Rev. 11/03/17

Scan Specifications for the 

        2017 Ohio IT 1040

                         Important Note

   The following document (2017 IT 1040) contains grids for placement 
   of information on this specific tax form. To accurately print, do not re-
   duce 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 IT 1040 test samples must be completed and submitted 
   for approval no later than Dec.22, 2017. 

       Ohio Department of Taxation

                                  4485 Northland Ridge Blvd.

                                  Columbus, OH 43229

                                  tax.ohio.gov

Grid layout 

with notations

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3
4                                                          Do not staple or paper clip.
5                                                                     The date the return was generated 
6                                                                     by the taxpayer (MM DD YY).                                    2017 Ohio IT 1040 
7                                                                           Rev. 9/17                       Individual Income Tax Return
8                                                                                                                                                                                                                                                    17000110                       1
   88 88 88
9
                                                          X
10                                                             Check here if this is an amended return. Include the Ohio IT RE (do NOTPlacement of the 1D bar code and tax year is critical.  include a copy of the previously filed return). 
11                                                        X    Check here if this is a Net Operating Loss (NOL) carryback. Include OhioMakeSchedulesure to followIT NOL.the grid positions for layout. Do 
12                                                        Taxpayer's SSN (required)                                              If deceased Spouse’s SSNnot forget(if filingtojointly)get your bar code(s)Ifassignmentsdeceased                     forEnter school district # for 
13                                                                                                                                                     every form, version and page.                                                               this return (see instructions).
                                                          888 88 8888                                                                X       888 88 8888                                                                                    X
14                                                                                                                               check box                                                                                                 check box   SD#
                                                                                                                                                                                                                                                                      8888
15                                                        First name                                                                         M.I. Last name
16                                                                                                                                                        
                                                          JOHNXXXXXXXXXXX                                                                    Q    PUBL I CXXXXXXXXXXXXXX
17                                                        Spouse's first name (only if married filing jointly)                               M.I. Last name                                                                                NEW! This indicates the 
                                                                                                                                                                                                                                           sequence number.
18                                                                                                                                                        
                                                          JANEXXXXXXXXXXX                                                                    Q    PUBL I CXXXXXXXXXXXXXX
19                                                        Address line 1 (number and street) or P.O. Box
20
                                                          8888  CHERRY    LANEXXXXXXXXXXXXXXXXXXX
21                                                        Address line 2 (apartment number, suite number, etc.)
22
                                                          8888  CHERRY    LANEXXXXXXXXXXXXXXXXXXX
23                                                        City                                                                                           State                 ZIP code                                                     Ohio county (first four letters)
24
                                                          CITYXXXXXXXXXXXXXXXX                                                                           OH                    88888                                                        FRAN
25                                                        Foreign country (if the mailing address is outside the U.S.)                                   Foreign postal code
26
                                                          JAPANXXXXXXXXXXXXXXX                                                                                                 8888888
27                                                                                                  NEW! These fields may possibly be a negative value. 
28                                                         Ohio Residency Status–IncludeCheck applicablea “-“ sign hereboxif this line has a negative value.Filing Status– Check one (as reported on federal income tax return)

29                                                        X    Full-year     X      Part-year               X               Nonresident         XX         X         Single, head of household or qualifying widow(er)
30                                                             resident             resident                                Indicate state                             Married filing jointly
                                                                                                                                                             X
31                                                         Check applicable box for spouse (only if married filing jointly)
                                                                                                                            Nonresident                      X         Married filing separately
                                                               Full-year            Part-year 
32                                                        X    resident      X      resident                X               Indicate state      XX
33                                                                                                                                                                     Check here if you filed the federal extension 4868.
                                                                                                                                                             X
34                                                        Ohio Political Party Fund                                                                                                                                                         Do not place spaces between 
                                                                                                                                                             X         Check here if someone else is able to claim you (or your spouse if 
                                                                                                                                                                                                                                            whole dollar numbers. There 
35                                                        X    Check here if you want $1 to go to this fund.                                                           joint return) as a dependent.is only a space between dollar 
36                                                        X    Check here if your spouse wants $1 to go to this fund (if filing jointly).                                                                                                   amounts and cents fields.
37                                                         Note: Checking this box will not increase your tax or decrease your refund.
38
39                                                         1. Federal adjusted gross income (from the federal 1040, line 37; 1040A, line 21; 
                                                             1040EZ, line 4; 1040NR, line 36; or 1040NR-EZ, line 10). Include page 1 of your 
40                                                           federal return if the amount is zero or negative. Place a “-” in box at the right if negative. ..............1.                                                               -
                                                                                                                                                                                                                                               88888888888 00
41                                                                                                                          NEW! For static text use Arial font (black ink) and 
                             Do not staple or paper clip.                                                                   try to match size. For data entry fields (shown in 
42                                                         2a. Additions – Ohio Schedule A, line 10 (includered forschedule)identification...............................................................2a.purposes only), use Arial font     88888888888 00
43                                                                                                                          (black ink). All the data entry fields must follow 
44                                                                                                                          grid layout. Never hard code a negative sign, and 
                                                          2b. Deductions – Ohio Schedule A, line 35 (include schedule)............................................................2b.                                                          88888888888 00
45                                                                                                                          do not include the negative sign with the amounts. 
                                                                                                                            This is now a separate field.
46                                                         3. Ohio adjusted gross income (line 1 plus line 2a minus line 2b)........................................................ 3.                                                    -
                                                                                                                                                                                                                                               88888888888 00
47                                                          4. Exemption amount (if claiming dependent(s), include Schedule J) .................................................4.
                                                                                                                                                                                                                                                                      88888 00
48                                                               Number of exemptions claimed on your federal return:                        XX
49                                                          
                                                            5. Ohio income tax base (line 3 minus line 4; if less than zero, enter zero) .........................................5.                                                           88888888888 00
50
                                                            
51                                                          6. Taxable business income – Ohio Schedule IT BUS, line 13 (include schedule) ..............................6.
                                                                                                                                                                                                                                                888888888 00
52                                                                          2D barcode required. Delete this 
53                                                          7. Line 5 minus linebox6with(if lesstextthanand replacezero, enterit withzero) ............................................................................7.                      88888888888 00
54                                                                          the 2D barcode.
55
56
57                                                                                                                                                                                                                                             Target marks or registration marks 
                                                                                                                                                                                                                                               must measure 6 mm X 6 mm. The 
58                                                                                                                                                                                                                                             four target marks or registration 
59                                                                      Software vendors: Place 2D barcode in this location                                                                                                                    marks on every page must follow 
                                                                         Do not place a box around the 2D barcode. The box                                                                                                                     grid layout.
60                                                                                                                                                                                                                                          //       //
                                                                                    is only here for placement purposes.
61                                                                                                                                                                                                                                         Postmark datePostmark date CodeCode
62
63
64                                                                                                                                                                                         2017 IT 1040 – page 1 of 2
65
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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 1040 
7                       Rev. 9/17             Individual Income Tax Return                                                                                                                                               2
8   SSN    888 88 8888                                                                                                                                                                         17000210
9     7a. Amount from line 7 on page 1 ........................................................................................................7a.                                             88888888888 00
10    8a. Nonbusiness income tax liability on line 7a (see instructions for tax tables)...............................................8a.                                                             888888888 00
11   8b. Business income tax liability – Ohio Schedule IT BUS, line 14 (include schedule) ....................................8b.                                                                     8888888 00
12
     8c. Income tax liability before credits (line 8a plus line 8b) ..............................................................................8c.                                                 888888888 00
13
14   9. Ohio nonrefundable credits – Ohio Schedule of Credits, line 33 (include schedule) ....................................9.
                                                                                                                                                                                                      888888888 00
15    10. Tax liability after nonrefundable credits (line 8c minus line 9; if less than zero, enter zero)........................10. 
                                                                                                                                                                                                      888888888 00
                                                                                                                                                                                                      888888888 00
16    11. Interest penalty on underpayment of estimated tax (include Ohio IT/SD 2210)..........................................11.
17                                                                                                                                                 NEW! This indicates the 
     12. Use tax due on Internet, mail order or other out-of-state purchases (see instructions).                                                   sequence number.
18     Check here to certify that no use tax is due ....................................................................................           ....12.
                                                                                                                                         X                                                            888888888 00
19
     13. Total Ohio tax liability before withholding or estimated payments (add lines 10, 11 and 12) ...................13.                                                                           888888888 00
20
     14. Ohio income tax withheld (W-2, box 17; W-2G, box 15; 1099-R, box 12). Include W-2(s), W-2G(s) 
21     and 1099-R(s) with the return .....................................................................................................................14.
                                                                                                                                                                                                      888888888 00
22
     15. Estimated (2017 Ohio IT 1040ES) and extension (2017 Ohio IT 40P) payments and credit
23     carryforward from previous year return .......................................................................................................15.
                                                                                                                                                                                                      888888888 00
24
25   16. Refundable credits – Ohio Schedule of Credits, line 40 (include schedule) ...............................................16.
                                                                                                                                                                                                      888888888 00
26   17. Amended return only – amount previously paid with original and/or amended return .............................17.
                                                                                                                                                                                                      888888888 00
27
                                              NEW! This field may possibly be a negative value. 
28   18. Total Ohio tax payments (add linesInclude14, 15,a16“-“andsign17)here............................................................................18.if this line has a negative value.
                                                                                                                                                                                                      888888888 00
29   19. Amended return only – overpayment previously requested on original and/or amended return ..............19.
                                                                                                                                                                                                      888888888 00
30
31   20. Line 18 minus line 19.....................................................................................................................................20.                        -
                                                                                                                                                                                                      888888888 00
32   
33                If line 20 is MORE THAN line 13, skip to line 24. OTHERWISE, continue to line 21.
34
35
36   21. Tax liability (line 13 minus line 20). If line 20 is negative, ignore the "-" and add line 20 to line 13 .............21.
                                                                                                                                                                                                      888888888 00
                                                                                                                                                                                                      888888888 00
37    22. Interest and penalty due on late filing or late payment of tax (see instructions) ..............................................................22.
38
    23. Total amount due (line 21 plus line 22). Include Ohio IT 40P (if original return) or IT 40XP (if    
39       amended return) and make check payable to “Ohio Treasurer of State” ........... AMOUNT DUE23.
                                                                                                                                                                                                      888888888 00
40
41    24. Overpayment (line 20 minus line 13) ..........................................................................................................24.
                                                                                                                                                                                                      888888888 00
42    25.Original return only – amount of line 24 to be credited toward 2018 income tax liability ............................25.
                                                                                                                                                                                                      888888888 00
43  26. Original return only – amount of line 24 to be donated:
44        a. Wishes for Sick Children  b. Wildlife species                      c. Military injury relief
45
           8888 00                          8888 00                                  8888 00
46    
          d. Ohio History Fund        e. State nature preserves                 f. Breast / cervical cancer
47
48                                                                                                                Total ....26g.
           8888 00                          8888 00                                  8888 00                                                                                                          888888888 00
49
50   27. REFUND (line 24 minus lines 25 and 26g) .................................................................YOUR  REFUND27.
                                                                                                                                                                                                      888888888 00
51
52
   Sign Here (required): I have read this return. Under penalties of perjury, I declare that, to the best of my knowledge                          If your refund is $1.00 or less, no refund will be issued. 
53 and belief, the return and all enclosures are true, correct and complete.                                                                       If you owe $1.00 or less, no payment is necessary.
54
    Your signature  Date (MM/DD/YY)
55                                                                                                                                                NO Payment Included  –Mail to:
                                                                                                                                                                                              Ohio Department of Taxation
56 Spouse’s signature                                                               Phone number                                                                                              P.O. Box 2679
57                                                                                                                                                                                            Columbus, OH  43270-2679
58  XCheck here to authorize your preparer to discuss this  return with Taxation           
                                                                                                                                                                                              Payment Included  –Mail to:
59 Preparer's printed name                                                                                                                                                                    Ohio Department of Taxation
60 Phone number                                         Preparer's TIN (PTIN)                                                                                                                  P.O. Box 2057
                                                                                     PXXXXXXXX                                                                                                Columbus, OH  43270-2057
61
62
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64                                                                                                                2017 IT 1040 – page 2 of 2
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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 1040 
7                                                                         Rev. 9/17         Individual Income Tax Return
8                                                                                                                                                                                                             17000110                      1
   88 88 88
9
10                                                             Check here if this is an amended return. Include the Ohio IT RE (do NOT include a copy of the previously filed return). 
                                                          X
11                                                        X    Check here if this is a Net Operating Loss (NOL) carryback. Include Ohio Schedule IT NOL.
12                                                        Taxpayer's SSN (required)                     If deceased        Spouse’s SSN (if filing jointly)                                       If deceased   Enter school district # for 
13                                                                                                                                                                                                          this return (see instructions).
                                                          888 88 8888                                          X           888 88 8888                                                             X
14                                                                                                        check box                                                                               check box     SD#
                                                                                                                                                                                                                             8888
15                                                        First name                                                   M.I. Last name
16                                                                                                                                     
                                                          JOHNXXXXXXXXXXX                                              Q    PUBL I CXXXXXXXXXXXXXX
17                                                        Spouse's first name (only if married filing jointly)         M.I. Last name
18                                                                                                                                     
                                                          JANEXXXXXXXXXXX                                              Q    PUBL I CXXXXXXXXXXXXXX
19                                                        Address line 1 (number and street) or P.O. Box
20
                                                          8888  CHERRY    LANEXXXXXXXXXXXXXXXXXXX
21                                                        Address line 2 (apartment number, suite number, etc.)
22
                                                          8888  CHERRY    LANEXXXXXXXXXXXXXXXXXXX
23                                                        City                                                                        State  ZIP code                                              Ohio county (first four letters)
24
                                                          CITYXXXXXXXXXXXXXXXX                                                        OH     88888                                                 FRAN
25                                                        Foreign country (if the mailing address is outside the U.S.)                Foreign postal code
26
                                                          JAPANXXXXXXXXXXXXXXX                                                               8888888
27
28                                                         Ohio Residency Status – Check applicable box                                 Filing Status – Check one (as reported on federal income tax return)
29                                                        X    Full-year     X    Part-year X        Nonresident          XX          X    Single, head of household or qualifying widow(er)
30                                                             resident           resident           Indicate state                          Married filing jointly
                                                                                                                                        X
31                                                         Check applicable box for spouse (only if married filing jointly)
                                                                                                     Nonresident                        X    Married filing separately
                                                               Full-year          Part-year 
32                                                        X    resident      X    resident  X        Indicate state       XX
33                                                                                                                                           Check here if you filed the federal extension 4868.
                                                                                                                                        X
34                                                        Ohio Political Party Fund
                                                                                                                                        X    Check here if someone else is able to claim you (or your spouse if 
35                                                        X Check here if you want $1 to go to this fund.                                    joint return) as a dependent.
36                                                        X Check here if your spouse wants $1 to go to this fund (if filing jointly).
37                                                         Note: Checking this box will not increase your tax or decrease your refund.
38
39                                                         1. Federal adjusted gross income (from the federal 1040, line 37; 1040A, line 21; 
                                                             1040EZ, line 4; 1040NR, line 36; or 1040NR-EZ, line 10). Include page 1 of your 
40                                                           federal return if the amount is zero or negative. Place a “-” in box at the right if negative. ..............1.                      -
                                                                                                                                                                                                      88888888888 00
41                                                          
                             Do not staple or paper clip. 
42                                                         2a. Additions – Ohio Schedule A, line 10 (include schedule) ...............................................................2a.             88888888888 00
43                                                          
44
                                                          2b. Deductions – Ohio Schedule A, line 35 (include schedule)............................................................2b.                 88888888888 00
45                                                          
46                                                         3. Ohio adjusted gross income (line 1 plus line 2a minus line 2b)........................................................ 3.           -
                                                                                                                                                                                                      88888888888 00
47                                                          4. Exemption amount (if claiming dependent(s), include Schedule J) .................................................4.
                                                                                                                                                                                                                             88888 00
48                                                               Number of exemptions claimed on your federal return:  XX
49                                                          
                                                            5. Ohio income tax base (line 3 minus line 4; if less than zero, enter zero) .........................................5.                  88888888888 00
50
                                                            
