 8888888                             8 . 8888             888888888 00 
41 First name / entity                                           M.I. Last name 
42
43 JOHNXXXXXXXXXXX                                               Q  PUBL  I CXXXXXXXXXXXXXX 
                                                                  
   Address 
44
   8888 CHERRY            LANEXXXXXXXXXXXXXXXXXXX 
45
   City                                                                         State ZIP code 
46
   CITYXXXXXXXXXXXXXXXX                                                      OH       88888 
47
48
49
50
51
52
53
54
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                                                                                       2017 IT 1140 – page  6of 6
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Layout 

without grid

                                 Do not staple or paper clip. 

                                                                                        2017 Ohio IT 1140 
                                                     Rev. 8/17                      Pass-Through Entity and 
                                                                             Trust Withholding Tax Return                                                                            17170110
                              88 88 88                                                Use only black ink and UPPERCASE letters. 
                                                             X  Check here if amended return                       X    Check here if final return                                   For taxable year beginning in 
                                                                    X     Check here if the federal extension was granted                                                                    88 / 2017 
                              FEIN 
                                                                                    Entity Type:                     S corporation              X     Partnership 
                              88 8888888                                            (check only one)               X 
                                                                                                                   X Limited liability company  X     Trust 
                              Name of pass-through entity 
                              JOHNXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 

                              Address (if address change, check box)         X 
                              8888   CHERRY  LANEXXXXXXXXXXXXXXXXXXX 
                              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 
                                         888                    88                88888888888888888888                                                                               8888888 
                                                                Number of investors                           Ownership percentage 
                              Total number of investors         included on return                            of investors on return  Apportionment ratio, page 3, line 8
                              888888                            888888                                       8 . 8888                8 . 888888 

                              Schedule A – Reconciliation Tax and Payments 
                                                                                                              Column (I) – Withholding Tax                                           Column (II) – Entity Tax 
                                  1.Tax for each column (from Schedule B, line 11,           
                                    columns A and B or from Schedule D, line 5)  .............. 1.                      888888888 00                                               888888888 00 
                               2. Interest   penalty on underpayment of estimated tax 
 Do not staple or paper clip.       (include Ohio IT/SD 2210) ........................................... 2.            888888888 00                                               888888888 00 
                                2a. Add lines 1 and 2 ...................................................... 2a.        888888888 00                                               888888888 00 
                                3. Ohio IT 1140ES and UPC payments the entity or trust 
                                    made and/or 2016 overpayment credited to 2017 (see  
                                    Note 1 on page 7)  ........................................................ 3.      888888888 00                                               888888888 00 
                                3a. Payments transferred from Ohio IT 4708ES and UPC 
                                    (include schedule if required; see IT  1140 instructions)  
                                    and other payments previously made for this taxable year ..... 3a.                  888888888 00 
                               3b.  Payments transferred to Ohio IT 4708 and refunds, 
                                    if any, previously claimed for this taxable year ............ 3b.                   888888888 00 
                               3c.  Net payments (sum of lines 3 and 3a minus line 3b) 
                                    not less than zero ...................................................... 3c.       888888888 00                                               8888888888888888880000 
                                 4. For each column, subtract line 3c from line 2a ..............4.                -    888888888 00                     -                         888888888 00 
                                  5.  If the sum of line 4, columns (I) and (II) is an overpayment, enter that sum here..........     YOUR REFUND5.                               888888888 00 
                               6. If     the sum of line 4, columns (I) and (II) is a balance due or zero, enter here............................................6.                888888888 00 
                                    Interestandpenaltydueonlate-paidtaxand/orlate-filedreturn,ifany                      .......................................................7. 888888888 00 
                                8. Total amount due (add lines 6 and 7). Make check payable to Ohio Treasurer of State. 
                                   Include Ohio  UPC and place FEIN on check.................................................................. AMOUNT DUE8.                       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. 

