Form It 1040x - Ohio Amended Individual Income Tax Return

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Calendar Year
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IT 1040X
Ohio Amended Individual Income Tax Return
Rev. 6/11
For Department Use Only
Your fi rst name
M.I.
Last name
Your Social Security number
Filing Status:
(Check only one box in each column)
Original
Amended
If a joint return, spouse's fi rst name
M.I.
Last name
Spouse's SSN (only if MFJ)
Single or head of household or
qualifying widow(er)
Married fi ling joint return (MFJ)
County
Current address (number and street)
Married fi ling separately
City, town or post offi ce, state and ZIP code
Ohio school district #
NOL carryback? If yes, attach
(for the taxable year)
form IT NOL. Yes
No
Ohio Residency Status – Check applicable box
Nonresident
Part-year resident
As Filed
As Amended
Full-year resident
(indicate state)
or as Last Amended
(Complete and attach Explanation
Check applicable box for spouse (only if married fi ling jointly)
of Corrections on page 2.)
or as Last Corrected
Nonresident
Part-year resident
Full-year resident
(indicate state)
1.
00
1.
00
1. Federal adjusted gross income ..............................................................
2. Ohio form IT 1040
Schedule A
net adjustment (schedules men-
2.
00
2.
00
tioned herein can be found in Ohio IT 1040 instructions) .......................
3.
00
3.
00
3. Ohio adjusted gross income (line 2 added to or subtracted from line 1) ....
4.
00
4.
00
4. Personal and dependency exemptions ..................................................
5.
00
5.
00
5. Ohio taxable income (line 3 minus line 4) ..............................................
6.
00
6.
00
6. Tax on line 5 (see tax tables in Ohio form IT 1040 instructions) ............
7.
00
7.
00
7.
Schedule B
credits (cannot exceed line 6)............................................
8.
00
8.
00
8. Ohio tax less Schedule B credits (line 6 minus line 7) ...........................
9.
00
9.
00
9. Exemption credit ($20 per exemption) ...................................................
10.
00 10.
00
10. Ohio tax less exemption credit (line 8 minus line 9) ...............................
11.
00 11.
00
11. Joint fi ling credit (see Ohio form IT 1040 instructions) ...........................
12.
00 12.
00
12. Ohio tax less joint fi ling credit (line 10 minus line 11) .............................
13.
00 13.
00
13.
Schedule
C,
D
and
E
credits and manufacturing grant .........................
14.
00 14.
00
14. Ohio income tax (line 12 minus line 13) .................................................
15.
00 15.
00
15. Ohio
form IT/SD 2210
interest penalty (required) .................................
16.
00 16.
00
16. Ohio use tax...........................................................................................
17.
00 17.
00
17. Total Ohio tax (add lines 14, 15 and 16) ................................................
18.
00 18.
00
18. Ohio income tax withheld.......................................................................
19. Ohio estimated tax, Ohio form IT 40P extension payments and credit
19.
00 19.
00
carryover ................................................................................................
20.
00
20. Refundable credits ...................................................................................................................................
21.
00
21. Amounts previously paid..........................................................................................................................
22.
00
22. Total of lines 18 through 21......................................................................................................................
23. Overpayment shown on original return, previously fi led amended returns and previously corrected
23.
00
returns (even if you have not yet received the refund) ............................................................................
24.
00
24. Line 22 minus line 23 ...............................................................................................................................
25. If line 24 is less than line 17 (as amended), subtract line 24 from line 17 and enter the amount owed
25.
00
plus interest. Make your check or money order payable to Ohio Treasurer of State ....
AMOUNT DUE
26. If line 24 is greater than line 17 (as amended), subtract line 17 from line 24 and enter the amount
26.
00
of your refund ..........................................................................................................
YOUR REFUND
If you owe less than $1.01, no payment is necessary. If your refund is less than $1.01, no refund will be issued.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge
and belief it is true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Date received
Code
Interest
Your signature
Date (mm/dd/yyyy)
Mail to:
Spouse's signature (see Ohio form IT 1040 instructions)
Phone number
Ohio Department of Taxation
P.O. Box 1460
Preparer's name (please print)
Phone number
Columbus, OH 43216-1460
Do you authorize your preparer to contact us regarding this return?
Yes
No

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