51                                                          6. Taxable business income – Ohio Schedule IT BUS, line 13 (include schedule) ..............................6.
                                                                                                                                                                                                      888888888 00
52
53                                                          7. Line 5 minus line 6 (if less than zero, enter zero) ............................................................................7.     88888888888 00
54
55
56
57
58
59                                                                      Software vendors: Place 2D barcode in this location
                                                                        Do not place a box around the 2D barcode. The box 
60                                                                                                                                                                                                 //         //
                                                                                  is only here for placement purposes.
61                                                                                                                                                                                                Postmark datePostmark date CodeCode
62
63
64                                                                                                                                                          2017 IT 1040 – page 1 of 2
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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 1040 
7                       Rev. 9/17              Individual Income Tax Return                                                                                                                          2
8   SSN    888 88 8888                                                                                                                                                  17000210
9     7a. Amount from line 7 on page 1 ........................................................................................................7a.                      88888888888 00
10    8a. Nonbusiness income tax liability on line 7a (see instructions for tax tables)...............................................8a.                                      888888888 00
11   8b. Business income tax liability – Ohio Schedule IT BUS, line 14 (include schedule) ....................................8b.                                              8888888 00
12
     8c. Income tax liability before credits (line 8a plus line 8b) ..............................................................................8c.                          888888888 00
13
14   9. Ohio nonrefundable credits – Ohio Schedule of Credits, line 33 (include schedule) ....................................9.
                                                                                                                                                                               888888888 00
15    10. Tax liability after nonrefundable credits (line 8c minus line 9; if less than zero, enter zero)........................10. 
                                                                                                                                                                               888888888 00
                                                                                                                                                                               888888888 00
16    11. Interest penalty on underpayment of estimated tax (include Ohio IT/SD 2210)..........................................11.
17
     12. Use tax due on Internet, mail order or other out-of-state purchases (see instructions). 
18     Check here to certify that no use tax is due ....................................................................................           ....12.
                                                                                                                                         X                                     888888888 00
19
     13. Total Ohio tax liability before withholding or estimated payments (add lines 10, 11 and 12) ...................13.                                                    888888888 00
20
     14. Ohio income tax withheld (W-2, box 17; W-2G, box 15; 1099-R, box 12). Include W-2(s), W-2G(s) 
21     and 1099-R(s) with the return .....................................................................................................................14.
                                                                                                                                                                               888888888 00
22
     15. Estimated (2017 Ohio IT 1040ES) and extension (2017 Ohio IT 40P) payments and credit
23     carryforward from previous year return .......................................................................................................15.
                                                                                                                                                                               888888888 00
24
25   16. Refundable credits – Ohio Schedule of Credits, line 40 (include schedule) ...............................................16.
                                                                                                                                                                               888888888 00
26   17. Amended return only – amount previously paid with original and/or amended return .............................17.
                                                                                                                                                                               888888888 00
27
28   18. Total Ohio tax payments (add lines 14, 15, 16 and 17) ............................................................................18.
                                                                                                                                                                               888888888 00
29   19. Amended return only – overpayment previously requested on original and/or amended return ..............19.
                                                                                                                                                                               888888888 00
30
31   20. Line 18 minus line 19.....................................................................................................................................20. -
                                                                                                                                                                               888888888 00
32   
33                If line 20 is MORE THAN line 13, skip to line 24. OTHERWISE, continue to line 21.
34
35
36   21. Tax liability (line 13 minus line 20). If line 20 is negative, ignore the "-" and add line 20 to line 13 .............21.
                                                                                                                                                                               888888888 00
                                                                                                                                                                               888888888 00
37    22. Interest and penalty due on late filing or late payment of tax (see instructions) ..............................................................22.
38
    23. Total amount due (line 21 plus line 22). Include Ohio IT 40P (if original return) or IT 40XP (if    
39       amended return) and make check payable to “Ohio Treasurer of State” ........... AMOUNT DUE23.
                                                                                                                                                                               888888888 00
40
41    24. Overpayment (line 20 minus line 13) ..........................................................................................................24.
                                                                                                                                                                               888888888 00
42    25.Original return only – amount of line 24 to be credited toward 2018 income tax liability ............................25.
                                                                                                                                                                               888888888 00
43  26. Original return only – amount of line 24 to be donated:
44        a. Wishes for Sick Children  b. Wildlife species                   c. Military injury relief
45
            8888 00                         8888 00                              8888 00
46    
          d. Ohio History Fund        e. State nature preserves              f. Breast / cervical cancer
47
48                                                                                                                Total ....26g.
            8888 00                         8888 00                              8888 00                                                                                       888888888 00
49
50   27. REFUND (line 24 minus lines 25 and 26g) .................................................................YOUR  REFUND27.
                                                                                                                                                                               888888888 00
51
52
   Sign Here (required): I have read this return. Under penalties of perjury, I declare that, to the best of my knowledge                          If your refund is $1.00 or less, no refund will be issued. 
53 and belief, the return and all enclosures are true, correct and complete.                                                                       If you owe $1.00 or less, no payment is necessary.
54
    Your signature  Date (MM/DD/YY)
55                                                                                                                                                NO Payment Included  –Mail to:
                                                                                                                                                                       Ohio Department of Taxation
56 Spouse’s signature                                                           Phone number                                                                           P.O. Box 2679
57                                                                                                                                                                     Columbus, OH  43270-2679
58  X Check here to authorize your preparer to discuss this  return with Taxation   
                                                                                                                                                                       Payment Included  –Mail to:
59 Preparer's printed name                                                                                                                                             Ohio Department of Taxation
60 Phone number                                          Preparer's TIN (PTIN)                                                                                          P.O. Box 2057
                                                                                 PXXXXXXXX                                                                             Columbus, OH  43270-2057
61
62
63
64                                                                                                                2017 IT 1040 – page 2 of 2
65
66

Layout 

without grid

                                                          Do not staple or paper clip.

                                                                                                               2017 Ohio IT 1040 
                                                                          Rev. 9/17             Individual Income Tax Return
                                                                                                                                                                                                             17000110                     1
88 88 88

                                                          X    Check here if this is an amended return. Include the Ohio IT RE (doNOT include a copy of the previously filed return). 
                                                          X    Check here if this is a Net Operating Loss (NOL) carryback. Include Ohio Schedule IT NOL.
                                                          Taxpayer's SSN (required)                     If deceased       Spouse’s SSN (if filing jointly)                                       If deceased  Enter school district # for 
                                                                                                                                                         
                                                          888 88 8888                                          X          888 88 8888                                                              X          this return (see instructions).
                                                                                                          check box                                                                              check box    SD#   8888
                                                          First name                                                   M.I. Last name
                                                          JOHNXXXXXXXXXXX                                              Q    PUBL I      CXXXXXXXXXXXXXX
                                                          Spouse's first name (only if married filing jointly)         M.I. Last name
                                                          JANEXXXXXXXXXXX                                              Q    PUBL I      CXXXXXXXXXXXXXX
                                                          Address line 1 (number and street) or P.O. Box
                                                          8888  CHERRY    LANEXXXXXXXXXXXXXXXXXXX
                                                          Address line 2 (apartment number, suite number, etc.)
                                                          8888  CHERRY    LANEXXXXXXXXXXXXXXXXXXX
                                                          City                                                                        State   ZIP code                                             Ohio county (first four letters)
                                                          CITYXXXXXXXXXXXXXXXX                                                        OH      88888                                                FRAN
                                                          Foreign country (if the mailing address is outside the U.S.)                Foreign postal code
                                                          JAPANXXXXXXXXXXXXXXX                                                                8888888
                                                          Ohio Residency Status – Check applicable box                                  Filing Status – Check one (as reported on federal income tax return)
                                                          X    Full-year     X    Part-year     X    Nonresident          XX          X    Single, head of household or qualifying widow(er)
                                                               resident           resident           Indicate state                     X    Married filing jointly
                                                          Check applicable box for spouse (only if married filing jointly)
                                                                                                     Nonresident                        X    Married filing separately
                                                               Full-year          Part-year 
                                                          X    resident      X    resident      X    Indicate state       XX
                                                                                                                                        X    Check here if you filed the federal extension 4868.
                                                          Ohio Political Party Fund
                                                                                                                                        X    Check here if someone else is able to claim you (or your spouse if 
                                                          X Check here if you want $1 to go to this fund.                                    joint return) as a dependent.
                                                          X Check here if your spouse wants $1 to go to this fund (if filing jointly).
                                                          Note: Checking this box will not increase your tax or decrease your refund.
                                                           1. Federal adjusted gross income (from the federal 1040, line 37; 1040A, line 21; 
                                                             1040EZ, line 4; 1040NR, line 36; or 1040NR-EZ, line 10). Include page 1 of your 
                                                             federal return if the amount is zero or negative. Place a “-” in box at the right if negative. ..............1.                     -   88888888888 00
                                                           
                             Do not staple or paper clip. 
                                                           2a. Additions – Ohio Schedule A, line 10 (include schedule) ...............................................................2a.            88888888888 00
                                                           
                                                          2b. Deductions – Ohio Schedule A, line 35 (include schedule)............................................................2b.                88888888888 00
                                                           
                                                           3. Ohio adjusted gross income (line 1 plus line 2a minus line 2b)........................................................ 3.          -   88888888888 00
                                                           4. Exemption amount (if claiming dependent(s), include Schedule J) .................................................4.                              88888 00
                                                                Number of exemptions claimed on your federal return:   XX
                                                           
                                                           5. Ohio income tax base (line 3 minus line 4; if less than zero, enter zero) .........................................5.                  88888888888 00
                                                           
                                                           6. Taxable business income – Ohio Schedule IT BUS, line 13 (include schedule) ..............................6.                            888888888 00

                                                           7. Line 5 minus line 6 (if less than zero, enter zero) ............................................................................7.     88888888888 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.
                                                                                                                                                                                                 Postmark date        Code

                                                                                                                                                           2017 IT 1040 – page 1 of 2

                                                          2017 Ohio IT 1040 
                     Rev. 9/17             Individual Income Tax Return                                                                                                                           2
 SSN     888 88 8888                                                                                                                                                  17000210
   7a. Amount from line 7 on page 1 ........................................................................................................7a.                       88888888888 00
   8a. Nonbusiness income tax liability on line 7a (see instructions for tax tables)...............................................8a.                                      888888888 00
  8b. Business income tax liability – Ohio Schedule IT BUS, line 14 (include schedule) ....................................8b.                                              8888888 00
  8c. Income tax liability before credits (line 8a plus line 8b) ..............................................................................8c.                          888888888 00

  9. Ohio nonrefundable credits – Ohio Schedule of Credits, line 33 (include schedule) ....................................9.                                               888888888 00
   10. Tax liability after nonrefundable credits (line 8c minus line 9; if less than zero, enter zero)........................10.                                           888888888 00
   11. Interest penalty on underpayment of estimated tax (include Ohio IT/SD 2210)..........................................11.                                             888888888 00
  12. Use tax due on Internet, mail order or other out-of-state purchases (see instructions). 
    Check here to certify that no use tax is due .................................................................................... X....12.                              888888888 00
  13. Total Ohio tax liability before withholding or estimated payments (add lines 10, 11 and 12) ...................13.                                                    888888888 00
  14. Ohio income tax withheld (W-2, box 17; W-2G, box 15; 1099-R, box 12). Include W-2(s), W-2G(s) 
    and 1099-R(s) with the return .....................................................................................................................14.                  888888888 00
  15. Estimated (2017 Ohio IT 1040ES) and extension (2017 Ohio IT 40P) payments and credit
    carryforward from previous year return .......................................................................................................15.                       888888888 00

  16. Refundable credits – Ohio Schedule of Credits, line 40 (include schedule) ...............................................16.                                          888888888 00
  17. Amended return only – amount previously paid with original and/or amended return .............................17.                                                     888888888 00

  18. Total Ohio tax payments (add lines 14, 15, 16 and 17) ............................................................................18.                                 888888888 00
  19. Amended return only – overpayment previously requested on original and/or amended return ..............19.                                                            888888888 00

  20. Line 18 minus line 19.....................................................................................................................................20. -       888888888 00
  
               If line 20 is MORE THAN line 13, skip to line 24. OTHERWISE, continue to line 21.

