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Use only black ink.

12000102

Taxable year beginning in

2012

IT 1040 Rev. 10/12

Individual

Income Tax Return

Taxpayer Social Security no. (required)

If deceased

Spouse’s Social Security no. (only if joint return)

If deceased

Use UPPERCASE letters.	check box	check box
Use UPPERCASE letters.

Your ﬁrst name

M.I.

Last name

Spouse’s ﬁ rst name (only if married ﬁling jointly)

M.I.

Last name

Mailing address (for faster processing, use a street address)

City

State

ZIP code

Ohio county (ﬁ rst four letters)

Home address (if different from mailing address) – do NOT show city or state

ZIP code

County (ﬁ rst four letters)

Foreign country (provide this information if the mailing address is outside the U.S.)

Foreign postal code

E-mail address

Ohio Residency Status – Check applicable box

Check applicable box for spouse (only if married ﬁling jointly)

Full-year

Part-year

Nonresident

Full-year

Part-year

Nonresident

resident

Indicate state

resident

Indicate state

Filing Status – Check one (as reported on federal income tax return)

Do not use staples, tape or glue. Place your W-2(s), check

Single or head of household or qualifying widow(er)

(payable to Ohio Treasurer of State) and Ohio form

Married ﬁling jointly

IT 40P on top of your return. Include forms W-2G and

1099-R if tax was withheld. Place any other supporting

Married ﬁling separately

documents or statements after the last page of your return.

(enter spouse’s SS#)

Ohio Political Party Fund

Yes No

Go paperless. It’s FREE!

Do you want $1 to go to this fund?

Visit tax.ohio.gov to try Ohio I-File.

If joint return, does your spouse want $1 to go to this fund?...

Note: Checking “Yes” will not increase your tax or decrease your refund.

Most electronic ﬁ lers receive their refunds

Ohio School District Number for 2012

in 5-7 business days by direct deposit!

(see pages 43-48 of the instructions)

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


1.	Federal adjusted gross income (from IRS form 1040, line 37; 1040A, line 21;				,	,	,	. 0 0
	1040EZ, line 4; 1040NR, line 36; or 1040NR-EZ, line 10)			.... 1.	,	,	,	. 0 0
2.	Adjustments from line 47 on page 3 of Ohio form IT 1040 (enclose page 3)			.... 2.	,	,	,	. 0 0
3.	Ohio adjusted gross income (line 2 added to or subtracted from line 1)			.... 3.	,	,	,	. 0 0
4.	Personal exemption and dependent exemption deduction – multiply your personal						,	. 0 0
	and dependent exemptions	times $1,700 and enter the result here		4.			,	. 0 0
5.	Ohio taxable income (line 3 minus line 4; enter -0- if line 3 is less than line 4)			5.	,	,	,	. 0 0
6.	Tax on line 5 (see tax tables on pages 35-41 of the instructions)				6.	,	,	. 0 0
7.	Schedule B credits from line 57 on page 4 of Ohio form IT 1040 (enclose page 4)				7.	,	,	. 0 0
8.	Ohio tax less Schedule B credits (line 6 minus line 7; enter -0- if line 6 is less than line 7)				8.	,	,	. 0 0
9.	Exemption credit: Number of personal and dependent exemptions		times $20		9.			. 0 0
10.	Ohio tax less exemption credit (line 8 minus line 9; enter -0- if line 8 is less than line 9)				10.	,	,	. 0 0

2012 IT 1040

pg. 1 of 4	2012 IT 1040

							Taxable year beginning in		IT 1040 Rev. 10/12
							Taxable year beginning in
							2012
									Individual
									Individual
SS#		12000202							Income Tax Return
		12000202							Income Tax Return



