Form It 1040 - Individual Income Tax Return - 2012
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Do not use staples.
IT 1040
Taxable year beginning in
Rev.10/12
2012
Individual
Income Tax Return
Use only black ink.
12000106
Taxpayer Social Security no. (required)
If deceased
Spouse’s Social Security no. (only if joint return)
If deceased
check box
check box
Use UPPERCASE letters.
Your first name
M.I.
Last name
Spouse’s first name (only if married filing jointly)
M.I.
Last name
Mailing address (for faster processing, use a street address)
Ohio county (first four letters)
City
State
ZIP code
Home address (if different from mailing address) – do NOT show city or state
ZIP code
County (first four letters)
Foreign country (provide this information if the mailing address is outside the U.S.)
Foreign postal code
E-mail address
Ohio Residency Status
– Check applicable box
Check applicable box for spouse (only if married filing jointly)
Full-year
Part-year
Nonresident
Nonresident
Full-year
Part-year
Indicate state
resident
resident
resident
resident
Indicate state
Filing Status
– Check one (as reported on federal income tax return)
Single or head of household or qualifying widow(er)
Do not use staples, tape or glue. Place your W-2(s), check
(payable to Ohio Treasurer of State) and Ohio form
Married filing jointly
IT 40P on top of your return. Include forms W-2G and
Married filing separately
1099-R if tax was withheld. Place any other supporting
(enter spouse’s SS#)
documents or statements after the last page of your return.
Ohio Political Party Fund
Yes
No
Go paperless. It’s FREE!
Do you want $1 to go to this fund? ..........................................
Visit tax.ohio.gov to try Ohio I-File.
If joint return, does your spouse want $1 to go to this fund? ...
Note: Checking “Yes” will not increase your tax or decrease your refund.
Most electronic filers receive their refunds
Ohio School District Number for 2012
in 5-7 business days by direct deposit!
(see pages 43-48 of the instructions)
INCOME AND TAX INFORMATION
1. Federal adjusted gross income (from IRS form 1040, line 37; 1040A, line 21;
88 888 888 888
00
1040EZ, line 4; 1040NR, line 36; or 1040NR-EZ, line 10) ............................................................1.
88 888 888 888
00
2. Adjustments from line 47 on page 3 of Ohio form IT 1040 (enclose page 3) ..............................2.
0
page 3
88 888 888 888
00
0
3. Ohio adjusted gross income (line 2 added to or subtracted from line 1) .......................................3.
4. Personal exemption and dependent exemption deduction – multiply your personal
88 888
00
and dependent exemptions
times $1,700 and enter the result here ...................................4.
1700
1
88 888 888 888
00
5. Ohio taxable income (line 3 minus line 4; enter -0- if line 3 is less than line 4) ............................5.
0
888 888 888
00
6. Tax on line 5 (see tax tables on pages 35-41 of the instructions) .................................................6.
0
888 888 888
00
7. Schedule B credits from line 57 on page 4 of Ohio form IT 1040 (enclose page 4) ....................7.
88
page 4
888 888 888
00
0
8. Ohio tax less Schedule B credits (line 6 minus line 7; enter -0- if line 6 is less than line 7) .................8.
9888
00
1
20
9. Exemption credit: Number of personal and dependent exemptions
times $20 ................9.
888 888 888
00
0
10. Ohio tax less exemption credit (line 8 minus line 9; enter -0- if line 8 is less than line 9) .................10.
2012 IT 1040
2012 IT 1040
pg. 1 of 4
Click here for the 2012 Instruction Booklet
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