  21. Tax liability (line 13 minus line 20). If line 20 is negative, ignore the "-" and add line 20 to line 13 .............21.                                             888888888 00
   22. Interest and penalty due on late filing or late payment of tax (see instructions) ..............................................................22.                  888888888 00
 23. Total amount due (line 21 plus line 22). Include Ohio IT 40P (if original return) or IT 40XP (if    
      amended return) and make check payable to “Ohio Treasurer of State” ........... AMOUNT DUE23.                                                                        888888888 00

   24. Overpayment (line 20 minus line 13) ..........................................................................................................24.                    888888888 00
   25. Original return only – amount of line 24 to be credited toward 2018 income tax liability ............................25.                                             888888888 00
 26. Original return only – amount of line 24 to be donated:
        a. Wishes for Sick Children  b. Wildlife species                  c. Military injury relief

         8888 00                         8888 00                             8888 00
        d. Ohio History Fund       e. State nature preserves              f. Breast / cervical cancer

         8888 00                         8888 00                             8888 00                           Total ....26g.                                               888888888 00

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

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

                                                                                                               2017 IT 1040 – page 2 of 2

General information 

regarding this form

             General Information (2017 IT 1040):

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

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

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

2) 1D barcode - The last two numbers of the 1D barcode represent the vendor number. Use the same vendor 
number as you did for last year’s return. If you have a question about your barcode assignment, e-mail the Forms 
Unit at Forms@tax.state.oh.us. The first six numbers are constant for this form (170001XX - 170002XX). 

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

   NOTE: The vendor number also serves as the first two digits of the SSN 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) The possible negative fields for this return are lines 1, 3, and 20.  Do not hard-code negative signs. 

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

10) 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 documents generated from the software must in-
clude a 1D barcode identifying it as 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).

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

12) When the IT 1040 is filed as an amended return, please include the IT RE (Reason of Explanation and Cor-
rections). Make sure that any barcodes on this return represents your vendor number assignment. For example, 
if your last two digits of your 1D barcode are “05”, make sure that these are “05” also.

13) New! For all balance due returns, generate the proper payment voucher.  For an original return use the Ohio 
IT 40P and for an amended return use the Ohio IT 40XP.

14) 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.”

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

                                                      Rev. 11/03/17

Scan Specifications for the 

   2017 Ohio Schedule A

                   Important Note

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

   The 2017 Ohio Schedule A test samples must be completed and 
   submitted for approval no later than Dec.22, 2017. 

       Ohio Department of Taxation

                             4485 Northland Ridge Blvd.

                             Columbus, OH 43229

                             tax.ohio.gov

Grid layout 

with notations

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3
4                                Do not staple or paper clip. 
5                                            Thedatethereturnwasgenerated
6                                            bythetaxpayer(MMDDYY).          2017 Ohio Schedule A
7                                                 Rev. 8/17          Income Adjustments – Additions and Deductions
8                                                                                      SSNofprimaryfiler                                                                                                             17000310
   88 88 88
9                                                                                      888 88 8888                                                                                                                                                             3
10
11                                                                           Additions                      Placementofthe1Dbarcodeandtaxyeariscritical.
                                                                                                            Makesuretofollowthegridpositionsforlayout.Do
12                                             (add income items only to the extent not included on Ohio IT 1040, line 1)not forget to get your bar code(s) assignments for
                                                                                                            everyform,versionandpage.
13                                                                                                                                                                                                                   888888888 00
                                    1. Non-Ohio state or local government interest and dividends .....................................................................1.
14
15                                                                                                                                                                                                                   888888888 00
                                    Certain  Ohiopass-throughentityandfinancialinstitutionstaxespaid ......................................................2.
16                               
17                                  Reimbursement    ofcollegetuitionexpensesandfeesdeductedinanypreviousyear(s)and
                                    noneducation expendituresfromacollegesavingsaccount ....................................................................3.                                                                   888888 00
18
19                                                                                                                                                                                                                   888888888 00
                                    4. Losses from sale or disposition of Ohio public obligations .......................................................................4.
20                                                                           ForstatictextuseArialfont(blackink)andtryto
21                                                                           match size. For data entry fields (shown in red 
                                    5. Nonmedical withdrawals from a medical savingsforaccountidentification........................................................................5.purposes only), use Arial font 888888888 00
22                                                                           (black ink).All the data entry fields must follow
23                                  6. Reimbursement ofexpensespreviouslydeductedforOhioincometaxpurposes,butonlyifthegrid layout.
                                      reimbursement is not in federal adjusted gross income ............................................................................6.                                           888888888 00
24
25                                  Federal
26                                                                                                                                                                                                                   888888888 00
                                    Adjustment forInternalRevenueCodesections168(k)and179depreciationexpense ..........................7.
27
                                                                                                                                           NEW! Thisindicatesthe
                                    Federal  interestanddividendssubjecttostatetaxation ...........................................................................8.
28                                                                                                                                         sequence number.888888888 00
29
30                                                                                                                                                                                                                   888888888 00
                                    Miscellaneous federalincometaxadditions ............................................................................................. 9.
31
32                                                                                                                                                                                                                   88888888888 00
                                 10. Total additions (addlines1through9ONLY).EnterhereandonOhioIT1040,line2a) ........................10.
33
34
35                                                                           Deductions 
36                                             (deduct income items only to the extent included on Ohio IT 1040, line 1)
37                                   
   Do not staple or paper clip.  1Business     incomededuction–OhioScheduleITBUS,line11 ................................................................11.                                                                      888888 00
38
39                               
                                 12.Employee compensationearnedinOhiobyresidentsofneighboringstates ...........................................12.                                                                   888888888 00
40
41                                                                                                                                                                                                                   888888888 00
                                 State      ormunicipalincometaxoverpaymentsshownonthefederal1040,line10 .................................13.
42
43                                                                                                                                                                                                                   888888888 00
                                 Qualifying    SocialSecuritybenefitsandcertainrailroadretirementbenefits ...........................................14.
44
45                                15. Interest income from Ohio public obligations and from Ohio purchase obligations; gains from the 
46                                    sale or disposition of Ohio public obligations; public service payments received from the state of 
                                      Ohio; or income from a transfer agreement ............................................................................................15.                                      888888888 00
47                                                                                                                                                                                                                   888888888 00
                                  16. Amounts contributed to an individual development account ...................................................................16.
48
49                                                                                                                                                                                                                   888888888 00
                                 Amounts     contributedtoSTABLEaccount:Ohio’sABLEplan .................................................................17.
50
51                               Federal
52                               
                                 Federal     interestanddividendsexemptfromstatetaxation ....................................................................18.                                                     888888888 00
53
54                                                                                                                                                                                                                   888888888 00
                                  Adjustment   forInternalRevenueCodesections168(k)and179depreciationexpense ........................ 19.
55
56                               20. Refund orreimbursementsshownonthefederal1040,line21foritemizeddeductionsclaimedona
                                    prior yearfederalincometaxreturn ........................................................................................................20.                                     Targetmarksorregistrationmarks888888888 00
                                  21. Repayment of income reported in a prior year ........................................................................................21.
57                                                                                                                                                                                                                   mustmeasure6mmX6mm.The888888888 00
58                                                                                                                                                                                                                   four target marks or registration
                                                                                                                                                                                                                     marks on every page must follow
                                 Wage       expensenotdeductedduetoclaimingthefederalworkopportunitytaxcredit ............................22.
59                                                                                                                                                                                                                   grid layout.888888888 00
60
61                                                                                                                                                                                                                   888888888 00
                                 Miscellaneous    federalincometaxdeductions ........................................................................................23.
62                               
63
64                                                                                                          2017 Ohio Schedule A – page 1 of 2
65
66

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 Schedule A
7                    Rev. 8/17    Income Adjustments – Additions and Deductions
8                                                        SSNofprimaryfiler                                                                                                     17000410
9                                                        888 88 8888                                                                                                                              4
10 Uniformed Services
11                                                                                                                                                                             888888888 00
    Military   payforOhioresidentsreceivedwhilethemilitarymemberwasstationedoutsideOhio ............24.
12
13                                                                                                                                                                             888888888 00
    25. Certain income earned by military nonresidents and civilian nonresident spouses ..................................25.
14
15                                                                                                                                                                             888888888 00
    Uniformed    servicesretirementincome ...................................................................................................26.
16
17                                                                                                                                                                             888888888 00
    27.Military injuryrelieffund ......................................................................................................................................27.
18
19                                                                                                                                                                             888888888 00
    Certain    OhioNationalGuardreimbursementsandbenefits ...................................................................28.
20  
21 Education
22                                                                                                                                                                             888888 00
    Ohio      529contributions,tuitioncreditpurchases ..................................................................................... 29.
23
24  
    Pell/Ohio  CollegeOpportunitytaxablegrantamountsusedtopayroomandboard ..............................30.                                                                    888888 00
25
26 Medical
27                                                                                                                                                                             888888888 00
    Disability andsurvivorshipbenefits(donotincludepensioncontinuationbenefits) ...............................31.
28                                                                                                                                                                        NEW! Thisindicatesthe
29  Unreimbursed long-termcareinsurancepremiums,unsubsidizedhealthcareinsurancepremiums                                                                                   sequence number.
    and excesshealthcareexpenses(seeinstructionsforworksheet) ........................................................32.                                                      888888888 00
30
31  Funds      depositedinto,andearningsof,amedicalsavingsaccountforeligiblehealthcareexpenses
    (see instructionsforworksheet) ..............................................................................................................33.                           888888888 00
32
33  
    Qualified  organdonorexpenses (maximum $10,000 per taxpayer) ....................................................34.                                                                  88888 00
34
35                                                                                                                                                                        88888888888 00
    35. Total deductions (addlines11through34ONLY).EnterhereandonOhioIT1040,line2b ...........................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                                                              2017 Ohio Schedule A – page 2 of 2
65
66

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 Schedule A
7                                                 Rev. 8/17   Income Adjustments – Additions and Deductions
8                                                                                      SSNofprimaryfiler                                                                         17000310
   88 88 88
9                                                                                      888 88 8888                                                                                             3
10
11                                                                         Additions 
12                                             (add income items only to the extent not included on Ohio IT 1040, line 1)
13                                                                                                                                                                               888888888 00
                                    1. Non-Ohio state or local government interest and dividends .....................................................................1.
14
15                                                                                                                                                                               888888888 00
                                    Certain  Ohiopass-throughentityandfinancialinstitutionstaxespaid ......................................................2.
16                               
17                                  Reimbursement    ofcollegetuitionexpensesandfeesdeductedinanypreviousyear(s)and
                                    noneducation expendituresfromacollegesavingsaccount ....................................................................3.                   888888 00
18
19                                                                                                                                                                               888888888 00
                                    4. Losses from sale or disposition of Ohio public obligations .......................................................................4.
20
21                               
                                    5. Nonmedical withdrawals from a medical savings account ........................................................................5.          888888888 00
22
23                                  6. Reimbursement ofexpensespreviouslydeductedforOhioincometaxpurposes,butonlyifthe
                                      reimbursement is not in federal adjusted gross income ............................................................................6.       888888888 00
24
25                                  Federal
26                                                                                                                                                                               888888888 00
                                    Adjustment forInternalRevenueCodesections168(k)and179depreciationexpense ..........................7.
27
28                                                                                                                                                                               888888888 00
                                    Federal  interestanddividendssubjecttostatetaxation ...........................................................................8.
29
30                                                                                                                                                                               888888888 00
                                    Miscellaneous federalincometaxadditions ............................................................................................. 9.
31
32                                                                                                                                                                               88888888888 00
                                 10. Total additions (addlines1through9ONLY).EnterhereandonOhioIT1040,line2a) ........................10.
33
34
35                                                                  Deductions 
36                                             (deduct income items only to the extent included on Ohio IT 1040, line 1)
37                                   
   Do not staple or paper clip.  1Business     incomededuction–OhioScheduleITBUS,line11 ................................................................11.                      888888 00
38
39                               
                                 12.Employee compensationearnedinOhiobyresidentsofneighboringstates ...........................................12.                               888888888 00
40
41                                                                                                                                                                               888888888 00
                                 State      ormunicipalincometaxoverpaymentsshownonthefederal1040,line10 .................................13.
42
43                                                                                                                                                                               888888888 00
                                 Qualifying    SocialSecuritybenefitsandcertainrailroadretirementbenefits ...........................................14.
44
45                                15. Interest income from Ohio public obligations and from Ohio purchase obligations; gains from the 
46                                    sale or disposition of Ohio public obligations; public service payments received from the state of 
                                      Ohio; or income from a transfer agreement ............................................................................................15.  888888888 00
47                                                                                                                                                                               888888888 00
                                  16. Amounts contributed to an individual development account ...................................................................16.
48
49                                                                                                                                                                               888888888 00
                                 Amounts     contributedtoSTABLEaccount:Ohio’sABLEplan .................................................................17.
50
51                               Federal
52                               
                                 Federal     interestanddividendsexemptfromstatetaxation ....................................................................18.                 888888888 00
53
54                                                                                                                                                                               888888888 00
                                  Adjustment   forInternalRevenueCodesections168(k)and179depreciationexpense ........................ 19.
55
56                               20. Refund orreimbursementsshownonthefederal1040,line21foritemizeddeductionsclaimedona
                                    prior yearfederalincometaxreturn ........................................................................................................20. 888888888 00
57                                                                                                                                                                               888888888 00
                                  21. Repayment of income reported in a prior year ........................................................................................21.
58
59                                                                                                                                                                               888888888 00
                                 Wage       expensenotdeductedduetoclaimingthefederalworkopportunitytaxcredit ............................22.
60
61                                                                                                                                                                               888888888 00
                                 Miscellaneous    federalincometaxdeductions ........................................................................................23.
62                               
63
64                                                                                                  2017 Ohio Schedule A – page 1 of 2
65
66

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 Schedule A
7                    Rev. 8/17    Income Adjustments – Additions and Deductions
8                                                        SSNofprimaryfiler                                                                                                17000410
9                                                        888 88 8888                                                                                                                    4
10 Uniformed Services
11                                                                                                                                                                        888888888 00
    Military   payforOhioresidentsreceivedwhilethemilitarymemberwasstationedoutsideOhio ............24.
12
13                                                                                                                                                                        888888888 00
    25. Certain income earned by military nonresidents and civilian nonresident spouses ..................................25.
14
15                                                                                                                                                                        888888888 00
    Uniformed    servicesretirementincome ...................................................................................................26.
16
17                                                                                                                                                                        888888888 00
    27.Military injuryrelieffund ......................................................................................................................................27.
18
19                                                                                                                                                                        888888888 00
    Certain    OhioNationalGuardreimbursementsandbenefits ...................................................................28.
20  
21 Education
22                                                                                                                                                                        888888 00
    Ohio      529contributions,tuitioncreditpurchases ..................................................................................... 29.
23
24  
    Pell/Ohio  CollegeOpportunitytaxablegrantamountsusedtopayroomandboard ..............................30.                                                               888888 00
25
26 Medical
27                                                                                                                                                                        888888888 00
    Disability andsurvivorshipbenefits(donotincludepensioncontinuationbenefits) ...............................31.
28  
29  Unreimbursed long-termcareinsurancepremiums,unsubsidizedhealthcareinsurancepremiums
    and excesshealthcareexpenses(seeinstructionsforworksheet) ........................................................32.                                                 888888888 00
30
31  Funds      depositedinto,andearningsof,amedicalsavingsaccountforeligiblehealthcareexpenses
    (see instructionsforworksheet) ..............................................................................................................33.                      888888888 00
32
33  
    Qualified  organdonorexpenses (maximum $10,000 per taxpayer) ....................................................34.                                                  88888 00
34
35                                                                                                                                                                        88888888888 00
    35. Total deductions (addlines11through34ONLY).EnterhereandonOhioIT1040,line2b ...........................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                                                              2017 Ohio Schedule A – page 2 of 2
65
66

Layout 

without grid

                              Do not staple or paper clip. 