10a.	Amount from line 10 on page 1							10a.		,	,	.	0	0
11.	Joint ﬁling credit. See the instructions on page 20 for eligibility and documentation requirements											.	0	0
	(this credit is for married filing jointly status only).			% times line 10a (limit $650)				11.				.	0	0
12.	Ohio income tax less joint filing credit (line 10a minus line 11)				......................................................			12.		,	,	.	0	0
13.	Total credits from line 69 on page 4 of Ohio form IT 1040 (enclose page 4)							13.		,	,	.	0	0
14.	Manufacturing equipment grant. You must include the grant request form							14.		,	,	.	0	0
15.	Ohio income tax (line 12 minus lines 13 and 14; enter -0- if the total of lines 13 and 14 is more									,	,	.	0	0
	than line 12)							15.		,	,	.	0	0
16.	Interest penalty on underpayment of estimated tax. Enclose Ohio form IT/SD 2210 (see page									,	,	.	0	0
	21 of the instructions)							16.		,	,	.	0	0
	21 of the instructions)							16.		,	,	.	0	0
17.	Unpaid Ohio use tax (see the worksheet on page 33 of the instructions)							17.		,	,	.	0	0
18.	Total Ohio tax liability (add lines 15, 16 and 17)	....................................................					TOTAL TAX	18.		,	,	.	0	0
19.	Ohio income tax withheld (box 17 on W-2; box 14 on W-2G; and box 12 on 1099-R). Place									,	,	.	0	0
	W-2(s), W-2G(s) and 1099-R(s) on top of this return					AMOUNT WITHHELD		19.		,	,	.	0	0
	W-2(s), W-2G(s) and 1099-R(s) on top of this return					AMOUNT WITHHELD		19.
20.	Add the 2012 Ohio form IT 1040ES payment(s), 2012 Ohio form IT 40P extension payment(s)									,	,	.	0	0
	and 2011 overpayment credited to 2012							20.		,	,	.	0	0
21.	Refundable credits. Include certiﬁ cate(s) and K-1(s):
	a. Business jobs credit		b. Pass-through entity credit

,	,	. 0 0
c. Historic preservation credit

. 0 0

d. Motion picture production credit

. 0 0

22. Add lines 19, 20 and 21a, b, c and d			TOTAL PAYMENTS	22.
If line 22 is MORE THAN line 18, go to line 23. If line 22 is LESS THAN line 18, skip to line 27.
23.	If line 22 is MORE THAN line 18, subtract line 18 from line 22		AMOUNT OVERPAID	23.
24.	Amount of line 23 to be credited to 2013 income tax liability		CREDIT TO 2013	24.
25.	Amount of line 23 that you wish to donate to the following fund(s):
	a. Military injury relief	b. Ohio Historical Society

,	,	. 0 0
,	,	. 0 0
,	,	. 0 0

. 0 0

c. Wildlife species

d. Natural areas

	,	. 0 0	,	. 0 0			,	,	. 0 0
26.	Line 23 minus the sum of lines 24 and 25a, b, c and d. Enter here, then skip to line 28					26.
27.	If line 22 is LESS THAN line 18, subtract line 22 from line 18				AMOUNT DUE	27.	,	,	. 0 0
28.	Interest and penalty due on late-paid tax and/or late-ﬁ led return (see page 22 of the						,	,	. 0 0
	instructions)			INTEREST AND PENALTY		28.
If you entered an amount on line 26, skip to line 30. If you entered an amount on line 27, go to line 29.
29. Amount due plus interest and penalty (add lines 27 and 28). If payment is enclosed, make							,	,	. 0 0
	check payable to Ohio Treasurer of State and include Ohio form IT 40P (see our Web site at
	tax.ohio.gov)			AMOUNT DUE PLUS INTEREST AND PENALTY		29.
30. Refund less interest and penalty (line 26 minus line 28). Enter the amount here.						,	,	. 0 0
	(If line 28 is more than line 26, you have an amount due. Subtract line 26 from

	line 28 and enter this amount on line 29.)			.............................YOUR REFUND	30.

SIGN HERE (required)

I have read this return. Under penalties of perjury, I declare that, to the best of my knowledge and belief, the return and all enclosures are true, correct and complete.

Your signature	Date

Spouse’s signature (see page 10 of the instructions)	Phone number (optional)

Preparer’s printed name (see page 11 of the instructions)	Phone number

Do you authorize your preparer to contact us regarding this return? Yes No

If your refund is less than $1.01, no refund will be issued. If you owe less than $1.01, no payment is necessary.

For Department Use Only

, , .

Code

	MAILING INFORMATION:	NO Payment Enclosed – Mail to: Ohio Department of Taxation, P.O. Box 2679, Columbus, OH 43218-2679
	MAILING INFORMATION:	Payment Enclosed – Mail to: Ohio Department of Taxation, P.O. Box 2057, Columbus, OH 43218-2057

2012 IT 1040

pg. 2 of 4	2012 IT 1040

If line 2 (on page 1) is -0- or blank, do not mail page 3.

