Ohio Form It 1040Ez PDF Details

Ohio Form It 1040Ez is an easy to use state tax form that can be filed by taxpayers who have a simple tax return. The form can be used by residents of Ohio who have income from wages, salaries, tips, interest, dividends, and other types of income. If you are eligible to use Form 1040Ez, it can help make filing your state tax return quick and easy. For more information about using Ohio Form 1040Ez, visit the Ohio Department of Taxation's website.

Below is the information concerning the file you were seeking to fill out. It can show you the time it should take to finish ohio form it 1040ez, what fields you will have to fill in and several additional specific details.

QuestionAnswer
Form NameOhio Form It 1040Ez
Form Length16 pages
Fillable?Yes
Fillable fields2369
Avg. time to fill out39 min 49 sec
Other namesohio state tax forms printable, filling in ohio it 1040 2020 tax form pdf, 1099 form ohio printable, state of ohio tax forms 2021

Form Preview Example

Do not staple or paper clip.

 

2022 Ohio IT 1040

hio

 

Department of

Individual Income Tax Return

 

 

Taxation

Use only black ink/UPPERCASE letters. Use whole dollars only.

 

22000102

Sequence No. 1

AMENDED RETURN - Check here and include Ohio IT RE.

NOL CARRYBACK - Check here and include Schedule IT NOL.

Primary taxpayer's SSN (required)

 

If deceased

Spouse’s SSN (if filing jointly)

 

 

If deceased

School district #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do not staple or paper clip.

First name

 

 

 

 

 

 

 

M.I.

Last name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Spouse's first name (if filing jointly)

 

 

 

 

 

 

 

M.I.

Last name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address line 1 (number and street) or P.O. Box

Address line 2 (apartment number, suite number, etc.)

City

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State

 

ZIP code

 

 

 

 

 

Ohio county (first four letters)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

Foreign postal code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Residency StatusCheck only one for primary

 

 

Filing StatusCheck one (as reported on federal income tax return)

 

 

Resident

 

Part-year

 

 

Nonresident 

 

 

 

 

 

 

 

 

 

 

 

 

Single, head of household or qualifying widow(er)

 

 

 

 

 

 

 

resident

 

 

Indicate state

 

 

 

 

 

 

 

 

Married filing jointly

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check only one for spouse (if filing jointly)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Resident

 

Part-year

 

 

 

Nonresident 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Spouse’s

 

SSN

 

 

 

 

 

 

 

 

 

 

 

resident

 

 

 

Indicate state

 

 

 

 

 

 

 

 

Married filing separately

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ohio Nonresident StatementSee instructions for required criteria

 

 

 

 

 

Federal extension filers - check here.

 

 

Primary meets the five criteria for irrebuttable presumption as nonresident.

 

 

 

 

 

 

 

Spouse meets the five criteria for irrebuttable presumption as nonresident.

 

 

 

 

 

If someone can claim you (or your spouse if filing jointly) as a

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

dependent, check here.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Federal adjusted gross income (federal 1040 or 1040-SR, line 11). Place a "-" in the box

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

if negative

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.....1.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2a.Additions – Ohio Schedule of Adjustments, line 10 (include schedule)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2a.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2b.Deductions – Ohio Schedule of Adjustments, line 39 (include schedule)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2b.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. Ohio adjusted gross income (line 1 plus line 2a minus line 2b). Place a "-" in the box if negative

 

 

 

....3.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

..........................................................4. Exemption amount (include Schedule of Dependents if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of exemptions including you and your spouse/dependents, if applicable:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. Ohio income tax base (line 3 minus line 4; if negative, enter zero)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6. Taxable business income – Ohio Schedule IT BUS, line 13 (include schedule)

 

 

 

 

 

 

 

 

 

6.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7. Taxable nonbusiness income (line 5 minus line 6; if negative, enter zero)

 

 

 

 

 

 

 

 

 

 

 

 

 

7.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do not write in this area; for department use only.