                                                                 2017 Ohio Schedule A
                                               Rev. 8/17   Income Adjustments – Additions and Deductions
                                                                                    SSNofprimaryfiler                                                                         17000310
88 88 88
                                                                                    888 88 8888                                                                                             3
                                                                        Additions 
                                            (add income items only to the extent not included on Ohio IT 1040, line 1)
                                 1. Non-Ohio state or local government interest and dividends .....................................................................1.         888888888 00

                                 Certain  Ohiopass-throughentityandfinancialinstitutionstaxespaid ......................................................2.                    888888888 00
                              
                                 Reimbursement    ofcollegetuitionexpensesandfeesdeductedinanypreviousyear(s)and
                                 noneducation expendituresfromacollegesavingsaccount ....................................................................3.                   888888 00

                                 4. Losses from sale or disposition of Ohio public obligations .......................................................................4.      888888888 00
                              
                                 5. Nonmedical withdrawals from a medical savings account ........................................................................5.          888888888 00
                                 6. Reimbursement ofexpensespreviouslydeductedforOhioincometaxpurposes,butonlyifthe
                                   reimbursement is not in federal adjusted gross income ............................................................................6.       888888888 00
                                 Federal
                                 Adjustment forInternalRevenueCodesections168(k)and179depreciationexpense ..........................7.                                        888888888 00

                                 Federal  interestanddividendssubjecttostatetaxation ...........................................................................8.            888888888 00

                                 Miscellaneous federalincometaxadditions ............................................................................................. 9.     888888888 00

                              10. Total additions (addlines1through9ONLY).EnterhereandonOhioIT1040,line2a) ........................10.                                        88888888888 00

                                                                 Deductions 
                                            (deduct income items only to the extent included on Ohio IT 1040, line 1)
                                  
Do not staple or paper clip.  1Business     incomededuction–OhioScheduleITBUS,line11 ................................................................11.                      888888 00
                              
                              12.Employee compensationearnedinOhiobyresidentsofneighboringstates ...........................................12.                               888888888 00

                              State      ormunicipalincometaxoverpaymentsshownonthefederal1040,line10 .................................13.                                    888888888 00

                              Qualifying    SocialSecuritybenefitsandcertainrailroadretirementbenefits ...........................................14.                         888888888 00
                               15. Interest income from Ohio public obligations and from Ohio purchase obligations; gains from the 
                                   sale or disposition of Ohio public obligations; public service payments received from the state of 
                                   Ohio; or income from a transfer agreement ............................................................................................15.  888888888 00
                               16. Amounts contributed to an individual development account ...................................................................16.            888888888 00

                              Amounts     contributedtoSTABLEaccount:Ohio’sABLEplan .................................................................17.                      888888888 00
                              Federal
                              
                              Federal     interestanddividendsexemptfromstatetaxation ....................................................................18.                 888888888 00

                               Adjustment   forInternalRevenueCodesections168(k)and179depreciationexpense ........................ 19.                                        888888888 00
                              20. Refund orreimbursementsshownonthefederal1040,line21foritemizeddeductionsclaimedona
                                 prior yearfederalincometaxreturn ........................................................................................................20. 888888888 00
                               21. Repayment of income reported in a prior year ........................................................................................21.   888888888 00

                              Wage       expensenotdeductedduetoclaimingthefederalworkopportunitytaxcredit ............................22.                                    888888888 00

                              Miscellaneous    federalincometaxdeductions ........................................................................................23.         888888888 00
                              
                                                                                                 2017 Ohio Schedule A – page 1 of 2

 Do not staple or paper clip. 

                                      2017 Ohio Schedule A
                  Rev. 8/17    Income Adjustments – Additions and Deductions
                                                      SSNofprimaryfiler                                                                                                 17000410
                                                      888 88 8888                                                                                                                     4
Uniformed Services
 Military   payforOhioresidentsreceivedwhilethemilitarymemberwasstationedoutsideOhio ............24.                                                                    888888888 00

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

 Uniformed    servicesretirementincome ...................................................................................................26.                           888888888 00

 27.Military injuryrelieffund ......................................................................................................................................27. 888888888 00

 Certain    OhioNationalGuardreimbursementsandbenefits ...................................................................28.                                           888888888 00
 
Education
 Ohio      529contributions,tuitioncreditpurchases ..................................................................................... 29.                            888888 00
 
 Pell/Ohio  CollegeOpportunitytaxablegrantamountsusedtopayroomandboard ..............................30.                                                                888888 00
Medical
 Disability andsurvivorshipbenefits(donotincludepensioncontinuationbenefits) ...............................31.                                                         888888888 00
 
 Unreimbursed long-termcareinsurancepremiums,unsubsidizedhealthcareinsurancepremiums
 and excesshealthcareexpenses(seeinstructionsforworksheet) ........................................................32.                                                  888888888 00
 Funds      depositedinto,andearningsof,amedicalsavingsaccountforeligiblehealthcareexpenses
 (see instructionsforworksheet) ..............................................................................................................33.                       888888888 00
 
 Qualified  organdonorexpenses (maximum $10,000 per taxpayer) ....................................................34.                                                   88888 00

 35. Total deductions (addlines11through34ONLY).EnterhereandonOhioIT1040,line2b ...........................35.                                                          88888888888 00

                                                             2017 Ohio Schedule A – page 2 of 2

General information 

regarding this form

         General Information (2017 Schedule A):

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

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

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

2) 1D barcode - The last two numbers of the 1D barcode represent the vendor number. Use the same vendor 
number as you did for last year’s return. If you have a question about your barcode assignment, e-mail the Forms 
Unit at Forms@tax.state.oh.us. The first six numbers are constant for this form (170003XX - 170004XX). 

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

   NOTE: The vendor number also serves as the first two digits of the SSN 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) Provide guidance to customers regarding duplex printing that instructs them to print pages 1 and 2 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.

9) 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 documents generated from the software must in-
clude a 1D barcode identifying it as 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).

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

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

                                                             Rev. 11/03/17

Scan Specifications for the 

          2017 Ohio IT BUS – 

Business Income Schedule

                        Important Note

   The following document (2017 Ohio IT BUS) 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 BUS test samples must be completed and sub-
   mitted for approval no later than Dec.22, 2017. 

       Ohio Department of Taxation

                                4485 Northland Ridge Blvd.

                                Columbus, OH 43229

                                tax.ohio.gov

Grid layout 

with notations

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3
4                                Do not staple or paper clip. 
5                                        The date the return was generated 
6                                        by the taxpayer (MM DD YY).          2017 Ohio Schedule IT BUS 
7                                                    Rev. 08/17                                                    Business Income
                                                                                                                                                                                                                                                                        5
8                                                                                                                                                                                                                                          17260110
   88 88 88
9  Include on this Ohio Schedule IT BUS any income included in federal adjusted gross income that constitutes business income. See Ohio Revised Code 
10 (R.C.) section 5747.01(B). On page 2 of this schedule, list the sources of businessPlacementincomeofandtheyour1D barownershipcode andpercentage.tax year isIncludecritical.the Ohio Schedule IT 
11 BUS with Ohio IT 1040 if filing by paper (see instructions if filing electronically).Make sure to follow the grid positions for layout. Do 
12                                                   SSN of primary filer                                                                  not forget to get your bar code(s) assignments for  Check to indicate which taxpayer earned this income:
                                                                                                                                           every form, version and page.
13                                                   888 88 8888                                                                                                                 X Primary         X                                       Spouse
14
15  Part 1 – Business Income From IRS Schedules
16
17  Note: Do not include amounts listed on these IRS schedules that are nonbusiness income.                                                                                           NEW! This indicates the 
18  See R.C. 5747.01(C).                                                                                                                                                              sequence number.
19                                                                                                                                                                                                                                         888888888 00
                                 1. Schedule B – Interest and Ordinary Dividends ...........................................................................................1.
20
     
21                                                                                                                                                                                                                                   -     888888888 00
      2. Schedule C – Profit or Loss From Business (Sole Proprietorship)..............................................................2.
22
     
23                                                                                                                                                                                                                                   -     888888888 00
      3. Schedule D – Capital Gains and Losses .....................................................................................................3.
24
     
25                                                                                                                                                                                                                                   -     888888888 00
      4. Schedule E – Supplemental Income and Loss............................................................................................4.
26
      5. Guaranteed payments, compensation and/or wages from each pass-through entity in 
27                                                                    NEW! These fields may possibly be a negative value. 
                                   which you have at least a 20% directIncludeor indirecta “-“ signownershiphere ifinterest.this line hasNote:a negative Reciprocityvalue.
28                                                                                                                                                                                                                                         888888888 00
                                   agreements do not apply .............................................................................................................................5.
29
30                                                                                                                                                                                                                                   -     888888888 00
      6. Schedule F – Profit or Loss From Farming .................................................................................................6.
31
      7. Other items of income and gain separately stated on the federal Schedule K-1, gains 
32
                                   and/or losses reported on the federal 4797 and miscellaneous federal income tax 
33                                                                                                                                                                                                                                   -     888888888 00
                                   adjustments, if any ......................................................................................................................................7.
34
35                                                                                                                                                                                                                                   -     888888888 00
      8. Total of business income (add lines 1 through 7) ........................................................................................8.
36
37  Do not staple or paper clip. Part 2 – Business Income Deduction
38    9. All business income (enter the lesser of line 8 above or Ohio IT 1040, line 1). If zero 
39                                 or negative, stop here and do not complete Part 3 .....................................................................................9.                                                         -     888888888 00
40   
                                                                        NEW! For static text use Arial font (black ink) and 
41    10. Enter $250,000 if filing status is singletryortomarriedmatch size.filingForjointly;dataORentry fields (shown in 
42                                 Enter $125,000 if filing status is marriedredfilingfor identificationseparately .........................................................................10.purposes only), use Arial font Do not place spaces between888888 00
43                                                                      (black ink). All the data entry fields must follow                                                         whole dollar numbers. There 
                                                                        grid layout. Never hard code a negative sign, and                                                          is only a space between dollar 
44   11. Enter lesser of line 9 or line 10. Enterdoherenotandincludeon Ohiothe negativeSchedulesignA,withlinethe11amounts............................................11.amounts and cents fields.888888 00
45                                                                      This is now a separate field.
46  Part 3 – Taxable Business Income
47
    Note: If Ohio IT 1040, line 5 equals zero, do not complete Part 3.
48   
     12. Line 9 minus line 11 ...................................................................................................................................12. 
49                                                                                                                                                                                                                                         888888888 00
     13. Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5). 
50                                 Enter here and on Ohio IT 1040, line 6 .....................................................................................................13.2D barcode required. Delete this                         888888888 00
51                                                                                             box with text and replace it with 
     14. Business income tax liability – multiply line 13 by 3%the(.03).2DEnterbarcode.here and on Ohio IT 1040, 
52                                 line 8b ........................................................................................................................................................14.                                            8888888 00
53
54
55
56
57                                 Software vendors: Place 2D barcode in this location                                                                                                                                               Target marks or registration marks 
58                                       Do not place a box around the 2D barcode. The box                                                                                                                                           must measure 6 mm X 6 mm. The 
                                                                                                                                                                                                                                     four target marks or registration 
59                                                is only here for placement purposes.                                                                                                                                               marks on every page must follow 
60                                                                                                                                                                                                                                   grid layout.
61
62
63
                                                                                                                        2017 Ohio Schedule IT BUS – page 1 of 2
64
65
66

