Form It 1040 - Individual Income Tax Return - 2013 Page 3
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IT 1040
Taxable year beginning in
Rev. 11/13
2013
Individual
Income Tax Return
13000306
SS#
SCHEDULE A – Income Adjustments (Additions and Deductions)
Additions (add income items only to the extent not included on page 1, line 1).
0 0
.
33. Non-Ohio state or local government interest and dividends .........................................................33.
34. Certain Ohio pass-through entity and fi nancial institutions taxes paid and Ohio Revised Code
0 0
.
section 5733.40(A) pass-through entity adjustment ......................................................................34.
0 0
.
35a. Federal interest and dividends subject to state taxation .............................................................35a.
b. Reimbursement of college tuition expenses and fees deducted in any previous year(s) and
0 0
.
noneducation expenditures from a college savings account ..........................................................b.
0 0
.
c. Losses from sale or disposition of Ohio public obligations ............................................................. c.
0 0
.
d. Nonmedical withdrawals from a medical savings account ..............................................................d.
e. Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if
0 0
.
the reimbursement is not in federal adjusted gross income ............................................................e.
0 0
.
f. Lump sum distribution add-back and miscellaneous federal income tax adjustments ....................f.
0 0
.
g. Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense ................g.
0 0
.
36. Total additions (add lines 33 through 35g and enter here). You must complete the
applicable line items above ...........................................................................................36.
Deductions (deduct income items only to the extent included on page 1, line 1).
0 0
.
37a. Federal interest and dividends exempt from state taxation ........................................................37a.
0 0
.
b. Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense ................b.
38. Employee compensation earned in Ohio by full-year residents of neighboring states and certain
0 0
.
income earned by military nonresidents and civilian nonresident spouses ....................................38.
39a. Military pay for Ohio residents, but only if the military pay is included on line 1 of this return
0 0
.
and is received while the military member was stationed outside Ohio ......................................39a.
b. Uniformed services retirement income and military injury relief fund amounts included in
0 0
.
federal adjusted gross income (line 1 on page 1) ...........................................................................b.
0 0
.
40a. State or municipal income tax overpayments shown on IRS form 1040, line 10 ........................40a.
b. Refund or reimbursements shown on IRS form 1040, line 21 for itemized deductions claimed
0 0
.
on a prior year federal income tax return ........................................................................................b.
0 0
.
c. Repayment of income reported in a prior year and miscellaneous federal tax adjustments ........... c.
0 0
.
41. Small business investor income deduction ...................................................................................41.
0 0
.
42. Disability and survivorship benefi ts (do not include pension continuation benefi ts) .....................42.
0 0
.
43. Qualifying Social Security benefi ts and certain railroad retirement benefi ts .................................43.
0 0
.
44a. Education: Ohio 529 contributions; tuition credit purchases ...........................................................44a.
0 0
.
b. Pell/Ohio College Opportunity taxable grant amounts used to pay room and board ..........................b.
.
0 0
45. Certain Ohio National Guard reimbursements and benefi ts .........................................................45.
46a. Unreimbursed long-term care insurance premiums, unsubsidized health care insurance
0 0
.
premiums and excess health care expenses (see worksheet on page 27 of the instructions) ...46a.
b. Funds deposited into, and earnings of, a medical savings account for eligible health care
.
0 0
expenses (see worksheet on page 23 of the instructions) ..............................................................b.
c. Qualifi ed organ donor expenses (maximum $10,000 per taxpayer) and amounts contributed
0 0
.
to an individual development account ............................................................................................. c.
0 0
.
47. Wage expense not deducted due to the targeted jobs or the work opportunity tax credits ...........47.
48. Interest income from Ohio public obligations and from Ohio purchase obligations; gains from
the sale or disposition of Ohio public obligations; public service payments received from the
0 0
.
state of Ohio or income from a transfer agreement ......................................................................48.
0 0
.
49. Total deductions (add lines 37a through 48 only). You must complete the applicable
line items above ............................................................................................................ 49.
50. Net adjustments – If line 36 is MORE THAN line 49, enter the difference here
0 0
.
and on line 2 as a positive amount. If line 36 is LESS THAN line 49, enter
the difference here and on line 2 as a negative amount ............................................... 50.
2013 IT 1040
2013 IT 1040
pg. 3 of 4
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