                                                                                                                                                      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 1140 – page  1of 6

                                                               2017 Ohio IT 1140 
                             Rev. 8/17                    Pass-Through Entity and 
                                                    Trust Withholding Tax Return                                               17170210 
FEIN 
88 8888888 

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. 
Pass-throughentityofficeroragent(print)       
Titleofofficeroragent                                     Phonenumber                                                          Mail to: 
                                                                                                                       Ohio Dept. of Taxation 
Signatureofpass-throughofficeror                          Date(MM/DD/YY)                                                  P.O. Box 181140 
                                                                                                                       Columbus, OH 43218-1140 
Preparer’s name (print)                                   Phone number 

Preparer’s e-mail address                                 PTIN                                                         Instructions for this form are on our 
                                                                                                                          website at tax.ohio.gov. 
Do you authorize your preparer to contact us regarding this return?  Yes                 X No  X                                                  
                                                                                                 
Schedule B – Qualifying Pass-Through Entities – Tax Due 
Use this schedule to calculate the adjusted qualifying amounts and tax due for all qualifying investors in qualifying pass-through entities. Include federal K-1(s)  
and a listing of pass-through credits of participating investors. See “Special Notes” in the instructions, which are available on our website at tax.ohio.gov. 
                                                                                           (A)                                       (B) 
                                                                                     Qualifying Investors Who Are         Qualifying Investors Other 
                                                                                     Nonresident Individuals              Than Nonresident Individuals 
    1.Sum of all qualifying investors’ distributive       
  shares of income, gain, expenses and losses  ............. 1.                      -  888888888 00                   -  888888888 00 
 2a.  Add X  2/3,   X5/6 or X 6/6 (check applicable 
      box) of the qualifying investors’ distributive 
      shares of Internal Revenue Code (I.R.C.) 
      sections 168(k) and 179 depreciation expense 
      and miscellaneous federal income tax adjust-
      ments, if any.  Include a separate schedule 
      showing calculations  ................................................. 2a.       888888888 00                      888888888 00 
 2b.  Subtract qualifying investors’    distributive shares 
      of other statutory adjustments and miscella-
      neous federal income tax adjustments, if any .............2b.                     888888888 00                      888888888 00 
 3. Qualifying investors’ distributive shares of ad-
      justed qualifying amount: Sum of lines 1 and 
      2a minus line 2b ...........................................................3. -  888888888 00                   -  888888888 00 
  4. Add all qualifying investors’ distributive shares 
      of expenses and losses incurred in connection 
      with all direct and indirect transactions between  
      the qualifying pass-through entity and its related 
      members, including certain investors’ family 
      members (see Note 2 on page 7). However, do  
      not add expenses or losses incurred in connec-
      tion with sales of inventory to the extent that the 
      cost of the inventory and the loss incurred were 
      calculated in accordance with I.R.C. sections  
      263A and 482 (see Note 3 on page 7)  ......................... 4.              -  888888888 00                   -  888888888 00 
  5. If the qualifying pass-through entity is either 
      a partnership or a limited liability company 
      treated as a partnership,  add all qualifying 
      investors’ distributive shares of guaranteed        
      payments that the qualifying pass-through 
      entity made to any qualifying investor directly 
      or indirectly owning at least 20% of the qualify-
      ing pass-through entity  ................................................ 5.      888888888 00                      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 1140 – page  2of 6

                                                             2017 Ohio IT 1140 
                           Rev. 8/17                   Pass-Through Entity and 
                                                  Trust Withholding Tax Return                                                                        17170310 
FEIN 
88 8888888 

Schedule B – Qualifying Pass-Through Entities – Tax Due...cont. 
                                                                                                                         (A)                                     (B) 
    6.If the qualifying pass-through entity is an S corporation, add all                                      Qualifying Investors Who Are         Qualifying Investors Other
      qualifying investors’  distributive shares of compensation that the                                     Nonresident Individuals          Than Nonresident Individuals 
      qualifying pass-through entity S corporation made to any qualifying 
      investor directly or indirectly owning at least 20% of the qualifying 
      pass-through entity. Reciprocity agreements do not apply. (See 
      Note 3 on page 7.)  ................................................................................ 6.      888888888 00                          888888888 00 
   7.Qualifying investors’ adjusted distributive shares. Add lines          
      3, 4, 5 and 6, but not less than -0-.....................................................  7.                888888888 00                          888888888 00 