SS#

12000302

Taxable year beginning in

2012

IT 1040 Rev. 10/12

Individual

Income Tax Return

SCHEDULE A – Income Adjustments (Additions and Deductions)
Additions (add income items only to the extent not included on page 1, line 1).				,	,	. 0 0
31.	Non-Ohio state or local government interest and dividends		31.
32.	Certain pass-through entity Ohio taxes paid and Ohio Revised Code section 5733.40(A)			,	,	. 0 0
	pass-through entity adjustment		32.
33a.	Federal interest and dividends subject to state taxation		33a.	,	,	. 0 0
b. Reimbursement of college tuition expenses and fees deducted in any previous year(s) and				,	,	. 0 0
	noneducation expenditures from a college savings account		b.
c. Losses from sale or disposition of Ohio public obligations			c.	,	,	. 0 0
d. Nonmedical withdrawals from a medical savings account			d.	,	,	. 0 0
e. Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if				,	,	. 0 0
	the reimbursement is not in federal adjusted gross income		e.
f. Lump sum distribution add-back and miscellaneous federal income tax adjustments			f.	,	,	. 0 0
g. Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense			g.	,	,	. 0 0
34.	Total additions (add lines 31 through 33g and enter here). You must complete the		,	,	,	. 0 0
	applicable line items above	34.
Deductions (deduct income items only to the extent included on page 1, line 1).						. 0 0
35a. Federal interest and dividends exempt from state taxation			35a.	,	,
b. Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense			b.	,	,	. 0 0
36.	Employee compensation earned in Ohio by full-year residents of neighboring states and certain			,	,	. 0 0
	income earned by military nonresidents and civilian nonresident spouses		36.
37a.	Military pay for Ohio residents, but only if the military pay is included on line 1 of this return			,	,	. 0 0
	and is received while the military member was stationed outside Ohio		37a.
b. Military retirement income and military injury relief fund amounts included in federal adjusted				,	,	. 0 0
	gross income (line 1 on page 1)		b.
38a.	State or municipal income tax overpayments shown on IRS form 1040, line 10		38a.	,	,	. 0 0
b. Refund or reimbursements shown on IRS form 1040, line 21 for itemized deductions claimed				,	,	. 0 0
	on a prior year federal income tax return		b.
c. Repayment of income reported in a prior year and miscellaneous federal tax adjustments			c.	,	,	. 0 0
39.	Disability and survivorship beneﬁ ts (do not include pension continuation beneﬁts)		39.	,	,	. 0 0

40.	Qualifying Social Security beneﬁ ts and certain railroad retirement beneﬁts		40.	,	,	. 0 0

41a.	Education: Ohio 529 contributions; tuition credit purchases		41a.	,	,	. 0 0
						. 0 0
b.	Pell/Ohio College Opportunity taxable grant amounts used to pay room and board		b.	,	,
42.	Certain Ohio National Guard reimbursements and beneﬁts		42.	,	,	. 0 0
43a.	Unreimbursed long-term care insurance premiums, unsubsidized health care insurance			,	,	. 0 0
	premiums and excess health care expenses (see worksheet on page 27 of the instructions) ...		43a.
b. Funds deposited into, and earnings of, a medical savings account for eligible health care				,	,	. 0 0
	expenses (see worksheet on page 28 of the instructions)		b.

c. Qualiﬁ ed organ donor expenses (maximum $10,000 per taxpayer) and amounts contributed				,	,	. 0 0
	to an individual development account		c.
44.	Wage expense not deducted due to the targeted jobs or the work opportunity tax credits		44.	,	,	. 0 0
45.	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			,	,	. 0 0
	state of Ohio or income from a transfer agreement		45.

46.	Total deductions (add lines 35a through 45 only). You must complete the applicable
	line items above	46.
47.	Net adjustments – If line 34 is MORE THAN line 46, enter the difference here
	and on line 2 as a positive amount. If line 34 is LESS THAN line 46, enter		.... 47.

	the difference here and on line 2 as a negative amount

,	,	,	.	0	0

,	,	,	.	0	0

2012 IT 1040

pg. 3 of 4

2012 IT 1040

If line 7 (page 1) and line 13 (page 2) are both -0- or blank, do not mail page 4.

