Do not use staples. Use only black ink and UPPERCASE letters.
2016 Ohio Schedule J
Dependents Claimed on the Ohio IT 1040 Return
Rev. 9/16
16230102
SSN of primary fi ler
Do not list below the primary fi ler 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)
Dependent’s relationship to you (required)
/
/
Dependent’s fi rst name (required)
M.I. Last name (required)
2.
Dependent’s SSN (required)
Dependent's date of birth (MM/DD/YYYY)
Dependent’s relationship to you (required)
/
/
Dependent’s fi rst name (required)
M.I. Last name (required)
3.
Dependent’s SSN (required)
Dependent's date of birth (MM/DD/YYYY)
Dependent’s relationship to you (required)
/
/
Dependent’s fi rst name (required)
M.I. Last name (required)
4.
Dependent’s SSN (required)
Dependent's date of birth (MM/DD/YYYY)
Dependent’s relationship to you (required)
/
/
Dependent’s fi rst name (required)
M.I. Last name (required)
5.
Dependent’s SSN (required)
Dependent's date of birth (MM/DD/YYYY)
Dependent’s relationship to you (required)
/
/
Dependent’s fi rst name (required)
M.I. Last name (required)
6.
Dependent’s SSN (required)
Dependent's date of birth (MM/DD/YYYY)
Dependent’s relationship to you (required)
/
/
Dependent’s fi rst name (required)
M.I. Last name (required)
7.
Dependent’s SSN (required)
Dependent's date of birth (MM/DD/YYYY)
Dependent’s relationship to you (required)
/
/
Dependent’s fi rst name (required)
M.I. Last name (required)
Do not write in this area; for department use only.
2016 Ohio Schedule J – pg. 1 of 2