  8. Apportionment      ratio from Schedule C, line 4, below............................8.                                  8.888888                                8.888888 
 
 9. Qualifying investors’ adjusted qualifying amount: Line 7 times 
      line 8. Complete the remainder of this schedule only if the sum 
      of columns A and B on line 9 exceeds $1,000   .....................................9.                        888888888 00                          888888888 00 
  10.    Tax rate (see Note 4 on page 7) ........................................................ 10.                              X .05                                 X .085 
11.  Tax due: Line 9 times line 10. Round tax to the nearest dollar. Enter  
      the column A  amount on page 1, line 1, column I; enter the column 
      B amount on page 1, line 1, column II .................................................. 11.                 888888888 00                          888888888 00 
Schedule C – Qualifying Pass-Through Entities – Apportionment Worksheet 
Usethisscheduletocalculatetheapportionmentratioforaqualifyingpass-throughentitythatisnotafinancialinstitutionasdefinedinOhioRevisedCode                                           
section(R.C.)5725.01.Ifthepass-throughentityisafinancialinstitution,refertotheinstructions.                                   Note: All ratios are to be carried to six decimal places. 
 1.  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 1a and 1b)                         88888888888 00                                                    ÷               88888888888 00 

                                                                                                                 Ratio                  Weight           Weighted Ratio 
                                                                        =                                     8. 888888          x =8.88                 8. 888888 
                                                                 Within Ohio                                                                   Total Everywhere 
 2.  Payroll                                           88888888888 00                                                    ÷               88888888888 00 
                                                                                                                 Ratio                  Weight           Weighted Ratio 
 
                                                                        =                                     8. 888888          x =8.88                 8. 888888 
                                                                 Within Ohio                                                                   Total Everywhere 
 3.  Sales                                             88888888888 00                                                    ÷               88888888888 00 
                                                                                                                 Ratio                  Weight           Weighted Ratio 
 
                                                                        =                                     8. 888888             =8.88                8. 888888 
                                                                                                                                 x 
                                                                                                                                                         Weighted Ratio 
 4.  Total weighted apportionment ratio (add lines 1c, 2 and 3). Enter ratio here and on line 8, above (both columns)....................4.              8. 888888 
Note: If the denominator of any factor is zero, the weight given to the other factors must be proportionately increased so that the total weight given to the 
combined number of factors used is 100%, i.e., if no property/payroll, use 25% and 75%; if no sales, use 50% property/payroll; if only one factor, use 100%. 

                   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 1140 – page  3of 6

                                                            2017 Ohio IT 1140 
                        Rev. 8/17                  Pass-Through Entity and 
                                               Trust Withholding Tax Return                                                                                                  17170410 
FEIN 
88 8888888 

Schedule D – Trusts – Tax Due 
Use this schedule   to calculate the adjusted qualifying amounts and  withholding tax   due for nonresident individuals                                                 who are beneficiaries of trusts   that  
made distributions of either income or gain attributable to the trust’s ownership of or disposition of either tangible personal property located in Ohio or real 
property located in Ohio. 
 1. Sum  of all distributions to nonresident individuals of income or gain attributable to the trust’s 
     ownership of or disposition of either tangible personal property located in Ohio or real property 
     located in Ohio ........................................................................................................................................ 1.      - 888888888 00 
 
2a. Add    2/3,    5/6 or          6/6 (check applicable box) of I.R.C. section 168(k) depreciation     
         X       X               X 
     expense and miscellaneous federal income tax adjustments attributed to nonresident individu-
     alswhoarebeneficiariesoftrusts.Includeaseparatescheduleshowing                             ...................... 2a.                                              888888888 00 
 
  2b. Other statutory adjustments and miscellaneous federal income tax adjustments attributed to 
     nonresidentindividualswhoarebeneficiariesof             ......................................................................... 2b.                              888888888 00 
 
 3. Adjusted qualifying amount: sum of lines 1 and 2a minus line 2b. Complete the remainder of 
     the worksheet only if line 3 exceeds $1,000  ........................................................................................... 3.                      - 888888888 00 

  4. Tax rate  ...................................................................................................................................................4.             X .05
 
   5. Tax due: Line 3 times line 4. Round tax to the nearest dollar. Enter here and on page 1, line 1, 
     column I...................................................................................................................................................   5.   888888888 00 

Schedule E – Investor Information 
Provide investor information for all  (resident and nonresident) investors in the pass-through entity or trust. List investors by highest to lowest ownership percent-
age. Use an additional sheet, if necessary. See Note 5 on page 7 for the amount of pass-through entity tax credits. 
  X   Check the box if the investor is included on the return. 