MM-DD-YY Code

2022 IT 1040 – page 1 of 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2022 Ohio IT 1040

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SSN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Individual Income Tax Return

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7a.Amount from line 7 on page 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7a.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8a.Nonbusiness income tax liability on line 7a (see instructions for tax tables)

 

 

 

 

 

8a.

8b.Business income tax liability – Ohio Schedule IT BUS, line 14 (include schedule)

 

 

 

 

 

8b.

8c. Income tax liability before credits (line 8a plus line 8b)

 

 

 

 

 

 

 

 

 

 

 

 

8c.

9. Ohio nonrefundable credits – Ohio Schedule of Credits, line 35 (include schedule)

9.

10.Tax liability after nonrefundable credits (line 8c minus line 9; if negative, enter zero)

10.

11. Interest penalty on underpayment of estimated tax (include Ohio IT/SD 2210)

11.

12.Unpaid use tax (see instructions)

............................................................................................................................

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12.

13.Total Ohio tax liability before withholding or estimated payments (add lines 10, 11 and 12)

13.

14.Ohio income tax withheld – Schedule of Ohio Withholding, part A, line 1 (include schedule and

 

 

 

 

 

 

 

 

 

 

income statements)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14.

15.Estimated and extension payments (from Ohio IT 1040ES and IT 40P), and credit carryforward

 

 

 

 

 

 

 

 

 

 

from last year's return

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15.

16.Refundable credits – Ohio Schedule of Credits, line 41 (include schedule)

16.

17. Amended return only – amount previously paid with original and/or amended return

17.

18. Total Ohio tax payments (add lines 14, 15, 16 and 17)

 

 

 

 

 

 

 

18.

19.Amended return only – overpayment previously requested on original and/or amended return

19.

20.Line 18 minus line 19. Place a "-" in the box if negative

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

......20.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If line 20 is MORE THAN line 13, skip to line 24. OTHERWISE, continue to line 21.

 

 

 

 

 

 

 

 

 

21.Tax due (line 13 minus line 20). If line 20 is negative, ignore the "-" and add line 20 to line 13

21.

22.Interest due on late payment of tax (see instructions)

 

 

 

 

 

 

 

22.

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 DUE23.

24.Overpayment (line 20 minus line 13)

 

 

 

 

 

 

 

24.

25. Original return only – portion of line 24 carried forward to next year’s tax liability

25.

26. Original return only – portion of line 24 you wish to donate:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a. Wildlife Species

 

b. Military Injury Relief

c. Ohio History Fund

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total....26g.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d. Nature Preserves/Scenic Rivers

 

e. Breast/Cervical Cancer

f. Wishes for Sick Children

 

 

 

 

 

 

 

 

 

22000202 Sequence No. 2

27. REFUND (line 24 minus lines 25 and 26g).............................................................................YOUR REFUND27.

 

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.

Primary signature

 

 

Phone number

 

 

NO Payment Included Mail to:

 

Spouse’s signature

 

Date

Ohio Department of Taxation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

P.O. Box 2679

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check here to authorize your preparer to discuss this return with the Department.

Columbus, OH 43270-2679

 

Preparer's printed name

 

Phone number

Payment Included Mail to:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ohio Department of Taxation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

P.O. Box 2057

 

 

 

 

 

Preparer's TIN (PTIN)

P

 

 

 

 

 

 

 

 

 

Columbus, OH 43270-2057

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2022 IT 1040 – page 2 of 2

2022 Ohio Schedule

of Adjustments

Use only black ink. Use whole dollars only.

Primary taxpayer’s SSN

22000302

Sequence No. 3

 

Additions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Only add the following amounts if they are not included on Ohio IT 1040, line 1)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

Non-Ohio state or local government interest and dividends

1.

 

 

 

 

 

 

 

 

 

 

 

2.