SS#

12000402

SCHEDULE B – Nonbusiness Credits

Taxable year beginning in

2012

IT 1040 Rev. 10/12

Individual

Income Tax Return

48.	Retirement income credit (limit $200 per return). See the table on page 29 of the instructions ....		48.			. 0 0
49.	Senior citizen credit (you must be 65 or older to claim this credit; limit $50 per return)	.............	49.			. 0 0
50.	Lump sum distribution credit (you must be 65 or older to claim this credit)		50.	,	,	. 0 0
51.	Child care and dependent care credit (see the worksheet on page 30 of the instructions)		51.		,	. 0 0
52.	Lump sum retirement credit		52.	,	,	. 0 0
53.	If line 5 on page 1 is $10,000 or less, enter $88; otherwise, enter -0- or leave blank		53.			. 0 0
54.	Displaced worker training credit (see the worksheet and instructions on pages 30 and 31)				,	. 0 0
	(limit $500 per taxpayer)		54.		,	. 0 0
55.	Ohio political contributions credit (limit $50 per taxpayer)		55.			. 0 0
56.	Ohio adoption credit ($1,500 per child adopted during the year)		56.		,	. 0 0
57.	Total Schedule B credits (add lines 48 through 56). Enter here and on page 1, line 7		57.	,	,	. 0 0
57.			57.
SCHEDULE C – Full-Year Ohio Resident Credit
58.	Enter the portion of line 3 on page 1 subjected to tax by other states or the District of		,	,	,	. 0 0
	Columbia while you are an Ohio resident (limits apply – see page 31 of the instructions)....	58.	,	,	,	. 0 0
59.	Enter Ohio adjusted gross income (line 3 on page 1)	59.	,	,	,	. 0 0
60.	Divide line 58 by line 59 and enter the result here (four digits; do not round). .			,	,	. 0 0
	Multiply this factor by the amount on line 12 on page 2 and enter the result here		60.	,	,	. 0 0
61.	Enter the 2012 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			,	,	. 0 0
	(limits apply – see page 31 of the instructions)		61.	,	,	. 0 0
62.	Enter the smaller of line 60 or line 61. This is your Ohio resident tax credit. Enter here and on			,	,	. 0 0
	line 67 below. If you ﬁ led a return for 2012 with a state(s) other than Ohio, enter the two-letter			,	,	. 0 0

	state abbreviation in the box(es) below		62.

SCHEDULE D – Nonresident / Part-Year Resident Credit (date of part-year residency

)

63.	Enter the portion of Ohio adjusted gross income (line 3) that was not earned or received		,	,	,	. 0 0
	in Ohio. Include Ohio form IT 2023 if required (see page 31 of the instructions)	63.	,	,	,	. 0 0
64.	Enter the Ohio adjusted gross income (line 3 on page 1)	64.	,	,	,	.	0 0
65.	Divide line 63 by line 64 and enter the result here (four digits; do not round). .		65.	,	,	.	0 0
	Multiply this factor by the amount on line 12. Enter here and on line 68 below		65.

SUMMARY OF CREDITS FROM SCHEDULES C, D AND E

66.	Enter the amount from line 10 of Schedule E, Nonrefundable Business Credits (see page 32 of
	the instructions)	66.
67.	Enter the amount from line 62 above	67.
68.	Enter the amount from line 65 above	68.
69.	Add lines 66, 67 and 68. Enter here and on page 2, line 13	69.

,	,	. 0 0
,	,	. 0 0
,	,	. 0 0
,	,	. 0 0

MAILING INFORMATION

NO Payment Enclosed – Mail to:

Ohio Department of Taxation

P.O. Box 2679

Columbus, OH 43218-2679

Enclose your federal income

tax return if line 1 on page 1 of this

return is -0- or negative.

Payment Enclosed – Mail to: Ohio Department of Taxation P.O. Box 2057

Columbus, OH 43218-2057

2012 IT 1040

pg. 4 of 4	2012 IT 1040

Question	Answer
Form Name	Form It 1040 Ohio
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	PIT_IT1040 2012it1040 fillable form

Form It 1040 Ohio – Fill Out and Use This PDF

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