| OHIO DEPARTMENT OF TAXATION |
| 2D ACCEPTANCE TESTING SYSTEM (ATS) TY 2022 |
| Testing Information for paper returns (ONLY) |
| If you have any questions please email forms at Forms@tax.state.oh.us |
| BEFORE YOU BEGIN |
| Please complete the Ohio Notice of Intent and e-mail it to the department at Forms@tax.state.oh.us. The Notice of Intent is provided via email from the department. |
| Within this Excel spreadsheet, you will find test scenarios that represent the 2022 IT/SD Waiver, IT 1040, Schedule of Adjustments, IT BUS, Schedule of Credits, Schedule of Dependents, IT Schedule of Withholding, IT RE, IT RC, IT 40P, IT 40XP, SD 100, SD Schedule of Withholding, SD RE, SD 40P, and SD 40XP. Please follow the 2022 2D Schema provided by the department when programing all line items. All tests must be submitted. If there are any limitations to your software that will not allow you to follow the tests, please provide the list on a separate sheet of paper or in your e-mail. |
| |
| Test changes since released 10/28/22 |
| 10/31/22 - Test 11 1099r #1 SD #5903 withholding amount |
| 11/1/22 - Test 3 Corrected Self Employment Tax Deduction |
| |
| NEW THIS YEAR |
| |
| Tax brackets adjusted for tax year 2022 by the Ohio General Assembly. |
| All scenarios are considered timely filed unless the scenario includes a date the return was filed. Untimely filed returns should include a calculation for interest due on late payment of tax. |
| |
| Header: |
| |
| Ohio IT 1040/ SD100 |
| • Interest rate for calendar year 2023 is 5% |
| |
| Ohio Schedule of Credits: |
Vocational job credit
• New nonrefundable credit for TY2022
• Certificate issued to taxpayer who qualifies by the Ohio Department of Education |
Layout changes
• Resident credit calculation moved off form to a standalone schedule (IT RC)
• Credit, itself still reported on the schedule and included in calculation of total nonrefundable credits |
| |
| IT RC - Ohio Resident Credit Calculation (new form requirement) |
| 2D barcode added to form for TY 2022 |
| Calculation changed to be based upon tax less additional credits less Nonresident credit |
| |
| Estimated Payment Voucher Testing |
| IT1040ES vouchers - if you support 2023 estimated payment vouchers please include them with the test as provided in the ATS test scenarios |
| SD100ES vouchers - if you support 2023 estimated payment vouchers please include them with the test as provided in the ATS test scenarios |
| |
| REMINDERS |
| Modified Adjusted Gross Income (MAGI): |
| New method to determine a taxpayer’s personal exemption amount and certain credits introduced in TY2019 |
| To Calculate MAGI:Ohio Adjusted Gross Income (Ohio IT1040, line 3) plus Business Income Deduction (Schedule of Adjustments, line 11). If there is no business income deduction taken, the OAGI (Ohio adjusted gross income) and the MAGI (modified adjusted gross income) would be the same. |
| Use MAGI to determine a taxpayer's personal exemption amount |
| Use MAGI to determine if a taxpayer qualifies for the child care and dependent care credit |
| Use MAGI less exemptions to determine if they qualify for the credits listed below: |
• Retirement income credit
• Lump sum retirement credit
• Senior citizen credit
• Lump sum distribution credit
• Exemption credit
• Joint filing credit |
Income for Earned Income Tax Base School Districts are now limited to income included in MAGI
• Wages plus Net Earnings from Self-Employment less Federal Conformity Adjustments cannot exceed MAGI
• When these amounts exceed MAGI either wages or Net Earnings from Self-Employment must be reduced in order to limit the taxable income to MAGI |
| Make sure to review the Schema info for "Required, fields" and the character limitations for each form for current year updates. |
| |
| WHO MUST TEST? |
| Software developers must test each package they offer (professional, on-line, and consumer products). |
| Software developers must test each product they offer. |
| All software products must pass Ohio ATS each year before their paper forms before receiving an approval rating on our website |
| Rebranded products may be required to complete additional 2D testing. |
| Note:Returns generated/submitted from an unapproved software product causes processing issues and delays. Please do not generate 2D returns until the product is approved by the department. |
| |
| WHY TEST? |