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 Schedule IT BUS 
7                     Rev. 08/17       Business Income
                                                                                                                      6
8                                                                     17260210
9                                      SSN of primary filer
10                                     888 88 8888
11
12 Part 4 – Business Entity
13
14 If you have more than 18 entities, complete additional copies of this page and include with your income tax return.
15 1.  Name of entity                  FEIN/SSN                                Percentage of ownership
16     JOHNXXXXXXXXXXXXXXXX            888888888                               888.88
17 2.  Name of entity                  FEIN/SSN                  NEW! This indicates the Percentage of ownership
                                                                 sequence number.
18                                     888888888                               888.88
       JOHNXXXXXXXXXXXXXXXX
19 3.  Name of entity                  FEIN/SSN                                Percentage of ownership
20                                     888888888                               888.88
       JOHNXXXXXXXXXXXXXXXX
21 4.  Name of entity                  FEIN/SSN                                Percentage of ownership
22                                                                             888.88
       JOHNXXXXXXXXXXXXXXXX            888888888
23 5.  Name of entity                  FEIN/SSN                                Percentage of ownership
24                                     888888888                               888.88
       JOHNXXXXXXXXXXXXXXXX
25 6.  Name of entity                  FEIN/SSN                                Percentage of ownership
       JOHNXXXXXXXXXXXXXXXX
26                                     888888888The percentage of ownership888.88field-
27     Name of entity                  FEIN/SSN            contains a decimal. Percentage of ownership
   7.
28     JOHNXXXXXXXXXXXXXXXX            888888888                               888.88
29 8.  Name of entity                  FEIN/SSN                                Percentage of ownership
30     JOHNXXXXXXXXXXXXXXXX            888888888                               888.88
31 9.  Name of entity                  FEIN/SSN                                Percentage of ownership
32     JOHNXXXXXXXXXXXXXXXX            888888888                               888.88
33 10. Name of entity                  FEIN/SSN                                Percentage of ownership
34     JOHNXXXXXXXXXXXXXXXX            888888888                               888.88
35 11. Name of entity                  FEIN/SSN                                Percentage of ownership
36     JOHNXXXXXXXXXXXXXXXX            888888888                               888.88
37 12. Name of entity                  FEIN/SSN                                Percentage of ownership
38     JOHNXXXXXXXXXXXXXXXX            888888888                               888.88
39     Name of entity                  FEIN/SSN                                Percentage of ownership
   13.
40                                     888888888                               888.88
       JOHNXXXXXXXXXXXXXXXX
41 14. Name of entity                  FEIN/SSN                                Percentage of ownership
42                                     888888888                               888.88
       JOHNXXXXXXXXXXXXXXXX
43 15. Name of entity                  FEIN/SSN                                Percentage of ownership
44                                     888888888                               888.88
       JOHNXXXXXXXXXXXXXXXX
45 16. Name of entity                  FEIN/SSN                                Percentage of ownership
46                                     888888888                               888.88
       JOHNXXXXXXXXXXXXXXXX
47 17. Name of entity                  FEIN/SSN                                Percentage of ownership
48                                     888888888                               888.88
       JOHNXXXXXXXXXXXXXXXX
49 18. Name of entity                  FEIN/SSN                                Percentage of ownership
50                                                                             888.88
       JOHNXXXXXXXXXXXXXXXX            888888888
51
52
53
54
55
56
57
58
59
60
61
62
63
                                       2017 Ohio Schedule IT BUS – page 2 of 2
64
65
66

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 Schedule IT BUS 
7                                Rev. 08/17                                                    Business Income
                                                                                                                                                                                                                         5
8                                                                                                                                                                                                        17260110
   88 88 88
9  Include on this Ohio Schedule IT BUS any income included in federal adjusted gross income that constitutes business income. See Ohio Revised Code 
10 (R.C.) section 5747.01(B). On page 2 of this schedule, list the sources of business income and your ownership percentage. Include the Ohio Schedule IT 
11 BUS with Ohio IT 1040 if filing by paper (see instructions if filing electronically).
12                               SSN of primary filer                                                          Check to indicate which taxpayer earned this income:
13                               888 88 8888                                                                                     X Primary         X                                                     Spouse
14
15  Part 1 – Business Income From IRS Schedules
16
17  Note: Do not include amounts listed on these IRS schedules that are nonbusiness income. 
18  See R.C. 5747.01(C).

19                                                                                                                                                                                                       888888888 00
                                 1. Schedule B – Interest and Ordinary Dividends ...........................................................................................1.
20
     
21                                                                                                                                                                                                     - 888888888 00
      2. Schedule C – Profit or Loss From Business (Sole Proprietorship)..............................................................2.
22
     
23                                                                                                                                                                                                     - 888888888 00
      3. Schedule D – Capital Gains and Losses .....................................................................................................3.
24
     
25                                                                                                                                                                                                     - 888888888 00
      4. Schedule E – Supplemental Income and Loss............................................................................................4.
26
      5. Guaranteed payments, compensation and/or wages from each pass-through entity in 
27
                                   which you have at least a 20% direct or indirect ownership interest. Note: Reciprocity 
28                                                                                                                                                                                                       888888888 00
                                   agreements do not apply .............................................................................................................................5.
29
30                                                                                                                                                                                                     - 888888888 00
      6. Schedule F – Profit or Loss From Farming .................................................................................................6.
31
      7. Other items of income and gain separately stated on the federal Schedule K-1, gains 
32
                                   and/or losses reported on the federal 4797 and miscellaneous federal income tax 
33                                                                                                                                                                                                     - 888888888 00
                                   adjustments, if any ......................................................................................................................................7.
34
35                                                                                                                                                                                                     - 888888888 00
      8. Total of business income (add lines 1 through 7) ........................................................................................8.
36
37  Do not staple or paper clip. Part 2 – Business Income Deduction
38    9. All business income (enter the lesser of line 8 above or Ohio IT 1040, line 1). If zero 
39                                 or negative, stop here and do not complete Part 3 .....................................................................................9.                           - 888888888 00
40   
41    10. Enter $250,000 if filing status is single or married filing jointly; OR
42                                 Enter $125,000 if filing status is married filing separately .........................................................................10.                                   888888 00
43
44   11. Enter lesser of line 9 or line 10. Enter here and on Ohio Schedule A, line 11 ...........................................11.                                                                          888888 00
45
46  Part 3 – Taxable Business Income
47
    Note: If Ohio IT 1040, line 5 equals zero, do not complete Part 3.
48   
     12. Line 9 minus line 11 ...................................................................................................................................12. 
49                                                                                                                                                                                                       888888888 00
     13. Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5). 
50                                 Enter here and on Ohio IT 1040, line 6 .....................................................................................................13.                       888888888 00
51   
     14. Business income tax liability – multiply line 13 by 3% (.03). Enter here and on Ohio IT 1040, 
52                                 line 8b ........................................................................................................................................................14.         8888888 00
53
54
55
56
57                               Software vendors: Place 2D barcode in this location
58                               Do not place a box around the 2D barcode. The box 
59                               is only here for placement purposes.
60
61
62
63
                                                                                               2017 Ohio Schedule IT BUS – page 1 of 2
64
65
66

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 Schedule IT BUS 
7                     Rev. 08/17       Business Income
                                                                                                                      6
8                                                                17260210
9                                      SSN of primary filer
10                                     888 88 8888
11
12 Part 4 – Business Entity
13
14 If you have more than 18 entities, complete additional copies of this page and include with your income tax return.
15 1.  Name of entity                  FEIN/SSN                  Percentage of ownership
16     JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
17 2.  Name of entity                  FEIN/SSN                  Percentage of ownership
18                                     888888888                 888.88
       JOHNXXXXXXXXXXXXXXXX
19 3.  Name of entity                  FEIN/SSN                  Percentage of ownership
20                                     888888888                 888.88
       JOHNXXXXXXXXXXXXXXXX
21 4.  Name of entity                  FEIN/SSN                  Percentage of ownership
22                                                               888.88
       JOHNXXXXXXXXXXXXXXXX            888888888
23 5.  Name of entity                  FEIN/SSN                  Percentage of ownership
24                                     888888888                 888.88
       JOHNXXXXXXXXXXXXXXXX
25 6.  Name of entity                  FEIN/SSN                  Percentage of ownership
26                                     888888888                 888.88
       JOHNXXXXXXXXXXXXXXXX
27     Name of entity                  FEIN/SSN                  Percentage of ownership
   7.
28     JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
29 8.  Name of entity                  FEIN/SSN                  Percentage of ownership
30     JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
31 9.  Name of entity                  FEIN/SSN                  Percentage of ownership
32     JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
33 10. Name of entity                  FEIN/SSN                  Percentage of ownership
34     JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
35 11. Name of entity                  FEIN/SSN                  Percentage of ownership
36     JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
37 12. Name of entity                  FEIN/SSN                  Percentage of ownership
38     JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
39     Name of entity                  FEIN/SSN                  Percentage of ownership
   13.
40                                     888888888                 888.88
       JOHNXXXXXXXXXXXXXXXX
41 14. Name of entity                  FEIN/SSN                  Percentage of ownership
42                                     888888888                 888.88
       JOHNXXXXXXXXXXXXXXXX
43 15. Name of entity                  FEIN/SSN                  Percentage of ownership
44                                     888888888                 888.88
       JOHNXXXXXXXXXXXXXXXX
45 16. Name of entity                  FEIN/SSN                  Percentage of ownership
46                                     888888888                 888.88
       JOHNXXXXXXXXXXXXXXXX
47 17. Name of entity                  FEIN/SSN                  Percentage of ownership
48                                     888888888                 888.88
       JOHNXXXXXXXXXXXXXXXX
49 18. Name of entity                  FEIN/SSN                  Percentage of ownership
50                                                               888.88
       JOHNXXXXXXXXXXXXXXXX            888888888
51
52
53
54
55
56
57
58
59
60
61
62
63
                                       2017 Ohio Schedule IT BUS – page 2 of 2
64
65
66

Layout 

without grid

                              Do not staple or paper clip. 

                                                                          2017 Ohio Schedule IT BUS 
                                          Rev. 08/17                                        Business Income
                                                                                                                                                                                                                      5
                                                                                                                                                                                                      17260110
88 88 88
Include on this Ohio Schedule IT BUS any income included in federal adjusted gross income that constitutes business income. See Ohio Revised Code 
(R.C.) section 5747.01(B). On page 2 of this schedule, list the sources of business income and your ownership percentage. Include the Ohio Schedule IT 
BUS with Ohio IT 1040 if filing by paper (see instructions if filing electronically).
                                                SSN of primary filer                                        Check to indicate which taxpayer earned this income:
                                                888 88 8888                                                                   X Primary         X                                                     Spouse

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

                              1. Schedule B – Interest and Ordinary Dividends ...........................................................................................1.                           888888888 00
  
   2. Schedule C – Profit or Loss From Business (Sole Proprietorship)..............................................................2.                                                               - 888888888 00
  
   3. Schedule D – Capital Gains and Losses .....................................................................................................3.                                                 - 888888888 00
  
   4. Schedule E – Supplemental Income and Loss............................................................................................4.                                                       - 888888888 00
   5. Guaranteed payments, compensation and/or wages from each pass-through entity in 
                                which you have at least a 20% direct or indirect ownership interest. Note: Reciprocity 
                                agreements do not apply .............................................................................................................................5.               888888888 00

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

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

 Do not staple or paper clip. Part 2 – Business Income Deduction
   9. All business income (enter the lesser of line 8 above or Ohio IT 1040, line 1). If zero 
                                or negative, stop here and do not complete Part 3 .....................................................................................9.                           - 888888888 00
  
   10. Enter $250,000 if filing status is single or married filing jointly; OR
                                Enter $125,000 if filing status is married filing separately .........................................................................10.                                   888888 00

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

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

                                  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 Ohio Schedule IT BUS – page 1 of 2

                                    2017 Ohio Schedule IT BUS 
                   Rev. 08/17       Business Income
                                                                                                                   6
                                                              17260210
                                    SSN of primary filer
                                    888 88 8888

Part 4 – Business Entity
If you have more than 18 entities, complete additional copies of this page and include with your income tax return.
1.  Name of entity                  FEIN/SSN                  Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
2.  Name of entity                  FEIN/SSN                  Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
3.  Name of entity                  FEIN/SSN                  Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
4.  Name of entity                  FEIN/SSN                  Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
5.  Name of entity                  FEIN/SSN                  Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
6.  Name of entity                  FEIN/SSN                  Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
7.  Name of entity                  FEIN/SSN                  Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
8.  Name of entity                  FEIN/SSN                  Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
9.  Name of entity                  FEIN/SSN                  Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
10. Name of entity                  FEIN/SSN                  Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
11. Name of entity                  FEIN/SSN                  Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
12. Name of entity                  FEIN/SSN                  Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
13. Name of entity                  FEIN/SSN                  Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
14. Name of entity                  FEIN/SSN                  Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
15. Name of entity                  FEIN/SSN                  Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
16. Name of entity                  FEIN/SSN                  Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
17. Name of entity                  FEIN/SSN                  Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX            888888888                 888.88
18. Name of entity                  FEIN/SSN                  Percentage of ownership
    JOHNXXXXXXXXXXXXXXXX            888888888                 888.88

                                    2017 Ohio Schedule IT BUS – page 2 of 2

General information 

regarding this form

             General Information (2017 IT BUS):

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

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

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

2) 1D barcode - The last two numbers of the 1D barcode represent the vendor number. Use the same vendor 
number as you did for last year’s return. If you have a question about your barcode assignment, e-mail the Forms 
Unit at Forms@tax.state.oh.us. The first six numbers are constant for this form (172601XX - 172602XX). 

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

   NOTE: The vendor number also serves as the first two digits of the SSN 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) The possible negative fields for this return are lines 2, 3, 4, 6, 7, 8 and 9. Do not hard-code negative signs.

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

10) 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 documents generated from the software must in-
clude a 1D barcode identifying it as 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).

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

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

                                                           Rev. 11/03/17

Scan Specifications for the 

    2017 Ohio Schedule 

               of Credits

                        Important Note

   The following document (2017 Ohio Schedule of Credits) contains 
   grids for placement 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 Schedule of Credits test samples must be com-
   pleted and submitted for approval no later than Dec.22, 2017. 