SSN                                     FEIN                                      Percent of ownership                                 Amount of PTE tax credit 
888 88 8888                            88 8888888                                  8.8888                                                                          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 

  X   Check the box if the investor is included on the return. 

SSN                                     FEIN                                      Percent of ownership                                 Amount of PTE tax credit 
888 88 8888                            88 8888888                                  8.8888                                                                          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 1140 – page  4of 6

                                                      2017 Ohio IT 1140 
                      Rev. 8/17                Pass-Through Entity and 
                                           Trust Withholding Tax Return                                             17170510 
FEIN 
88 8888888 

Schedule E – Investor Information...cont. 
Provide investor information for all  (resident and nonresident) investors in the pass-through entity or trust. List investors by highest to lowest ownership percent-
age. Use an additional sheet, if necessary. See Note 5 on page 7 for the amount of pass-through entity tax credits. 

X    Check the box if the investor is included on the return. 

SSN                                   FEIN                                   Percent of ownership Amount of PTE tax credit 
888 88 8888                           88 8888888                             8 . 8888             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 

X    Check the box if the investor is included on the return. 

SSN                                   FEIN                                   Percent of ownership Amount of PTE tax credit 
888 88 8888                           88 8888888                             8.8888               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 

X    Check the box if the investor is included on the return. 

SSN                                   FEIN                                   Percent of ownership Amount of PTE tax credit 
888 88 8888                           88 8888888                             8 . 8888             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 1140 – page  5of 6

                                                      2017 Ohio IT 1140 
                      Rev. 8/17                   Pass-Through Entity and 
                                           Trust Withholding Tax Return                                             17170610 
FEIN 
88 8888888 

Schedule E – Investor Information...cont. 
Provide investor information for all  (resident and nonresident) investors in the pass-through entity or trust. List investors by highest to lowest ownership percent-
age. Use an additional sheet, if necessary. See Note 5 on page 7 for the amount of pass-through entity tax credits. 

X    Check the box if the investor is included on the return. 

SSN                                   FEIN                                   Percent of ownership Amount of PTE tax credit 
888 88 8888                           88 8888888                             8 . 8888             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 

X    Check the box if the investor is included on the return. 

SSN                                   FEIN                                   Percent of ownership Amount of PTE tax credit 
888 88 8888                           88 8888888                             8.8888               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 

X    Check the box if the investor is included on the return. 

SSN                                   FEIN                                   Percent of ownership Amount of PTE tax credit 
888 88 8888                           88 8888888                             8 . 8888             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 1140 – page  6of 6

General information 

regarding this form

        General Information (2017 Ohio IT 1140): 
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 1140. 

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 (171701XX - 171706XX). 

  17 = tax year 
  17 = Ohio IT 1140 
  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 mustinclude  a leading zero on ratio fields.For  example,ifthe      ratio is .000026,itshould      display as 0.000026. 

9)  The possible negative fields for this return are Schedule A: both columns of line 4; Schedule B: both columns 
of lines 1, 3 and 4 and Schedule D, lines 1 and 3. 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 cor-
rections 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 1140

                     Important Note 

It is required  that vendors program the Ohio IT1140 to include 2D barcodes. 

                                   2017 Ohio IT  1140  

 Pass-Through Entity and Trust Withholding Tax Return 

                           2D Barcode Instructions  
 
 General Information 
    •  The Ohio   IT 1140 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                     1717<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 1140 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_1140 
 •  Submissions must include 
    •    Ohio form STF- Approval Request for Scannable Tax Forms 
    •    One (1) full field sample     in a PDF format 
    •    Six (6) test scenarios for the Ohio IT 1140 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_1140_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 1140     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.