Ohio pass-through entity taxes excluded from federal adjusted gross income

2.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

Ohio 529 plan funds used for non-qualified expenses

3.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

Losses from sale or disposition of Ohio public obligations

4.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.

Nonmedical withdrawals from a medical savings account

5.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.

Reimbursement of expenses previously deducted on an Ohio income tax return

6.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Federal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.

Internal Revenue Code 168(k) and 179 depreciation expense addback

7.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.

Exempt federal interest and dividends subject to state taxation

8.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9.

Federal conformity additions

9.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10.

Total additions (add lines 1 through 9 ONLY). Enter here and on Ohio IT 1040, line 2a

10.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Deductions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Only deduct the following amounts if they are included on Ohio IT 1040, line 1)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11.

Business income deduction – Ohio Schedule IT BUS, line 11

11.

 

 

 

 

 

 

 

 

 

 

 

12.

Employee compensation earned in Ohio by residents of neighboring states

12.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13.

Taxable refunds, credits, or offsets of state and local income taxes (federal 1040, Schedule 1, line 1)

13.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14.

Taxable Social Security benefits (federal 1040 and 1040-SR, line 6b)

14.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15.

Certain railroad benefits

15.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16.

Interest income from Ohio public obligations and purchase obligations; gains from the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

disposition of Ohio public obligations; or income from a transfer agreement

16.

 

 

 

 

 

 

 

 

 

 

 

17.

Amounts contributed to an Ohio county's individual development account program

17.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18.

Amounts contributed to a STABLE account: Ohio's ABLE plan

18.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

19.

Income earned in Ohio by a qualifying out-of-state business or employee for disaster

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

work conducted during a disaster response period

19.

 

 

 

 

 

 

 

 

 

 

 

Federal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20.

Federal interest and dividends exempt from state taxation

20.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21.

Deduction of prior year 168(k) and 179 depreciation addbacks

21.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

22.

Refund or reimbursements from the federal 1040, Schedule 1, line 8z for federal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

itemized deductions claimed on a prior year return

22.

 

 

 

 

 

 

 

 

 

 

 

2022 Schedule of Adjustments – page 1 of 2

2022 Ohio Schedule

of Adjustments

Primary taxpayer’s SSN

23.

Repayment of income reported in a prior year

 

 

 

 

 

 

 

 

 

 

 

 

 

23.

 

 

 

 

 

 

 

 

 

 

 

 

24.

Wage expense not deducted based on the federal work opportunity tax credit

24.

25.

Federal conformity deductions

25.

Uniformed Services

 

 

 

26.

Military pay received by Ohio residents while stationed outside Ohio

26.

27.

Compensation earned by nonresident military servicemembers and their civilian spouses

27.

28.

Uniformed services retirement income

28.

29.

Military injury relief fund grants and veteran’s disability severance payments

29.

30.

Certain Ohio National Guard reimbursements and benefits

30.

Education

 

 

 

31.

Amounts contributed to Ohio CollegeAdvantage: Ohio’s 529 Plan

31.

32.

Pell/Ohio College Opportunity taxable grant amounts used to pay room and board

32.

33.

Ohio educator expenses in excess of federal deduction

33.

Medical

 

 

 

34.

Disability benefits

34.

35.

Survivor benefits

35.

36.

Unreimbursed medical and health care expenses (see instructions for worksheet; include a copy)

...................36.

37.

Medical savings account contributions/earnings (see instructions for worksheet; include a copy)

37.

38.

Qualified organ donor expenses

38.

39.

Total deductions (add lines 11 through 38 ONLY). Enter here and on Ohio IT 1040, line 2b

39.

 

 

 

 

22000402

Sequence No. 4

2022 Schedule of Adjustments – page 2 of 2

2022 Ohio Schedule IT BUS

 

Business Income

 

Use only black ink/UPPERCASE letters.

22260102

Primary taxpayer’s SSN

 

Sequence No. 5

Enter all business income that you (and your spouse, if filing jointly) received during the tax year on this schedule. Enter only those amounts that are included in your federal adjusted gross income. Only one IT BUS should be used for each return filed. See R.C. 5747.01(B). Use whole dollars only.

