Form It 10 - Ohio Income Tax Information Notice - 2014

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Reset Form
Please do not use staples.
IT 10
Rev. 12/14
Ohio Income Tax
Taxable Year
Information Notice
07120102
Please use only black ink.
For use only by individuals claiming to owe no Ohio individual income tax for the year.
This notice must be filed by the filing deadline.
Although you may not be required to file an Ohio income tax return, filing this notice may help you avoid being considered a delinquent taxpayer. If your
filing status is married filing jointly and you want to file this notice, you can do so only if your spouse is eligible to file this notice.
Taxpayer Social Security no. (required)
Spouse’s Social Security no.
(only if joint notice)
Use UPPERCASE letters.
Your first name
M.I.
Last name
Spouse’s first name (only if joint notice)
M.I.
Last name
Address
County (first four letters)
City
State
ZIP code
Filing Status
– Check one (as reported on federal income tax return)
Single, head of household
Married filing separately
Married filing jointly
 
or qualifying widow(er)
Enter spouse’s SS#
I am not required to file an Ohio income tax return because:
1.
I moved out of the state of Ohio before Jan. 1st of the taxable year,
3.
I had Ohio taxable income (line 5 on Ohio form IT 1040) of $10,000
and I had no income in Ohio during the taxable year.
or less on the last day of the taxable year. Therefore, I owe no Ohio
income tax. I understand that I may owe school district income tax
if I am domiciled in a school district that imposes school district
I moved to the state of
income tax.
/
/
M M
D D
Y Y Y Y
Date moved
4.
I was in the military stationed in Ohio during the taxable year and
my only source of income earned in Ohio is from the military, but
2.
During the taxable year I was a full-year resident of one of the
I am a resident of the state of
following states, and I had no taxable income in Ohio other
than compensation (wages, salaries or tips) from unrelated
employers:
5.
I am using an Ohio address for mailing purposes only.
Kentucky
Indiana
West Virginia
6.
I am a civilian spouse of a nonresident service member on duty
Michigan
Pennsylvania
stationed in Ohio, solely because of military orders. My state of
residence is
SIGN HERE
(required if sending by mail)
Sending in this notice does not constitute the filing of an income tax return.
Federal Privacy Act
I have read this notice. Under penalties of perjury, I declare that, to the best of my knowledge and belief, the
Notice
notice and all enclosures are true, correct and complete.
Because we require you to provide

us with a Social Security number,
Your signature
Date (MM/DD/YYYY)
the Federal Privacy Act of 1974

requires us to inform you that
Spouse’s signature
Date (MM/DD/YYYY)
providing us with your Social Se-
curity number is mandatory. Ohio

Revised Code sections 5703.05,
Preparer’s name (please print)
Phone number
5703.057 and 5747.08 authorize
us to request this information. We
Do you authorize your preparer to contact us regarding this notice?
Yes
No
need your Social Security number
in order to administer this tax.
Mail to: Ohio Department of Taxation, P.O. Box 2679, Columbus, OH 43270-2679
IT 10
IT 10
Questions? Call us toll-free at 1-800-282-1780.

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