       Ohio Department of Taxation

                             4485 Northland Ridge Blvd.

                             Columbus, OH 43229

                             tax.ohio.gov

Grid layout 

with notations

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3
4                                                            Do not staple or paper clip. 
5
6                                                               The date the return was generated  2017 Ohio Schedule of Credits
7                                                               by the taxpayerRev.(MM08/17DD YY).          Nonrefundable and Refundable
                                                                                                                                                                                                                                                               17280110
8                                                                                                                                    SSN of primary filer
9  88 88 88                                                                                                                      888 88 8888                                                                                                                                             7
10
                                                                                                                                     Placement of the 1D barcode and tax year is critical. 
11                                                                                                    Nonrefundable CreditsMake sure to follow the grid positions for layout. Do 
12                                                              1. Tax liability before credits (from Ohio IT 1040, line 8c) ..............................................................................1.not forget to get your barcode(s) assignments for 888888888 00
13                                                                                                                                   every form, version and page.
14                                                              2. Retirement income credit (limit $200 per return) (see instructions for table) ............................................2.                                                                        888 00
15
16                                                              3. Lump sum retirement credit – Ohio LS WKS, Section III, line 6 (include worksheet) ..............................3.                                                                             888888 00
17                                                              4. Senior citizen credit (must be 65 or older to claim this credit; limit $50 per return) ...............................4.                                                                            8888 00
18                                                            
19                                                              5. Lump sum distribution credit – Ohio LS WKS, Section IV, line 3 (include worksheet) .............................5.NEW! This indicates the 
                                                                                                                                                                                                                                                                  8888 00
20                                                                                                                                                                            sequence number.
21                                                              6. Child care and dependent care credit (see instructions for worksheet).......................................... .........6.
                                                                                                                                                                                                                                                                  8888 00
22
                                                                7.  Displaced worker training credit (see instructions for worksheet) (limit $500 per taxpayer) ..................7.                                                                              8888 00
23
24                                                              8. Campaign contribution credit for Ohio statewide office or General Assembly (limit $50 per taxpayer) .....8.                                                                                         888 00
25
                                                                                                                                     For static text use Arial font (black ink) and try to 
26                                                              9. Income-based exemption credit ($20 times the number ofmatchexemptions)size. For.................................................9.data entry fields (shown in red 
                                                                                                                                                                                                                                                                       888 00
27                                                                                                                                   for identification purposes only), use Arial font 
                                                               10. Total (add lines 2 through 9) ..................................................................................................................10.                                         888888888 00
28                                                                                                                                   (black ink). All the data entry fields must follow 
                                                                                                                                     grid layout.
29                                                             11. Tax less credits (line 1 minus line 10; if less than -0-, enter -0-) ............................................................11.
                                                                                                                                                                                                                                                               888888888 00
30                                                            
31                                                             12. Joint filing credit (see instructions).              88 %mestithe amount on line 11(limit $650) ....................................12.                                                             888 00
32
33                                                             13. Earned income credit .............................................................................................................................13.
                                                                                                                                                                                                                                                                       888 00
34
                                                                                                                                                                                                                                                                  88888 00
35                              Do not staple or paper clip.   14. Ohio adoption credit (limit $10,000 per adopted child) .......................................................................14.
36
37                                                             15. Job retention credit, nonrefundable portion (include a copy of the credit certificate) .............................15.
                                                                                                                                                                                                                                                                  8888888 00
38
39                                                             16. Credit for eligible new employees in an enterprise zone (include a copy of the credit certificate) .........16.
                                                                                                                                                                                                                                                                  8888888 00
40
41                                                             17. Credit for purchases of grape production property ................................................................................17.
                                                                                                                                                                                                                                                                  8888888 00
42
43                                                             18. Invest Ohio credit (include a copy of the credit certificate) ....................................................................18.
                                                                                                                                                                                                                                                                  8888888 00
44
45                                                             19. Technology investment credit carryforward (include a copy of the credit certificate) .............................19.                                                                          8888888 00
46
47                                                             20. Enterprise zone day care and training credits (include a copy of the credit certificate) .........................20.                                                                          8888888 00
48                                                            21. Research and development credit (include a copy of the credit certificate) ...........................................21.
                                                                                                                                                                                                                                                                  8888888 00
49
                                                               22. Ohio historic preservation credit, nonrefundable carryforward portion (include a copy of the credit 
50                                                                certificate) ..............................................................................................................................................22.
                                                                                                                                                                                                                                                                  8888888 00
51                                                                                                                                          2D barcode required. Delete this 
52                                                             23. Total (add lines 12 through 22) ..............................................................................................................23.box with text and replace it with 
                                                                                                                                                                                                                                                                  8888888 00
53                                                                                                                                          the 2D barcode.
54                                                             24. Tax less additional credits (line 11 minus line 23; if less than -0-, enter -0-) ...........................................24.
                                                                                                                                                                                                                                                               888888888 00
55
56
57                                                                                                                                                                                                                                                    Target marks or registration marks 
58                                                                       Software vendors: Place 2D barcode in this location                                                                                                                          must measure 6 mm X 6 mm. The 
                                                                                                                                                                                                                                                      four target marks or registration 
59                                                                       Do not place a box around the 2D barcode. The box                                                                                                                            marks on every page must follow 
60                                                                                     is only here for placement purposes.                                                                                                                           grid layout.
61
62
63
64                                                                                                                               2017 Ohio Schedule of Credits – page 1 of 2
65
66

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 Schedule of Credits
7                      Rev. 08/17      Nonrefundable and Refundable
                                                                                                                                                   17280210
8                                                                                                        SSN of primary filer
9                                                                                                        888 88 8888                                                  8
10
11 Nonresident Credit  
12 Date of nonresidency            to                                                                    State of residency
                         88 88 88                              88 88 88                                                      XX
13  
14   25. Enter the portion of Ohio adjusted gross income (Ohio 
15       IT 1040, line 3) that was not earned or received in 
         Ohio. Include Ohio IT NRC if required ...............................25.                        888888888 00
16
     26. Enter the Ohio adjusted gross income (Ohio IT 1040, 
17       line 3) ....................................................................................26. 88888888888 00
18
19  27. Divide line 25 by line 26 and enter the result here (four digits; do not round).                 .8888                                NEW! This indicates the 
                                                                                                                                              sequence number.
20      Multiply this factor by the amount on line 24 to calculate your nonresident credit ...................................27.                  888888888 00
21
22 Resident Credit
23   28. Enter the portion of Ohio adjusted gross income (Ohio 
24       IT 1040, line 3) subjected to tax by other states or the 
         District of Columbia while you were an Ohio resident 
25       (limits apply) .....................................................................28.         888888888 00
26
27
28  29. Enter the Ohio adjusted gross income (Ohio IT 1040, 
         line 3) .............................................................................29.        88888888888 00
29
30  30. Divide line 28 by line 29 and enter the result here (four digits; do not round).
                                                                                                         .8888
31
     Multiply this factor by the amount on line 24 and enter
32       the result here ................................................................30.             888888888 00
33                                                                                                                             .
34   31. Enter the 2017 income tax, less all credits other than
35       withholding and estimated tax payments and overpayment 
         carryforwards from previous years, paid to other states or 
36       the District of Columbia (limits apply) .............................31.
                                                                                                         888888888 00
37
     32. Enter the smaller of line 30 or line 31. This is your Ohio resident tax credit. Enter the two-letter 
38       state abbreviation in the boxes below for each state in which income was subject to tax .....................32.                          888888888 00
39
         XX XX XX XX     XX XX
40  
41  33. Total nonrefundable credits (add lines 10, 23, 27 and 32; enter here and on Ohio IT 1040, line 9) ..33.
                                                                                                                                                   888888888 00
42
43
44                                 Refundable Credits
45   34. Historic preservation credit (include a copy of the credit certificate) ......................................................34.
                                                                                                                                                   88888888 00
46  
47   35. Job creation credit and job retention credit, refundable portion (include a copy of the credit certificate) ...35.
                                                                                                                                                   88888888 00
48
49   36. Pass-through entity credit (include a copy of the Ohio K-1s) .................................................................36.
                                                                                                                                                   88888888 00
50
51   37. Motion picture production credit (include a copy of the credit certificate) ..............................................37.             88888888 00
52  
53   38. Financial Institutions Tax (FIT) credit (include a copy of the Ohio K-1s) ................................................38.
                                                                                                                                                   88888888 00
54
55   39. Venture capital credit (include a copy of the credit certificate) ...............................................................39.      88888888 00
56
57   40. Total refundable credits (add lines 34 through 39; enter here and on Ohio IT 1040, line 16) .............40.
                                                                                                                                                   888888888 00
58
59
60
61
62
63
64                                                                2017 Ohio Schedule of Credits – page 2 of 2
65
66

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 Schedule of Credits
7                                                                               Rev. 08/17        Nonrefundable and Refundable
                                                                                                                                                                                                                                17280110
8                                                                                                                                    SSN of primary filer
9  88 88 88                                                                                                                      888 88 8888                                                                                                   7
10
11                                                                                                Nonrefundable Credits
12                                                              1. Tax liability before credits (from Ohio IT 1040, line 8c) ..............................................................................1.                   888888888 00
13
14                                                              2. Retirement income credit (limit $200 per return) (see instructions for table) ............................................2.                                         888 00
15
16                                                              3. Lump sum retirement credit – Ohio LS WKS, Section III, line 6 (include worksheet) ..............................3.                                           888888 00
17                                                              4. Senior citizen credit (must be 65 or older to claim this credit; limit $50 per return) ...............................4.                                             8888 00
18                                                            
19                                                              5. Lump sum distribution credit – Ohio LS WKS, Section IV, line 3 (include worksheet) .............................5.
                                                                                                                                                                                                                                8888 00
20
21                                                              6. Child care and dependent care credit (see instructions for worksheet).......................................... .........6.
                                                                                                                                                                                                                                8888 00
22
                                                                7.  Displaced worker training credit (see instructions for worksheet) (limit $500 per taxpayer) ..................7.                                            8888 00
23
24                                                              8. Campaign contribution credit for Ohio statewide office or General Assembly (limit $50 per taxpayer) .....8.                                                          888 00
25
                                                                                                                                                                                                                                        888 00
26                                                              9. Income-based exemption credit ($20 times the number of exemptions) .................................................9.
27
                                                               10. Total (add lines 2 through 9) ..................................................................................................................10.          888888888 00
28
29                                                             11. Tax less credits (line 1 minus line 10; if less than -0-, enter -0-) ............................................................11.
                                                                                                                                                                                                                                888888888 00
30                                                            
31                                                             12. Joint filing credit (see instructions).              88 %mestithe amount on line 11(limit $650) ....................................12.                              888 00
32
33                                                             13. Earned income credit .............................................................................................................................13.
                                                                                                                                                                                                                                        888 00
34
                                                                                                                                                                                                                                88888 00
35                              Do not staple or paper clip.   14. Ohio adoption credit (limit $10,000 per adopted child) .......................................................................14.
36
37                                                             15. Job retention credit, nonrefundable portion (include a copy of the credit certificate) .............................15.
                                                                                                                                                                                                                                8888888 00
38
39                                                             16. Credit for eligible new employees in an enterprise zone (include a copy of the credit certificate) .........16.
                                                                                                                                                                                                                                8888888 00
40
41                                                             17. Credit for purchases of grape production property ................................................................................17.
                                                                                                                                                                                                                                8888888 00
42
43                                                             18. Invest Ohio credit (include a copy of the credit certificate) ....................................................................18.
                                                                                                                                                                                                                                8888888 00
44
45                                                             19. Technology investment credit carryforward (include a copy of the credit certificate) .............................19.                                        8888888 00
46
47                                                             20. Enterprise zone day care and training credits (include a copy of the credit certificate) .........................20.                                        8888888 00
48                                                            21. Research and development credit (include a copy of the credit certificate) ...........................................21.
                                                                                                                                                                                                                                8888888 00
49
                                                               22. Ohio historic preservation credit, nonrefundable carryforward portion (include a copy of the credit 
50                                                                certificate) ..............................................................................................................................................22.
                                                                                                                                                                                                                                8888888 00
51
52                                                             23. Total (add lines 12 through 22) ..............................................................................................................23.
                                                                                                                                                                                                                                8888888 00
53
54                                                             24. Tax less additional credits (line 11 minus line 23; if less than -0-, enter -0-) ...........................................24.
                                                                                                                                                                                                                                888888888 00
55
56
57
58                                                                       Software vendors: Place 2D barcode in this location
59                                                                       Do not place a box around the 2D barcode. The box 
60                                                                                     is only here for placement purposes.
61
62
63
64                                                                                                                               2017 Ohio Schedule of Credits – page 1 of 2
65
66

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 Schedule of Credits
7                      Rev. 08/17      Nonrefundable and Refundable
                                                                                                                                              17280210
8                                                                                                        SSN of primary filer
9                                                                                                        888 88 8888                                      8
10
11 Nonresident Credit  
12 Date of nonresidency            to                                                                    State of residency
                         88 88 88                              88 88 88                                                      XX
13  
14   25. Enter the portion of Ohio adjusted gross income (Ohio 
15       IT 1040, line 3) that was not earned or received in 
         Ohio. Include Ohio IT NRC if required ...............................25.                        888888888 00
16
     26. Enter the Ohio adjusted gross income (Ohio IT 1040, 
17       line 3) ....................................................................................26. 88888888888 00
18
19  27. Divide line 25 by line 26 and enter the result here (four digits; do not round).                 .8888
20      Multiply this factor by the amount on line 24 to calculate your nonresident credit ...................................27.             888888888 00
21
22 Resident Credit
23   28. Enter the portion of Ohio adjusted gross income (Ohio 
24       IT 1040, line 3) subjected to tax by other states or the 
         District of Columbia while you were an Ohio resident 
25       (limits apply) .....................................................................28.         888888888 00
26
27
28  29. Enter the Ohio adjusted gross income (Ohio IT 1040, 
         line 3) .............................................................................29.        88888888888 00
29
30  30. Divide line 28 by line 29 and enter the result here (four digits; do not round).
                                                                                                         .8888
31
     Multiply this factor by the amount on line 24 and enter
32       the result here ................................................................30.             888888888 00
33                                                                                                                             .
34   31. Enter the 2017 income tax, less all credits other than
35       withholding and estimated tax payments and overpayment 
         carryforwards from previous years, paid to other states or 
36       the District of Columbia (limits apply) .............................31.
                                                                                                         888888888 00
37
     32. Enter the smaller of line 30 or line 31. This is your Ohio resident tax credit. Enter the two-letter 
38       state abbreviation in the boxes below for each state in which income was subject to tax .....................32.                     888888888 00
39
         XX XX XX XX     XX XX
40  
41  33. Total nonrefundable credits (add lines 10, 23, 27 and 32; enter here and on Ohio IT 1040, line 9) ..33.
                                                                                                                                              888888888 00
42
43
44                                 Refundable Credits
45   34. Historic preservation credit (include a copy of the credit certificate) ......................................................34.
                                                                                                                                              88888888 00
46  
47   35. Job creation credit and job retention credit, refundable portion (include a copy of the credit certificate) ...35.
                                                                                                                                              88888888 00
48
49   36. Pass-through entity credit (include a copy of the Ohio K-1s) .................................................................36.
                                                                                                                                              88888888 00
50
51   37. Motion picture production credit (include a copy of the credit certificate) ..............................................37.        88888888 00
52  
53   38. Financial Institutions Tax (FIT) credit (include a copy of the Ohio K-1s) ................................................38.
                                                                                                                                              88888888 00
54
55   39. Venture capital credit (include a copy of the credit certificate) ...............................................................39. 88888888 00
56
57   40. Total refundable credits (add lines 34 through 39; enter here and on Ohio IT 1040, line 16) .............40.
                                                                                                                                              888888888 00
58
59
60
61
62
63
64                                                                2017 Ohio Schedule of Credits – page 2 of 2
65
66

Layout 

without grid

                                                          Do not staple or paper clip. 