Part 1 – Business Income From IRS Schedules

Note: Do not include amounts listed on the IRS schedules below that are nonbusiness income.

See R.C. 5747.01(C). If the amount on a line is negative, place a “-“ in the box provided.

1.

Schedule B – Interest and Ordinary Dividends

1.

2.

Schedule C – Net Profit or Loss From Business (Sole Proprietorship)

 

 

 

....2.

 

3.

Schedule D – Capital Gains and Losses

 

 

 

....3.

4.

Schedule E – Supplemental Income and Loss

 

 

....4.

 

 

5.

Guaranteed payments or compensation from a pass-through entity to a 20% or greater direct

 

 

 

or indirect owner

5.

6.

Schedule F – Net Profit or Loss From Farming

 

 

 

.... 6.

 

7.

Other business income or loss not reported above (e.g. form 4797 amounts)

 

....7.

 

8.

Total business income (add lines 1 through 7)

 

....8.

 

Part 2 – Business Income Deduction

 

 

9.

Enter the lesser of line 8 above or Ohio IT 1040, line 1. If negative, enter zero;

 

 

 

stop here and do not complete Part 3

9.

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.

11.

Enter the lesser of line 9 or line 10. Enter here and on Ohio Schedule of Adjustments, line 11

11.

Part 3 – Taxable Business Income

Note: If Ohio IT 1040, line 5 is zero, do not complete Part 3.

12.

Line 9 minus line 11

12.

 

 

 

 

 

 

 

 

 

 

 

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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14.

Business income tax liability – multiply line 13 by 3% (.03). Enter here and on Ohio IT 1040, line 8b

14.

 

 

 

 

 

 

 

 

.

 

 

Do not write in this area; for department use only.

2022 Schedule IT BUS – page 1 of 2

2022 Ohio Schedule IT BUS

Business Income

Primary taxpayer’s SSN

Part 4 – Business Sources

22260202

Sequence No. 6

List all sources of business income, with Ohio sources listed first. Also separately list your ownership percentage and/or your spouse’s ownership percent- age (if filing jointly). If necessary, complete additional copies of this page and include with your return.

1. FEIN / SSNPrimary ownership

.

Business name

%

Spouse’s ownership

 

 

 

.

 

 

%

 

 

 

 

 

 

2. FEIN / SSN

Primary ownership

Spouse’s ownership

.

Business name

%

.

%

3. FEIN / SSN

Primary ownership

Spouse’s ownership

.

Business name

%

.

%

4. FEIN / SSN

Primary ownership

Spouse’s ownership

.

Business name

%

.

%

5. FEIN / SSN

Primary ownership

Spouse’s ownership

.

Business name

%

.

%

6. FEIN / SSN

Primary ownership

Spouse’s ownership

.

Business name

%

.

%

7. FEIN / SSN

Primary ownership

Spouse’s ownership

.

Business name

%

.

%

8. FEIN / SSN

Primary ownership

Spouse’s ownership

.

Business name

%

.

%

2022 Schedule IT BUS – page 2 of 2

hio

Department of

2022 Ohio Schedule of Credits

Taxation

Use only black ink. Use whole dollars only.

 

 

 

Primary taxpayer’s SSN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

22280102 Sequence No. 7

Many of these credits must be calculated using a worksheet and/or be supported by additional required documentation. See the instructions for worksheets and information on supporting documentation.

Nonrefundable Credits

1.

Tax liability before credits (from Ohio IT 1040, line 8c)

1.

2.

Retirement income credit (include 1099-R forms)

2.

3.

Lump sum retirement credit (include a copy of the worksheet and 1099-R forms)

3.

4.

Senior citizen credit (must be 65 or older to claim this credit)

4.

5.

Lump sum distribution credit (include a copy of the worksheet and 1099-R forms)

5.

