Instructions For Filing: Personal & School District Income Tax & Telefile - Department Of Taxation State Of Ohio - 2012 Page 16
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642012 Ohio Forms IT 1040EZ / IT 1040 / Instructions
Sample W-2 – This form reports taxpayers' wages and withholding
See "Ohio Income Tax Withheld" on page 19 (Ohio form IT 1040EZ) and page 21 (Ohio form IT 1040)
Place all W-2 documents on top of page 1 of your Ohio income tax return. Do not use staples, tape or glue.
a Employee’s social security number
22222
OMB No. 1545-0008
b Employer identification number (EIN)
1 Wages, tips, other compensation
2 Federal income tax withheld
Box b – Employer
XX-XXXXXXX
identifi cation number
c Employer’s name, address, and ZIP code
3 Social security wages
4 Social security tax withheld
5 Medicare wages and tips
6 Medicare tax withheld
7 Social security tips
8 Allocated tips
d Control number
9
10 Dependent care benefits
e Employee’s first name and initial
Last name
Suff.
11 Nonqualified plans
12a
C
o
d
e
13
Statutory
Retirement
Third-party
12b
employee
plan
sick pay
C
o
d
e
14 Other
12c
C
o
d
e
12d
C
o
Box 15 – If this shows
d
e
f Employee’s address and ZIP code
a state other than OHIO
State
15
Employer’s state ID number
16
17 State income tax
18
19
20
State wages, tips, etc.
Local wages, tips, etc.
Local income tax
Locality name
or OH, do not include
$ XX,XXX.XX
$ X,XXX.XX
XX-XXXXXX
OH
the amount in box 17 as
part of your Ohio income
tax withholding.
W-2
2012
2011
Wage and Tax
Department of the Treasury—Internal Revenue Service
Statement
Form
Copy 1—For State, City, or Local Tax Department
Box 16 – Your state
wages, tips, etc.
Box 17 – Your state
income tax withholding
Box 19 – Do not include this amount as
part of your Ohio income tax withholding.
Sample W-2G – This form reports taxpayers' gambling winnings/withholding
See "Ohio Income Tax Withheld" on page 19 (Ohio form IT 1040EZ) and page 21 (Ohio form IT 1040)
Place all W-2G documents on top of page 1 of your Ohio income tax return. Do not use staples, tape or glue.
VOID
CORRECTED
OMB No. 1545-0238
PAYER’S name, address, ZIP code, federal identification
1 Gross winnings
2 Federal income tax withheld
Box 1 – Your gross
2012
number, and telephone number
$ XX,XXX.XX
winnings
3 Type of wager
4 Date won
Form W-2G
5 Transaction
6 Race
Certain
Gambling
7 Winnings from identical wagers
8 Cashier
Payer's federal
Winnings
XX-XXXXXXX
identifi cation number
9 Winner’s taxpayer identification no. 10 Window
WINNER’S name, address (including apt. no.), and ZIP code
Box 13 – If this shows
11 First I.D.
12 Second I.D.
Copy 1
a state other than OHIO
13 State/Payer’s state identification no. 14 State income tax withheld
or OH, do not include
For State Tax
OH XX-XXXXXX
$ X,XXX.XX
Department
the amount in box 14 as
part of your Ohio income
Under penalties of perjury, I declare that, to the best of my knowledge and belief, the name, address, and taxpayer identification number that I have furnished
correctly identify me as the recipient of this payment and any payments from identical wagers, and that no other person is entitled to any part of these payments.
tax withholding.
Signature
Date
W-2G
Form
Department of the Treasury - Internal Revenue Service
Box 14 – Your state
income tax withholding
- 16 -
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