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                                                                                                                                                         Rev. 8/14
                                                                                                                                                IT 1041
                                                                                      2014                                                      Fiduciary
                                                            14180102                                                                            Income Tax Return
         Check here if amended return

         Check here if fi nal return                                  Use only black ink.
  Federal employer I.D. no. (FEIN)           Social Security no. of decedent (estates only)                                                              For taxable year beginning in
                                                                                                                                                         MM / 2   0 14
  Use UPPERCASE letters.
 Name of trust or estate

 Name of trust or estate (second line)

 Fiduciary name and title

  Address (if address change, check box)

  City                                                                                State   ZIP code

  E-mail address

      Check Applicable Box(es)
                                                                                              Do not staple or otherwise attach. 
         Simple trust               OR          Complex trust                            Place any supporting documents, including K-1’s, 
                                                                                              after the last page of this return. 
         Resident trust             OR          Nonresident trust
                                                                                                                                                Mail to: 
         Irrevocable trust                      Testamentary trust                                                            Ohio Dept. of Taxation
         DRAFT 8/21/14P.O. Box 2619
                                                                                              Columbus, OH 43216-2619
         Bankruptcy estate                      Decedent’s estate                Instructions for this form are on our Web site at tax.ohio.gov. 

  INCOME AND TAX INFORMATION – If amount is negative, shade the negative sign (“–”) in the box provided. 

    1. Federal taxable income (from line 22 of IRS form 1041).Attach page 1 of IRS form 1041 ......                            ...1.            ,        ,          . 00
 
  2. Net adjustments from Schedule A, line 42   ............................................................................. ...2.             ,,.00
   
      3. Ohio taxable income (line 1 plus or minus line 2). Estates should skip lines 4-7 ...................                  ...3.            ,,.00
 
      4. Allocated qualifying trust amount from Schedule F, line 58 (trusts only) ................................             ...4.            ,,.00

   5. Apportioned trust income from Schedule G, line 61 (trusts only) ...........................................             ...5.             ,        ,          . 00

    6. Allocated trust income from Schedule H, line 64 (trusts only) ................................................         ...6.             ,        ,          . 00
 
   7. Modifi ed Ohio taxable income (trusts add lines 4, 5 and 6; if less than zero, enter -0-) ...................7.                            ,,.00
  8. Tax on Ohio taxable income (estates, line 3) or tax on modifi ed Ohio taxable income (trusts, 
      line 7). See tax table in the instructions.............................................................................................8. ,,.00
  
  9. Credits from Schedule B, line 47 (estates only)    ................................................................................9.      ,,.00
 
 10. Resident credit from Schedule C (estates); nonresident credit from Schedule D (estates); business 
      credit for estates and trusts from Schedule E (attach Schedule E), Schedule I credit (resident 
      trusts) and grant for new manufacturing M&E. Attach grant request form ...................................10.                             ,,.00

         2014 IT 1041                                                    pg. 1 of 5
                                                                                                                                                2014 IT 1041



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                                                                                                                                                                       Rev. 8/14
                                                                                                                                                              IT 1041
                                                                                              2014                                                            Fiduciary
   FEIN                                                          14180202                                                                                     Income Tax Return

   INCOME AND TAX INFORMATION...cont.

    11. Tax after nonrefundable credits and grant (line 8 minus the amount on lines 9 and 10) ................ 11.                                            ,,.00
 
   12. Interest penalty on underpayment of estimated tax (attach Ohio form IT/SD 2210).............................12.                                        ,,.00
 
   ...........................................................................................13.13. Total Ohio tax (sum of lines 11 and 12)                  ,,.00

  14. Net payments from line 77 on page 5..................14.                       ,     ,            . 00
 15. Refundable business credits (attach documen-
       tation)...................................................................15. ,,.00

 16. Total (sum of lines 14 and 15)..............................16.                 ,,.00
   17. If line 16 is more than line 13, subtract line 13 from line 16. This is your overpayment .................17.                                          ,,.00
 18. Amount of line 17 to be credited to 2015 estimated 
       tax liability .............................CREDIT TO 201518.                 ,,.00
   19. Amount of line 17 to be refunded (subtract line 18 from line 17)....................YOUR REFUND19.                                                   ,,.00
 20. Net amount due, if any (if line 13 is more than line 16, subtract line 16 from line 13, but not less 
       than -0-)..........................................................................................................................................20. ,,.00