6.

Child care & dependent care credit (include a copy of the worksheet)

6.

7.

Displaced worker training credit (include a copy of the worksheet and all required documentation)

7.

8.

Campaign contribution credit for Ohio statewide office or General Assembly

8.

9.

Income-based exemption credit

 

 

 

9.

10.

Total (add lines 2 through 9)

 

 

 

10.

11.

Tax less credits (line 1 minus line 10; if negative, enter zero)

11.

12.

Joint filing credit (see instructions for table).

 

 

% times line 11, up to $650

12.

 

 

13.

Earned income credit

 

 

 

13.

 

 

 

14.

Home school expenses credit (include copies of all required documentation)

14.

15.

Scholarship donation credit (include copies of all required documentation)

15.

16.

Nonchartered, nonpublic school tuition credit (include copies of all required documentation)

16.

17.

Vocational job credit (include a copy of the credit certificate)

17.

18.

Ohio adoption credit

 

 

 

18.

19.

Nonrefundable job retention credit (include a copy of the credit certificate)

19.

20.

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

20.

21. Grape production credit

 

 

 

21.

22.

InvestOhio credit (include a copy of the credit certificate)

22.

23.

Lead abatement credit (include a copy of the credit certificate)

23.

24.

Opportunity zone investment credit (include a copy of the credit certificate)

24.

Do not write in this area; for department use only.

2022 Schedule of Credits – page 1 of 2

 

2022 Ohio Schedule of Credits

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Primary taxpayer’s SSN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

25.

Technology investment credit carryforward (include a copy of the credit certificate)

25.

26.

Enterprise zone day care & training credits (include a copy of the credit certificate)

26.

27.

Research & development credit (include a copy of the credit certificate)

27.

28.

Nonrefundable Ohio historic preservation credit (include a copy of the credit certificate)

28.

29.

Total (add lines 12 through 28)

29.

30.

Tax less additional credits (line 11 minus line 29; if negative, enter zero)

30.

22280202

Sequence No. 8

Nonresident Credit

Dates of Ohio residency

to

Other state of residency

31.

Nonresident Portion of Ohio adjusted gross income -

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ohio IT NRC Section I, line 18 (include a copy)

31.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

32.

Ohio adjusted gross income (Ohio IT 1040, line 3)

32.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

33a.

Divide line 31 by line 32 (four decimals; do not round;

 

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

if greater than 1, enter 1.0000)

 

 

 

 

 

33a.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

33.

Nonresident credit (line 30 times line 33a)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

33.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Resident Credit

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

34.

Resident credit – Ohio IT RC, line 7 (include a copy)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

34.

 

 

 

 

 

 

 

 

 

 

 

35.

Total nonrefundable credits (add lines 10, 29, 33 and 34; enter here and on Ohio IT 1040, line 9)

35.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Refundable Credits

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

36.

Refundable Ohio historic preservation credit (include a copy of the credit certificate)

36.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

37.

Refundable job creation credit & job retention credit (include a copy of the credit certificate)

37.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

38.

Pass-through entity credit (include a copy of the Ohio IT K-1s)

 

 

 

 

 

 

 

38.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

39.

Motion picture & Broadway theatrical production credit (include a copy of the credit certificate)

39.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

40.

Venture capital credit (include a copy of the credit certificate)

 

 

 

 

 

 

 

40.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

41.

Total refundable credits (add lines 36 through 40; enter here and on Ohio IT 1040, line 16)

41.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2022 Schedule of Credits – page 2 of 2

2022 Ohio Schedule

of Dependents

Use only black ink/UPPERCASE letters.

Primary taxpayer's SSN

22230102

Sequence No. 9

Do not list the primary filer and/or spouse (if filing jointly) as dependents on this schedule. 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” if necessary.