                                                                                               2017 Ohio Schedule of Credits
                                                                             Rev. 08/17        Nonrefundable and Refundable
                                                                                                                                                                                                                              17280110
                                                                                                                                  SSN of primary filer
88 88 88                                                                                                                      888 88 8888                                                                                                    7
                                                                                               Nonrefundable Credits
                                                             1. Tax liability before credits (from Ohio IT 1040, line 8c) ..............................................................................1.                    888888888 00

                                                             2. Retirement income credit (limit $200 per return) (see instructions for table) ............................................2.                                          888 00

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

                                                             6. Child care and dependent care credit (see instructions for worksheet).......................................... .........6.                                   8888 00
                                                             7.  Displaced worker training credit (see instructions for worksheet) (limit $500 per taxpayer) ..................7.                                             8888 00

                                                             8. Campaign contribution credit for Ohio statewide office or General Assembly (limit $50 per taxpayer) .....8.                                                           888 00

                                                             9. Income-based exemption credit ($20 times the number of exemptions) .................................................9.                                                888 00
                                                            10. Total (add lines 2 through 9) ..................................................................................................................10.           888888888 00

                                                            11. Tax less credits (line 1 minus line 10; if less than -0-, enter -0-) ............................................................11.                          888888888 00
                                                           
                                                            12. Joint filing credit (see instructions).              88 %mestithe amount on line 11(limit $650) ....................................12.                               888 00

                                                            13. Earned income credit .............................................................................................................................13.                 888 00

                             Do not staple or paper clip.   14. Ohio adoption credit (limit $10,000 per adopted child) .......................................................................14.                             88888 00
                                                            15. Job retention credit, nonrefundable portion (include a copy of the credit certificate) .............................15.                                       8888888 00

                                                            16. Credit for eligible new employees in an enterprise zone (include a copy of the credit certificate) .........16.                                               8888888 00

                                                            17. Credit for purchases of grape production property ................................................................................17.                         8888888 00

                                                            18. Invest Ohio credit (include a copy of the credit certificate) ....................................................................18.                         8888888 00

                                                            19. Technology investment credit carryforward (include a copy of the credit certificate) .............................19.                                         8888888 00

                                                            20. Enterprise zone day care and training credits (include a copy of the credit certificate) .........................20.                                         8888888 00
                                                           21. Research and development credit (include a copy of the credit certificate) ...........................................21.                                      8888888 00
                                                            22. Ohio historic preservation credit, nonrefundable carryforward portion (include a copy of the credit 
                                                               certificate) ..............................................................................................................................................22. 8888888 00

                                                            23. Total (add lines 12 through 22) ..............................................................................................................23.             8888888 00

                                                            24. Tax less additional credits (line 11 minus line 23; if less than -0-, enter -0-) ...........................................24.                               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 Ohio Schedule of Credits – page 1 of 2

                                2017 Ohio Schedule of Credits
                    Rev. 08/17      Nonrefundable and Refundable
                                                                                                      SSN of primary filer                 17280210
                                                                                                      888 88 8888                                      8
Nonresident Credit  
Date of nonresidency  88 88 88  to                          88 88 88                                  State of residency   XX
 
  25. Enter the portion of Ohio adjusted gross income (Ohio 
      IT 1040, line 3) that was not earned or received in 
      Ohio. Include Ohio IT NRC if required ...............................25.                        888888888 00
  26. Enter the Ohio adjusted gross income (Ohio IT 1040, 
      line 3) ....................................................................................26. 88888888888 00

 27. Divide line 25 by line 26 and enter the result here (four digits; do not round).                 .8888
     Multiply this factor by the amount on line 24 to calculate your nonresident credit ...................................27.             888888888 00
Resident Credit
  28. Enter the portion of Ohio adjusted gross income (Ohio 
      IT 1040, line 3) subjected to tax by other states or the 
      District of Columbia while you were an Ohio resident 
      (limits apply) .....................................................................28.         888888888 00

 29. Enter the Ohio adjusted gross income (Ohio IT 1040, 
      line 3) .............................................................................29.        88888888888 00

 30. Divide line 28 by line 29 and enter the result here (four digits; do not round).                 .8888
  Multiply this factor by the amount on line 24 and enter
      the result here ................................................................30.             888888888 00
                                                                                                                             .
  31. Enter the 2017 income tax, less all credits other than
      withholding and estimated tax payments and overpayment 
      carryforwards from previous years, paid to other states or 
      the District of Columbia (limits apply) .............................31.                        888888888 00
  32. Enter the smaller of line 30 or line 31. This is your Ohio resident tax credit. Enter the two-letter 
      state abbreviation in the boxes below for each state in which income was subject to tax .....................32.                     888888888 00
      XX XX XX XX     XX XX
 33. Total nonrefundable credits (add lines 10, 23, 27 and 32; enter here and on Ohio IT 1040, line 9) ..33.                               888888888 00

                                Refundable Credits
  34. Historic preservation credit (include a copy of the credit certificate) ......................................................34.    88888888 00
 
  35. Job creation credit and job retention credit, refundable portion (include a copy of the credit certificate) ...35.                   88888888 00

  36. Pass-through entity credit (include a copy of the Ohio K-1s) .................................................................36.    88888888 00

  37. Motion picture production credit (include a copy of the credit certificate) ..............................................37.        88888888 00
 
  38. Financial Institutions Tax (FIT) credit (include a copy of the Ohio K-1s) ................................................38.        88888888 00

  39. Venture capital credit (include a copy of the credit certificate) ...............................................................39. 88888888 00

  40. Total refundable credits (add lines 34 through 39; enter here and on Ohio IT 1040, line 16) .............40.                         888888888 00

                                                               2017 Ohio Schedule of Credits – page 2 of 2

General information 

regarding this form

 General Information (2017 Schedule of Credits):

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

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

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

2) 1D barcode - The last two numbers of the 1D barcode represent the vendor number. Use the same vendor 
number as you did for last year’s return. If you have a question about your barcode assignment, e-mail the Forms 
Unit at Forms@tax.state.oh.us. The first six numbers are constant for this form (172801XX - 172802XX). 

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

   NOTE: The vendor number also serves as the first two digits of the SSN 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) Provide guidance to customers regarding duplex printing that instructs them to print pages 1 and 2 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.

9) 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 documents generated from the software must in-
clude a 1D barcode identifying it as 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).

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

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

                                                      Rev. 11/03/17

Scan Specifications for the 

   2017 Ohio Schedule J

                   Important Note

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

   The 2017 Ohio Schedule J test samples must be completed and 
   submitted for approval no later than Dec.22, 2017. 

       Ohio Department of Taxation

                             4485 Northland Ridge Blvd.

                             Columbus, OH 43229

                             tax.ohio.gov

Grid layout 

with notations

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3
4                               Do not staple or paper clip. 
5
                                                                                          Ohio Schedule J
6
7                                   The date the returnRev. 8/17was generated Dependents Claimed on the Ohio IT 1040 Return
                                    by the taxpayer (MM DD YY).
8                                                                                                                                                                         17230110
                                                                    Tax Year              SSN of primary filer (required)                                                                                      9
10                                                                  2017
9  88 88 88                                                                        Placement888of the88tax year8888and 1D barcode is critical. 
                                                                                   Make sure to follow the grid positions for layout. Do 
11 Do not list below the primary filer and/or spouse reported on Ohio IT 1040.not forget to get your barcode(s) assignments for  Use this schedule to claim dependents. If you have more than 15 dependents, 
12 complete additional copies of this schedule and include themeverywithform,yourversionincomeand page.tax return. Abbreviate the “Dependent’s relationship to you” below if there are 
13 not enough boxes to spell it out completely. 
14                               1. Dependent’s SSN (required)                Dependent's date of birth (MM DD YYYY - Required)                                      Dependent’s relationship to you (required)
15                                  888 88 8888                               88 88 8888                                                                             XXXXXXXXXXXXXXX
16                                  Dependent’s first name (required)         M.I. Dependent’s Last name (required)
17                                                                                              CXXXXXXXXXXXXXX
                                    JOHNXXXXXXXXXXX                           Q    PUBL I 
18
19                               2. Dependent’s SSN (required)                Dependent's date of birth (MM DD YYYY - Required)                                      Dependent’s relationship to you (required)
                                                                                   For static text use Arial font (black ink) and try to 
20                                  888 88 8888                               88 88 8888match size. For data entry fields (shown in red                              XXXXXXXXXXXXXXX
21                                  Dependent’s first name (required)         M.I. for identification purposes onlyDependent’s Last name (required)), use Arial font 
22                                                                                 (black ink). AllCXXXXXXXXXXXXXXthe data entry fields must follow 
                                    JOHNXXXXXXXXXXX                           Q    PUBL I 
23                                                                                 grid layout.
24                               3. Dependent’s SSN (required)                Dependent's date of birth (MM DD YYYY - Required)                                      Dependent’s relationship to you (required)
25                                  888 88 8888                               88 88 8888                                                                             XXXXXXXXXXXXXXX
26                                  Dependent’s first name (required)         M.I. Dependent’s Last name (required)
                                                                                                                                                                     NEW! This indicates the 
                                    JOHNXXXXXXXXXXX                           Q 
27                                                                                 PUBL I  CXXXXXXXXXXXXXX                                                           sequence number.
28
29                               4. Dependent’s SSN (required)                Dependent's date of birth (MM DD YYYY - Required)                                      Dependent’s relationship to you (required)
30                                  888 88 8888                               88 88 8888                                                                             XXXXXXXXXXXXXXX
31                                  Dependent’s first name (required)         M.I. Dependent’s Last name (required)
32                                                                                              CXXXXXXXXXXXXXX
                                    JOHNXXXXXXXXXXX                           Q    PUBL I 
33
34                               5. Dependent’s SSN (required)                Dependent's date of birth (MM DD YYYY - Required)                                      Dependent’s relationship to you (required)
35                                  888 88 8888                               88 88 8888                                                                             XXXXXXXXXXXXXXX
36                                  Dependent’s first name (required)         M.I. Dependent’s Last name (required)
37 Do not staple or paper clip.     JOHNXXXXXXXXXXX                           Q    PUBL I  CXXXXXXXXXXXXXX
38
39                               6. Dependent’s SSN (required)                Dependent's date of birth (MM DD YYYY - Required)                                      Dependent’s relationship to you (required)
40
                                    888 88 8888                               88 88 8888                                                                             XXXXXXXXXXXXXXX
41                                  Dependent’s first name (required)         M.I. Dependent’s Last name (required)
42                                                                                              CXXXXXXXXXXXXXX
                                    JOHNXXXXXXXXXXX                           Q    PUBL I 
43
44                               7. Dependent’s SSN (required)                Dependent's date of birth (MM DD YYYY - Required)                                      Dependent’s relationship to you (required)
45                                  888 88 8888                               88 88 8888                                                                             XXXXXXXXXXXXXXX
46                                  Dependent’s first name (required)         M.I. Dependent’s Last name (required)
47                                                                                              CXXXXXXXXXXXXXX
                                    JOHNXXXXXXXXXXX                           Q    PUBL I 
48
49                                                                                                                                                 2D barcode required. Delete this 
50                                                                                                                                                 box with text and replace it with 
51                                                                                                                                                 the 2D barcode.
52
53
54
55
56                                                                            Software vendors: Place 2D barcode in this location
57                                                                            Do not place a box around the 2D barcode. The box                                      Target marks or registration marks 
58                                                                                 is only here for placement purposes.                                              must measure 6 mm X 6 mm. The 
                                                                                                                                                                     four target marks or registration 
59                                                                                                                                                                   marks on every page must follow 
60                                                                                                                                                                   grid layout.
61
62
63
64                                                                                                          2017 Ohio Schedule J – page 1 of 2
65
66

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
                                                     Ohio Schedule J
6
7       Rev. 9/16                               Dependents Claimed on the Ohio IT 1040 Return
                                                                                                       17230210
8                                  Tax Year          SSN of primary filer (required)                                      10
9                                                           888 88 8888
10                                 2017
11 Do not list below the primary filer and/or spouse reported on Ohio IT 1040. Use this schedule to claim dependents. If you have more than 15 dependents, 
12 complete additional copies of this schedule and include them with your income tax return. Abbreviate the “Dependent’s relationship to you” below if there are 
13 not enough boxes to spell it out completely. 
14  8.  Dependent’s SSN (required)              Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
15      888 88 8888                             88 88 8888                                        XXXXXXXXXXXXXXX
16      Dependent’s first name (required)       M.I. Dependent’s Last name (required)
17                                                    CXXXXXXXXXXXXXX
        JOHNXXXXXXXXXXX                         Q    PUBL I 
18
19  9.  Dependent’s SSN (required)              Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
20      888 88 8888                             88 88 8888                                        XXXXXXXXXXXXXXX
21      Dependent’s first name (required)       M.I. Dependent’s Last name (required)
22                                                    CXXXXXXXXXXXXXX
        JOHNXXXXXXXXXXX                         Q    PUBL I 
23
24  10. Dependent’s SSN (required)              Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
25      888 88 8888                             88 88 8888                                        XXXXXXXXXXXXXXX
26      Dependent’s first name (required)       M.I. Dependent’s Last name (required)
                                                                                                  NEW! This indicates the 
        JOHNXXXXXXXXXXX                         Q 
27                                                   PUBL I  CXXXXXXXXXXXXXX                      sequence number.
28
29  11. Dependent’s SSN (required)              Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
30      888 88 8888                             88 88 8888                                        XXXXXXXXXXXXXXX
31      Dependent’s first name (required)       M.I. Dependent’s Last name (required)
32                                                    CXXXXXXXXXXXXXX
        JOHNXXXXXXXXXXX                         Q    PUBL I 
33
34  12. Dependent’s SSN (required)              Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
35      888 88 8888                             88 88 8888                                        XXXXXXXXXXXXXXX
36      Dependent’s first name (required)       M.I. Dependent’s Last name (required)
37                                                    CXXXXXXXXXXXXXX
        JOHNXXXXXXXXXXX                         Q    PUBL I 
38
39  13. Dependent’s SSN (required)              Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
40
        888 88 8888                             88 88 8888                                        XXXXXXXXXXXXXXX
41      Dependent’s first name (required)       M.I. Dependent’s Last name (required)
42                                                    CXXXXXXXXXXXXXX
        JOHNXXXXXXXXXXX                         Q    PUBL I 
43
44  14. Dependent’s SSN (required)              Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
45      888 88 8888                             88 88 8888                                        XXXXXXXXXXXXXXX
46      Dependent’s first name (required)       M.I. Dependent’s Last name (required)
47                                                    CXXXXXXXXXXXXXX
        JOHNXXXXXXXXXXX                         Q    PUBL I 
48
49 15.  Dependent’s SSN (required)              Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
50
        888 88 8888                             88 88 8888                                        XXXXXXXXXXXXXXX
51      Dependent’s first name (required)       M.I. Dependent’s Last name (required)
52
53      JOHNXXXXXXXXXXX                         Q    PUBL I  CXXXXXXXXXXXXXX
54
55
56
57
58
59
60
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64                                                                            2017 Ohio Schedule J – page 2 of 2        
65
66