 21. Interest and penalty on late-paid and/or late-fi led return, if any...........................................................21.                         ,,.00
  22. Total amount due, if any (sum of lines 20 and 21). Make check payable to Ohio Treasurer of State,
      include Ohio form IT 1041P and place FEIN on check ......................TOTAL AMOUNT DUE         22.                                                 ,,.00
                      If your refund is $1.00 or less, no refund will be issued. If you owe $1.00 or less, no payment is necessary.
   SIGN HERE (required)
   I declare under penalties of perjury that this report, including any accompanying schedules and 
   statements, has been examined by me and to the best of my knowledge and belief is a true, cor-                                                             For Department Use Only
   rect and complete return and report.
       DRAFT 8/21/14
   Signature of fi duciary or trust offi cer                      Preparer’s name (please print)

   Title                    Date                                Preparer’s address (including ZIP code)                                                       ,        ,        

   Fiduciary’s or trust offi cer’s phone number                  Preparer’s phone number
   Do you authorize your preparer to contact us regarding this return?  Yes            No                                                                       Code
   SCHEDULE A – ADJUSTMENTS TO FEDERAL TAXABLE INCOME NET OF RELATED EXPENSES
 Additions
   23.  Non-Ohio state or local government interest and dividends not distributed ...................................23.                                      ,,.00

 24.  Pass-through entity add-back and related member add-back........................................................24.                                     ,,.00

 25.  Income from an ESBT not shown in federal taxable income..........................................................25.                                    ,,.00

 26.  Losses from sale or other disposition of Ohio public obligations....................................................26.                                 ,,.00
 27.  Recovery of amount previously deducted or excluded...................................................................27.                                ,,.00
 28.  Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense
   2/3,       5/6 or 6/6 (check applicable box)            ........................................................................28.                  ,,.00
 
 29.  Federal personal exemption (estates only), lump sum distribution add-back and miscellaneous
      federal tax adjustments ..................................................................................................................29.           ,,.00

 30.  Expenses claimed on Ohio estate return (estates only).................................................................30.                               ,,.00

 31.  Total additions (add lines 23 through 30)........................................................................................31.                    ,,.00

           2014 IT 1041                                                              pg. 2 of 5                                                               2014 IT 1041



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                                                                                                                                                                      Rev. 8/14
                                                                                                                                                             IT 1041
                                                                                     2014                                                                    Fiduciary
  FEIN                                                  14180302                                                                                             Income Tax Return

  SCHEDULE A – ADJUSTMENTS TO FEDERAL TAXABLE INCOME NET OF RELATED EXPENSES...cont.
  Deductions – Note: Deduct income items described below only to the extent that those 
  amounts are not already deducted or excluded from federal taxable income after distributions.
  32. Federal interest and dividends exempt from state taxation net of related expenses          ....................32.                                     ,,.00
 
 33. Certain state and municipal income tax overpayments.................................................................33.                                 ,        ,        . 00

 34. Losses from an ESBT not shown in federal taxable income.........................................................34.                                     ,,.00
 35. Wage and salary expense not previously deducted due to the federal targeted jobs credit or 
       the work opportunity credit............................................................................................................35.            ,,.00
 36. Interest income from Ohio public obligations and Ohio purchase obligations and gains from 
       the sale or other disposition of Ohio public obligations.................................................................36.                          ,        ,        . 00
 37. Refunds or reimbursements of prior year federal itemized deductions and miscellaneous 
       federal tax adjustments.................................................................................................................37.           ,        ,        . 00

 38. Farm income from a farm of at least 10 acres (trusts only)...........................................................38.                                ,        ,        . 00
 39. Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense
   1/2,     1/5 or  1/6 (check applicable box). Attach a separate schedule showing cal-
  ........................................................................................................................................39.culations       ,,.00

  40. Repayment of income reported in a prior year and not otherwise deducted .................................40.                                           ,,.00

  41. Total deductions (sum of lines 32 through 40)...............................................................................41.                        ,,.00
 42. Net adjustments – If line 31 is MORE than line 41, enter the difference here and on line 2 as 
       positive. If line 31 is LESS than line 41, enter the difference here and on line 2 as negative                                  ......42.             ,        ,        . 00
  SCHEDULE B – ESTATE CREDITS

  43. Retirement income credit (see instructions for credit table) (limit – $200) ....................................43.                                                      . 00

  ..............................................................................44. 44. Senior citizen’s credit (limit $50 per return)                                       . 00
       DRAFT 8/21/14
  45. Child and dependent care credit (see instructions and worksheet in Ohio form IT 1040 booklet) .....45.                                                 ,,.00
 
  46. Ohio political contributions credit ..................................................................................................46.              ,,.00
  
  47. Total Schedule B credits (sum of lines 43 through 46) enter here and on line 9 ........................47.                                           ,,.00
  SCHEDULE C – ESTATE OHIO RESIDENT CREDIT
  48.  Enter the portion of line 3 subjected to tax by other states or the District of Columbia 
    while an Ohio resident. New limitation see instructions  ...................................................                    ...48.                 ,,.00

 49.  Enter Ohio taxable income (line 3).....................................................................................         ...49.                 ,,.00
 50.  Divide line 48 by line 49 and enter percentage here           %. Multiply this percentage 
       by the amount shown on line 8 reduced by any amount shown on line 9       ....................................50.                                     ,,.00
 51.  Enter the 2014 income tax, less all related credits other than withholding and estimated tax payments 
       and carryforwards from previous years, paid to other states or the District of Columbia. New limita-
       tion see instructions...................................................................................................................51.         ,,.00
 52.  Enter the smaller of line 50 or line 51. This is your Ohio resident tax credit. Enter here and on 
       line 10...........................................................................................................................................52. ,,.00
  SCHEDULE D – ESTATE NONRESIDENT CREDIT
 53.  Enter the portion of Ohio taxable income (line 3) not earned or received in Ohio 
    (attach Ohio form IT 2023)     .................................................................................................. ...53.                 ,,.00

  54.  Enter Ohio taxable income (line 3).....................................................................................        ...54.                 ,,.00
 55.  Divide line 53 by line 54 and enter percentage here           %. Multiply this percentage 
       by the amount shown on line 8 reduced by the amount shown on line 9. Enter here and on 
       line 10...........................................................................................................................................55. ,,.00

       2014 IT 1041                                                    pg. 3 of 5
                                                                                                                                                             2014 IT 1041



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                                                                                                                                                                      IT 1041   Rev. 8/14
                                                                                         2014                                                                         Fiduciary
   FEIN                                                    14180402                                                                                                   Income Tax Return

   SCHEDULE E – NONREFUNDABLE BUSINESS CREDITS
 Note: Schedule E is not included in this return (see instructions).
   SCHEDULE F, G, H AND I FOR TRUSTS ONLY
  See instructions for a detailed explanation of “Matching, Against Income and Gain, Expense Amounts and Distribution Deduction.” 
   SCHEDULE F – ALLOCATED QUALIFYING TRUST AMOUNTS
   This schedule is used to allocate qualifying trust amounts for trusts recognized gains or losses from the disposition of closely held investments.
 56.  Enter the trust’s portion of capital gains/losses recognized to the extent included in Ohio 
        taxable income (line 3) if the location of the physical assets of the closely held investee is 
        available .................................................................................................................................            ..56.  ,,.00

  57.  Enter the percentage of the closely held investee’s physical assets located within Ohio            ..............57.                                                     .
  58.  Multiply the amount on line 56 by the percentage on line 57. Enter here and on line 4   .........                                                        ..58. ,,.00
 
   SCHEDULE G – APPORTIONED INCOME FOR TRUSTS....................................................26.

        investment income not otherwise a part of business income and not included in line 56                                                                         ,,.
  59. Enter (i) the trust’s business income not included in line 56 and (ii) the trust’s qualifying ......                                                      ..59.                    00

  60.  Enter the Ohio apportionment ratio from line 75 of the apportionment worksheet on page 5 .........60.                                                                   .
 61.  Multiply the amount on line 59 by the apportionment ratio on line 60. Enter here and on               
        line 5  .......................................................................................................................................        ..61.  ,,.00
   SCHEDULE H – ALLOCATED NONBUSINESS INCOME FOR TRUSTS
  If distributive share is business income from a pass-through entity, please use Schedule G.
 62.  Resident trusts: Enter the trust’s portion of Ohio taxable income (line 3) not reported on lines 
        56 or 59  ...................................................................................................................................          ..62.  ,,.00
 63.  Nonresident trusts: Enter the trust’s portion of Ohio taxable income (line 3) not reported 
        on lines 56 or 59 to the extent such income (i) was derived from real or tangible property 
        located in or based in Ohio or (ii) was sitused to Ohio (see instructions for line 63) or (iii) DRAFT 8/21/14
        was described in Ohio Revised Code section 5747.212  ........................................................                                          ..63.  ,,.00