 

 

1. Dependent’s SSN

Dependent's date of birth (MM-DD-YYYY)

Dependent’s relationship to you

-

-

Dependent’s first name

 

 

 

 

 

 

 

 

 

M.I. Dependent's last name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. Dependent’s SSN

 

 

 

 

Dependent's date of birth (MM-DD-YYYY)

 

 

 

Dependent’s relationship to you

-

-

 

Dependent’s first name

 

 

 

 

 

 

 

 

 

 

 

 

M.I.

Dependent's last name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dependent’s SSN

 

 

 

 

Dependent's date of birth (MM-DD-YYYY)

 

 

 

Dependent’s relationship to you

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dependent’s first name

 

 

 

 

 

 

 

 

 

 

 

 

M.I.

Dependent's last name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

Dependent’s SSN

 

 

 

 

Dependent's date of birth (MM-DD-YYYY)

 

 

 

Dependent’s relationship to you

 

 

 

 

 

 

-

-

 

Dependent’s first name

 

 

 

 

 

 

 

 

 

 

 

 

M.I.

Dependent's last name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dependent’s SSN

 

 

 

 

Dependent's date of birth (MM-DD-YYYY)

 

 

 

Dependent’s relationship to you

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dependent’s first name

 

 

 

 

 

 

 

 

 

 

 

 

M.I.

Dependent's last name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.

Dependent’s SSN

 

 

 

 

Dependent's date of birth (MM-DD-YYYY)

 

 

 

 

Dependent’s relationship to you

 

 

 

 

 

 

-

-

Dependent’s first name

 

 

 

 

 

 

 

 

 

M.I. Dependent's last name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7. Dependent’s SSN

 

 

 

 

Dependent's date of birth (MM-DD-YYYY)

 

 

 

Dependent’s relationship to you

-

Dependent’s first name

-

M.I. Dependent's last name

Do not write in this area; for department use only.

2022 Schedule of Dependents – page 1 of 2

2022 Ohio Schedule

of Dependents

22230202

Primary taxpayer's SSN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sequence No. 10

8. Dependent’s SSN

 

 

 

 

 

 

Dependent's date of birth (MM-DD-YYYY)

 

 

 

 

 

 

Dependent’s relationship to you

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dependent’s first name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M.I.

 

Dependent's last name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9. Dependent’s SSN

 

 

 

 

 

Dependent's date of birth (MM-DD-YYYY)

 

 

 

 

 

Dependent’s relationship to you

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dependent’s first name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M.I.

 

Dependent's last name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10. Dependent’s SSN

 

 

 

 

 

 

 

Dependent's date of birth (MM-DD-YYYY)

 

 

 

 

 

 

Dependent’s relationship to you

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dependent’s first name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M.I.

 

Dependent's last name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. Dependent’s SSN

 

 

 

 

 

Dependent's date of birth (MM-DD-YYYY)

 

 

 

 

 

 

Dependent’s relationship to you

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dependent’s first name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M.I.

 

Dependent's last name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12. Dependent’s SSN

 

 

 

 

Dependent's date of birth (MM-DD-YYYY)

 

 

 

 

 

Dependent’s relationship to you

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dependent’s first name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M.I.

 

Dependent's last name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13. Dependent’s SSN

 

 

 

 

 

Dependent's date of birth (MM-DD-YYYY)

 

 

 

 

 

Dependent’s relationship to you

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dependent’s first name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M.I.

 

Dependent's last name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14. Dependent’s SSN

 

 

 

 

Dependent's date of birth (MM-DD-YYYY)

 

 

 

 

 

Dependent’s relationship to you

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dependent’s first name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M.I.

 

Dependent's last name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15. Dependent’s SSN

 

 

 

 

Dependent's date of birth (MM-DD-YYYY)

 

 

 

 

 

Dependent’s relationship to you

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dependent’s first name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M.I.

 

Dependent's last name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2022 Schedule of Dependents – page 2 of 2

Watch Ohio Form It 1040Ez Video Instruction

Please rate Ohio Form It 1040Ez

1 Votes
If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .