Form It 1040x - Ohio Amended Individual Income Tax Return Page 2
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5IT 1040X
Rev. 6/11
Reason and Explanation of Corrections
Please attach documentation to support any adjustments to line items. Refer to the chart on page 4 of the
instructions to identify required documentation for complete processing of the amended return.
Taxpayer name
Social Security number
Year
Reason(s):
Net operating loss carryback (IMPORTANT: Be sure to
Joint fi ling credit increased
complete and attach Ohio form IT NOL, Net Operating Loss
Joint fi ling credit decreased
Carryback Worksheet and check the box on the front of this
Ohio use tax increased
return indicating you are amending for an NOL.)
Ohio use tax decreased
Federal adjusted gross income decreased
Ohio form IT/SD 2210 interest penalty amount increased
Federal adjusted gross income increased
Ohio form IT/SD 2210 interest penalty amount decreased
Filing status changed
Manufacturing grant increased
Residency status changed
Manufacturing grant decreased
Exemptions increased
Refundable business credits increased
Exemptions decreased
Refundable business credits decreased
Ohio form IT 1040, Schedule A, additions to income
Ohio withholding increased
Ohio form IT 1040, Schedule A, deductions from income
Ohio withholding decreased
Ohio form IT 1040, Schedule B, credit increased
Estimated and/or Ohio form IT 40P amount or previous year
Ohio form IT 1040, Schedule B, credit decreased
carryforward overpayment increased
Ohio form IT 1040, Schedule C, credit increased
Estimated and/or Ohio form IT 40P amount or previous year
Ohio form IT 1040, Schedule C, credit decreased
carryforward overpayment decreased
Ohio form IT 1040, Schedule D, credit increased
Amount paid with original fi ling did not equal amount reported
Ohio form IT 1040, Schedule D, credit decreased
as paid with the original fi ling
Ohio form IT 1040, Schedule E, credit increased
Ohio form IT 1040, Schedule E, credit decreased
Detailed explanation of adjusted items (attach additional sheet(s) if necessary):
E-mail address (optional)
Telephone number (optional)
Federal Privacy Act Notice
Because we require you to provide us with a Social Security number, the Federal Privacy Act of
1974 requires us to inform you that providing us with your Social Security number is mandatory.
Ohio Revised Code sections 5703.05, 5703.057 and 5747.08 authorize us to request this informa-
tion. We need your Social Security number in order to administer this tax.
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