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
                                                                           Ohio Schedule J
6
7                                   Rev. 8/17                         Dependents Claimed on the Ohio IT 1040 Return
8                                                                                                                       17230110
                                                               Tax Year    SSN of primary filer (required)                                                        9
9  88 88 88                                                                       888 88 8888
10                                                             2017
11 Do not list below the primary filer and/or spouse reported on Ohio IT 1040. Use this schedule to claim dependents. If you have more than 15 dependents, 
12 complete additional copies of this schedule and include them with your income tax return. Abbreviate the “Dependent’s relationship to you” below if there are 
13 not enough boxes to spell it out completely. 
14                               1. Dependent’s SSN (required)        Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
15                                  888 88 8888                       88 88 8888                                        XXXXXXXXXXXXXXX
16                                  Dependent’s first name (required) M.I. Dependent’s Last name (required)
17                                                                          CXXXXXXXXXXXXXX
                                    JOHNXXXXXXXXXXX                   Q    PUBL I 
18
19                               2. Dependent’s SSN (required)        Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
20                                  888 88 8888                       88 88 8888                                        XXXXXXXXXXXXXXX
21                                  Dependent’s first name (required) M.I. Dependent’s Last name (required)
22                                                                          CXXXXXXXXXXXXXX
                                    JOHNXXXXXXXXXXX                   Q    PUBL I 
23
24                               3. Dependent’s SSN (required)        Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
25                                  888 88 8888                       88 88 8888                                        XXXXXXXXXXXXXXX
26                                  Dependent’s first name (required) M.I. Dependent’s Last name (required)
27                                                                         PUBL I  CXXXXXXXXXXXXXX
                                    JOHNXXXXXXXXXXX                   Q 
28
29                               4. Dependent’s SSN (required)        Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
30                                  888 88 8888                       88 88 8888                                        XXXXXXXXXXXXXXX
31                                  Dependent’s first name (required) M.I. Dependent’s Last name (required)
32                                                                          CXXXXXXXXXXXXXX
                                    JOHNXXXXXXXXXXX                   Q    PUBL I 
33
34                               5. Dependent’s SSN (required)        Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
35                                  888 88 8888                       88 88 8888                                        XXXXXXXXXXXXXXX
36                                  Dependent’s first name (required) M.I. Dependent’s Last name (required)
37 Do not staple or paper clip.     JOHNXXXXXXXXXXX                   Q    PUBL I  CXXXXXXXXXXXXXX
38
39                               6. Dependent’s SSN (required)        Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
40
                                    888 88 8888                       88 88 8888                                        XXXXXXXXXXXXXXX
41                                  Dependent’s first name (required) M.I. Dependent’s Last name (required)
42                                                                          CXXXXXXXXXXXXXX
                                    JOHNXXXXXXXXXXX                   Q    PUBL I 
43
44                               7. Dependent’s SSN (required)        Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
45                                  888 88 8888                       88 88 8888                                        XXXXXXXXXXXXXXX
46                                  Dependent’s first name (required) M.I. Dependent’s Last name (required)
47                                                                          CXXXXXXXXXXXXXX
                                    JOHNXXXXXXXXXXX                   Q    PUBL I 
48
49
50
51
52
53
54
55
56                                                             Software vendors: Place 2D barcode in this location
57                                                             Do not place a box around the 2D barcode. The box 
58                                                                         is only here for placement purposes.
59
60
61
62
63
64                                                                                 2017 Ohio Schedule J – page 1 of 2
65
66

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
                                                     Ohio Schedule J
6
7       Rev. 9/16                               Dependents Claimed on the Ohio IT 1040 Return
                                                                                                  17230210
8                                  Tax Year          SSN of primary filer (required)                             10
9                                                           888 88 8888
10                                 2017
11 Do not list below the primary filer and/or spouse reported on Ohio IT 1040. Use this schedule to claim dependents. If you have more than 15 dependents, 
12 complete additional copies of this schedule and include them with your income tax return. Abbreviate the “Dependent’s relationship to you” below if there are 
13 not enough boxes to spell it out completely. 
14  8.  Dependent’s SSN (required)              Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
15      888 88 8888                             88 88 8888                                        XXXXXXXXXXXXXXX
16      Dependent’s first name (required)       M.I. Dependent’s Last name (required)
17                                                    CXXXXXXXXXXXXXX
        JOHNXXXXXXXXXXX                         Q    PUBL I 
18
19  9.  Dependent’s SSN (required)              Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
20      888 88 8888                             88 88 8888                                        XXXXXXXXXXXXXXX
21      Dependent’s first name (required)       M.I. Dependent’s Last name (required)
22                                                    CXXXXXXXXXXXXXX
        JOHNXXXXXXXXXXX                         Q    PUBL I 
23
24  10. Dependent’s SSN (required)              Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
25      888 88 8888                             88 88 8888                                        XXXXXXXXXXXXXXX
26      Dependent’s first name (required)       M.I. Dependent’s Last name (required)
27                                                   PUBL I  CXXXXXXXXXXXXXX
        JOHNXXXXXXXXXXX                         Q 
28
29  11. Dependent’s SSN (required)              Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
30      888 88 8888                             88 88 8888                                        XXXXXXXXXXXXXXX
31      Dependent’s first name (required)       M.I. Dependent’s Last name (required)
32                                                    CXXXXXXXXXXXXXX
        JOHNXXXXXXXXXXX                         Q    PUBL I 
33
34  12. Dependent’s SSN (required)              Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
35      888 88 8888                             88 88 8888                                        XXXXXXXXXXXXXXX
36      Dependent’s first name (required)       M.I. Dependent’s Last name (required)
37                                                    CXXXXXXXXXXXXXX
        JOHNXXXXXXXXXXX                         Q    PUBL I 
38
39  13. Dependent’s SSN (required)              Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
40
        888 88 8888                             88 88 8888                                        XXXXXXXXXXXXXXX
41      Dependent’s first name (required)       M.I. Dependent’s Last name (required)
42                                                    CXXXXXXXXXXXXXX
        JOHNXXXXXXXXXXX                         Q    PUBL I 
43
44  14. Dependent’s SSN (required)              Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
45      888 88 8888                             88 88 8888                                        XXXXXXXXXXXXXXX
46      Dependent’s first name (required)       M.I. Dependent’s Last name (required)
47                                                    CXXXXXXXXXXXXXX
        JOHNXXXXXXXXXXX                         Q    PUBL I 
48
49 15.  Dependent’s SSN (required)              Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
50
        888 88 8888                             88 88 8888                                        XXXXXXXXXXXXXXX
51      Dependent’s first name (required)       M.I. Dependent’s Last name (required)
52
53      JOHNXXXXXXXXXXX                         Q    PUBL I  CXXXXXXXXXXXXXX
54
55
56
57
58
59
60
61
62
63
64                                                                            2017 Ohio Schedule J – page 2 of 2        
65
66

 Layout 

without grid

                             Do not staple or paper clip. 
                                                                        Ohio Schedule J
                                 Rev. 8/17                         Dependents Claimed on the Ohio IT 1040 Return
                                                                                                                     17230110
                                                            Tax Year    SSN of primary filer (required)                                                        9
88 88 88                                                    2017               888 88 8888
Do not list below the primary filer and/or spouse reported on Ohio IT 1040. Use this schedule to claim dependents. If you have more than 15 dependents, 
complete additional copies of this schedule and include them with your income tax return. Abbreviate the “Dependent’s relationship to you” below if there are 
not enough boxes to spell it out completely. 
                              1. Dependent’s SSN (required)        Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
                                 888 88 8888                       88 88 8888                                        XXXXXXXXXXXXXXX
                                 Dependent’s first name (required) M.I. Dependent’s Last name (required)
                                 JOHNXXXXXXXXXXX                   Q    PUBL I  CXXXXXXXXXXXXXX

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

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

                              5. Dependent’s SSN (required)        Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
                                 888 88 8888                       88 88 8888                                        XXXXXXXXXXXXXXX
                                 Dependent’s first name (required) M.I. Dependent’s Last name (required)
Do not staple or paper clip.     JOHNXXXXXXXXXXX                   Q    PUBL I  CXXXXXXXXXXXXXX

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

                                                            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 Ohio Schedule J – page 1 of 2

                                                  Ohio Schedule J
     Rev. 9/16                               Dependents Claimed on the Ohio IT 1040 Return
                                                                                               17230210
                                Tax Year          SSN of primary filer (required)                             10
                                2017                     888 88 8888
Do not list below the primary filer and/or spouse reported on Ohio IT 1040. Use this schedule to claim dependents. If you have more than 15 dependents, 
complete additional copies of this schedule and include them with your income tax return. Abbreviate the “Dependent’s relationship to you” below if there are 
not enough boxes to spell it out completely. 
 8.  Dependent’s SSN (required)              Dependent's date of birth (MM DD YYYY - Required) Dependent’s relationship to you (required)
     888 88 8888                             88 88 8888                                        XXXXXXXXXXXXXXX
     Dependent’s first name (required)       M.I. Dependent’s Last name (required)
     JOHNXXXXXXXXXXX                         Q    PUBL I  CXXXXXXXXXXXXXX

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

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

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

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

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

                                                                           2017 Ohio Schedule J – page 2 of 2        

General information 

regarding this form

         General Information (2017 Schedule J):

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

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

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

2) 1D barcode - The last two numbers of the 1D barcode represent the vendor number. Use the same vendor 
number as you did for last year’s return. If you have a question about your barcode assignment, e-mail the Forms 
Unit at Forms@tax.state.oh.us. The first six numbers are constant for this form (172301XX - 172302XX). 

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

   NOTE: The vendor number also serves as the first two digits of the SSN 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) Provide guidance to customers regarding duplex printing that instructs them to print pages 1 and 2 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.

9) 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 documents generated from the software must in-
clude a 1D barcode identifying it as 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).

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

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

Ohio  ITRE
Note: This form is not captured, but is required for 

submissions of any amended test scenarios. The last 

two-digits of the barcode for this form is the same as 

what you were assigned for the other scanned forms.

                                                                                                    Tax Year              IT RE
                                                                                                                          Rev. 9/17

                                                               17270110

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

First name                                            M.I.Last name

Reason(s):
 Net operating loss carryback (IMPORTANT: Be sure to complete          Ohio Schedule of Credits, resident credit increased
 and include Ohio Schedule IT NOL, Net Operating Loss Carryback        Ohio Schedule of Credits, resident credit decreased
 [available at tax.ohio.gov] and check the box on the front of the 
 Ohio IT 1040 indicating that you are amending for a NOL.)             Ohio Schedule of Credits, refundable credit(s) increased
 Federal adjusted gross income increased                               Ohio Schedule of Credits, refundable credit(s) decreased
 Federal adjusted gross income decreased*                              Ohio IT/SD 2210 interest penalty amount increased
 Filing status changed*                                                Ohio IT/SD 2210 interest penalty amount decreased
 Residency status changed                                              Ohio sales and use tax increased
 Exemptions increased (include Schedule J)*                            Ohio sales and use tax decreased
 Exemptions decreased (include Schedule J)                             Ohio withholding increased
 Ohio Schedule A, additions to income                                  Ohio withholding decreased
 Ohio Schedule A, deductions from income                               Estimated and/or Ohio IT 40P amount or previous year 
                                                                       carryforward overpayment increased
 Ohio Schedule of Credits, nonrefundable credit(s) increased
                                                                       Estimated and/or Ohio IT 40P amount or previous year 
 Ohio Schedule of Credits, nonrefundable credit(s) decreased           carryforward overpayment decreased
 Ohio Schedule of Credits, nonresident credit increased                Amount paid with original filing did not equal amount reported as 
 Ohio Schedule of Credits, nonresident credit decreased                paid with the original filing

*To avoid delays you must include a copy of your federal account transcript OR a copy of your federal amended income tax return with a 
copy of the federal acceptance letter or refund check.
Detailed explanation of adjusted items (include additional sheet[s] if necessary):

E-mail address                                                     Telephone number

                                            Federal Privacy Act Notice
 Because we require you to provide us with a Social Security number, the Federal Privacy Act of 1974 requires us to inform you that 
 providing us your Social Security number is mandatory. Ohio Revised Code sections 5703.05, 5703.057 and 5747.08 authorize us to 
 request this information. We need your Social Security number in order to administer this tax. 

   Additional Instructions 

   for the 2D barcode and 

regarding submissions, 

testing and notifications 

for the 2017 Ohio  IT10                                           40

                    Important Note

It is required that vendors program the Ohio  IT 410 0 to include 2D barcodes.

                     2017 Ohio IT 1040 

          Individual Income Tax Return Bundle 

                     2D Barcode Instructions 
 
 General Information 
 • The Ohio IT 1040 bundle 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                              1700<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 1040 bundle test packets is December 22, 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_1040 
    •       Submissions must include 
            • Ohio form STF- Approval Request for Scannable Tax Forms 
            • One (1) full field sample in a PDF format 
            •    Sixteen (16) test scenarios for the Ohio IT 1040 bundle provided by the Ohio 
                  Department of Taxation. These test scenarios can include the following return, 
                  schedules, documents and vouchers: Ohio IT 1040, Schedule A, IT BUS, Schedule 
                  of Credits, Schedule J, IT RE, IT 40P, IT 40XP and others depending on the 
                  scenario. Send only the forms that each scenario requires. Note: Make sure to 
                  send in the correct payment voucher if a scenario requires it. 
                 • 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_1040_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 1040 bundle packets commences on December 8, 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