  .................................................................. 64.  Add lines 62 and 63 and enter here and on line 6                                     ..64.  ,,.00

   SCHEDULE I – TAX CREDIT FOR RESIDENT TRUSTS
 65.  Enter the amount of allocated resident trust nonbusiness income (line 62, above) subject 
        to tax in one or more states or in the District of Columbia  ......................................................                                    ..65.  ,,.00

  ..........................................................................................................66. 66.  Enter the amount from line 8                     ,,.00

  67.  Enter the amount of modifi ed Ohio taxable income from line 7  ......................................................67.                                        ,,.00
 68.  Divide line 66 by line 67 and enter the percentage here. This is the average effective tax 
        rate .................................................................................................................................................68.               .
   69.  Multiply the amount on line 65 by the percentage reported on line 68   ...................................                                             ..69.  ,,.00
 70.  Enter the amount of tax actually paid by the resident trust to another state or the District of 
        Columbia on the trust’s allocated nonbusiness income  ..................................................................70.                                   ,,.00
 71.  Enter the smaller of the amount on lines 69 and 70. This is the resident trust’s Ohio tax 
        credit. Enter here and on line 10 ....................................................................................................71.                     ,,.00

           2014 IT 1041                                                 pg. 4 of 5
                                                                                                                                                                      2014 IT 1041



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                                                                                                      IT 1041                 8/14
                                                                                              2014    Fiduciary
 FEIN                                                  14180502                                       Income Tax Return

 APPORTIONMENT WORKSHEET
 Use this worksheet to calculate the apportionment ratio for the trust’s modifi ed business income and qualifying investment income included in Ohio tax-
 able income. Note: All ratios are to be carried to six decimal places.
 72.  Property                                               Within Ohio                                           Total Everywhere
   a) Owned (average cost)                             ,,.00                                                     ,,.00
 
                                                             Within Ohio                                           Total Everywhere
   b) Rented (annual rental X 8)                       ,,.00                                                     ,,.00

                                                             Within Ohio                                           Total Everywhere
   c) Total (lines 72a and 72b)                        ,,.00                                        ÷            ,,.00

                                                                                              Ratio   Weight                Weighted Ratio
                                                                  =      .                            x  .20   =   .

                                                             Within Ohio                                           Total Everywhere
 
 73.  Payroll                                          ,,.00                                        ÷            ,,.00

                                                                                              Ratio   Weight                Weighted Ratio
                                                                  =      .                            x  .20   =   .

      DRAFTWithin Ohio                                                        8/21/14Total Everywhere
 74.  Sales                                            ,,.00                                        ÷            ,,.00

                                                                                              Ratio   Weight                Weighted Ratio
                                                                  =      .                            x  .60   =   .

                                                                                                                            Weighted Ratio
 75.  Total weighted apportionment ratio (add weighted ratio from lines 72c, 73 and 74). Enter ratio here and on 
   Schedule G, line 60 (carry to six decimal places).                                                              .

 Note: If the denominator of any factor is zero, the weight given to the other factors must be proportionately increased so that the total weight given to 
 the combined number of factors used is 100%, i.e., if no property/payroll, use 25% and 75%; if no sales, use 50% property/payroll.

 NET PAYMENT WORKSHEET – INCLUDE 1099(s) and W-2(s)
 76a. Estimated payments                                     76b. Prior year credit carryover         76c. 1099 withholdings
              ,        ,                . 00                 ,           ,                    . 00               ,          ,      . 00
 76d. W-2 withholdings                            76e. Refunds previously claimed
                                                    
              ,        ,                . 00                 ,           ,                    . 00
 77. Net payments (sum of lines 76a-d minus line 76e). Enter here and on page 2, line 14.
                ,           ,             .       00

       2014 IT 1041                                                    pg. 5 of 5
                                                                                                      2014 IT 1041






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