| The purpose of testing is to ensure, prior to live processing, that: 1) returns are transmitted in the correct format and meet the Ohio 2D specifications; 2) returns have no validation or math errors; and 3) required fields post to the Ohio master file correctly. |
| |
| WHEN DOES TESTING BEGIN? |
| November 1st, 2022 |
| |
| ATS TESTS |
| Developers must use the test scenarios in this publication for Ohio 2D Barcode ATS testing. |
| The scenarios tests that test only specific items are shown below. If you do not support the items, please do not send the tests. |
| • Test 13 - Standalone SD100 |
| • Test 15 - Amended 1040 and Amended SD 100 |
| • Test 16 - Amended 1040 and Amended SD 100 |
| • Test 17 - IT 10 |
| Developers whose software products support non-resident returns must submit all tests NOT listed above, regardless of software limitations. However, you may make adjustments to the test scenarios when the software doesn't support a line on the return.Remember the Ohio taxable income, joint filing credit and use tax must always match the test scenario. |
| There is a list at the bottom of each test identifying the line items that are tested in each scenario. |
| |
| TESTING GUIDELINES |
| Please send an email to the Forms Unit at Forms@tax.state.oh.us with a list of Submission IDs each time you send a set of tests. |
| When calculating the tax, please be sure to calculate based on the tax brackets and not the tax tables. |
| Although we accept returns with limitations, the Ohio income tax base, joint filing credit and use tax amount must match the test scenario. You must adjust your tests accordingly. |
| Although we accept returns with limitations they must be completed in their entirety. |
| Please use the phrases and abbreviations provided in the test package. This will affect your list of miscompares. |
| Enter the data in the same order as it appears in the scenario. This will affect your list of miscompares. |
| When submitting returns with multiple school district returns and/or multiple income statements, please be sure to submit them in the same order as they appear in the test scenario. This will affect your miscompares. |
| We have provided alternate instructions for certain test items that are common software limitations. If you do not support the original data, please refer to the alternate instructions provided in the form of notes within the tests or use the alternate tests. There are also important notes for alternate instructions in the "What is Tested?" section at the bottom of each test. |
| Please be sure to review the current test scenarios. From time to time, there is a need to revise the test scenarios. Any changes will be noted at the top of this information page along with the top of the revised tests. |
| When sending an e-mail, please provide your name and phone number. |
| |
| Approval |
| Upon completion of the Ohio ATS test you will receive an approval letter via e-mail. Upon approval, we will add your product information to our web site with general information (company name, address, help desk number, e-mail address and/or a list of your software limitations). |
| |
| IMPORTANT |
| Please review the coding behind a rejected return and fix any programming errors on all test scenarios to prevent other returns from having the same errors. |
| It is REQUIRED for tax year 2022, to send us a FULL-FILL IN VERSION for these form(s).The FULL-FILL IN VERSION and ALL TEST SCENARIOS MUST BE sent VIA E-MAIL ONLY to Forms@tax.state.oh.us. |
| Please proof the static text and test the 1D barcodes before submitting full-fill and test scenarios. Testing the 1D and 2D barcodes is very critical before submitting. This may cause a rejection, which can delay approval. |
| |
| DEADLINE FOR THE FIRST SUBMISSION OF FULL FILLIN FORMS and 2D TESTS is December 1st, 2022 |
| RESUBMITS will continue to be accepted after this date, however, approval may be delayed. |
| Ohio Test #1 |
|
|
IT1040WithSD100 |
| Taxpayer Information |
|
Description |
|
| TaxpayerSSN |
|
Primary Social Security Number |
400-XX-7601 |
| FirstName |
|
Primary First Name |
I'MA |
| LastName |
|
Primary Last Name |
BUCKEYE |
| DateOfBirth |
|
Date of Birth - Primary |
1959-01-01 |
| |
|
|
|
| USPhone |
|
Taxpayer's Phone Number |
[<=9999999]###-#### |
| EmailAddress |
|
Taxpayer's E-mail Address |
BUCKEYE@OHIO.GOV |
| |
|
|
|
| AddressLine1Txt |
|
Foreign Address Line 1 |
1099 NUTT ST |
| AddressLine2Txt |
|
Foreign Address Line 2 |
APT 2A |
| CityNm |
|
Foreign City |
VICTORIA |
| ProvinceOrStateNm |
|
Foreign Province |
BRITISH COLUMBIA |
| CountryCd |
|
Foreign Country |
CANADA |
| ForeignPostalCd |
|
Foreign Postal Code |
V8X 3X4 |
| |
|
|
|
| Please use the following address if your software does not support a foreign address. |
|
|
|
| AddressLine1 |
|
Address Line 1 |
123 BUCKEYE WAY |
| City |
|
City |
NORTHWOOD |
| State |
|
State |
OH |
| ZIPCode |
|
Zip Code |
43619 |
| |
|
|
|
| MailingAddressCounty |
|
Ohio County |
FRANKLIN |
| SchoolDistrictNumber |
|
Ohio Public School District Number - Resident District |
9999 |
| |
|
|
|
| Preparer Information |
|
|
|
| Paid Preparer |
|
|
|
| PTIN |
|
Paid Preparer's PTIN |
P24682468 |
| PreparerFirmEIN |
|
Paid Preparer's Firm ID Number |
987654321-0000000 |
| BusinessNameLine1Txt |
|
Paid Preparer's Business Name |
TAX INC |
| PreparerPersonNm |
|
Paid Preparer's name |
CARL BROWN |
| |
|
|
|
| AddressLine1Txt |
|
Preparer's US Address |
123 MAIN ST |
| CityNm |
|
City |
TIPP CITY |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
ZIP Code |
45371 |
| |
|
|
|
| PhoneNum |
|
Paid Preparer's US Phone Number |
[<=9999999]###-#### |
| EmailAddressTxt |
|
Paid Preparer's Email Address |
CARLBROWN@TAXINC.COM |
| |
|
|
|
| ContactPreparerAuthorization |
|
Preparer Authorization Check Box |
Yes |
| |
|
|
|
| *IT Waiver Required* |
|
|
|
| Reason |
|
Taxpayer opts not to file electronically |
X |
| |
|
|
|
| Income Statements |
|
|
|
| W-2 #1 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
113456789-####### |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
LOAFER'S SANDWICH SHOPPE |
| |
|
|
|
| Employer Foreign Address |
|
|
|
| AddressLine1Txt |
|
Foreign Address Line 1 |
14A LOAFERS LANE |
| CityNm |
|
Foreign City |
VICTORIA |
| ProvinceOrStateNm |
|
Foreign Province |
BRITISH COLUMBIA |
| CountryCd |
|
Foreign Country |
CA |
| ForeignPostalCd |
|
Foreign Postal Code |
V8X 3X4 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7601 |
| EmployeNm |
|
Employee's Name |
I'MA BUCKEYE |
| |
|
|
|
| AddressLine1Txt |
|
Foreign Address Line 1 |
1099 NUTT ST |
| AddressLine2Txt |
|
Foreign Address Line 2 |
APT 2A |
| CityNm |
|
Foreign City |
VICTORIA |
| ProvinceOrStateNm |
|
Foreign Province |
BRITISH COLUMBIA |
| CountryCd |
|
Foreign Country |
CA |
| ForeignPostalCd |
|
Foreign Postal Code |
V8X 3X4 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$12,420.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$300.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$12,420.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$770.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$12,420.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$180.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
51345678-000000 |
| StateWagesAmt |
|
State Wages |
$12,420.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$70.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$12,420.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$248.00 |
| LocalityNm |
|
Name of Locality |
TIPP CITY |
| |
|
|
|
| SchoolDistrictWages |
|
School District Wages |
$12,420.00 |
| SchoolDistrictTaxWithheld |
|
School District Tax Withheld |
$31.00 |
| SchoolDistrictNumber |
|
School District # |
2307 |
| |
|
|
|
| Other Withholding Statement |
|
|
|
| FormType |
|
Income Statement Form Type |
1042-S |
| |
|
|
|
| PayerName |
|
Payer's Name |
THE OHIO STATE UNIVERSITY |
| AddressLine1Txt |
|
Payer's Address |
2525 BUCKEYE WAY |
| AddressLine2Txt |
|
|
|
| CityNm |
|
Payer's City |
COLUMBUS |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZipCd |
|
Payer's Zip Code |
43210 |
| |
|
|
|
| PayerEIN |
|
Payer's Identification Number |
976452521-0000000 |
| |
|
|
|
| PayeeName |
|
Payee's Name |
I'MA BUCKEYE |
| AddressLine1Txt |
|
Payee's Address Line 1 Txt |
1099 NUTT ST |
| AddressLine2Txt |
|
Payee's Address Line 2 Txt |
APT 2A |
| CityNm |
|
Payee's City |
VICTORIA |
| ProvinceOrStateNm |
|
Payee's State or Province |
BRITISH COLUMBIA |
| CountryCd |
|
Payee's Country |
CA |
| ForeignPostalCd |
|
Payee's Foreign Zip Code |
V8X 3X4 |
| |
|
|
|
| PayeeSSN |
|
Recipient ID Number |
400-XX-7601 |
| |
|
|
|
| IncomeAmount |
|
Federal Taxable Income |
$3,500.00 |
| WithholdingAmount |
|
Federal Tax Withheld |
$350.00 |
| |
|
|
|
| StateAbbreviationCd |
|
State |
OH |
| PayerStateIDNum |
|
State ID |
54-986565 |
| StateIncomeAmt |
|
State Taxable Income |
$3,500.00 |
| StateIncomeTaxAmt |
|
State Tax Withheld |
$35.00 |
| |
|
|
|
| LocalIncomeAmt |
|
Local Taxable Income |
$3,500.00 |
| LocalIncomeTaxAmt |
|
Local Tax Withheld |
$35.00 |
| LocalityNm |
|
Locality Name |
COLUMBUS |
| |
|
|
|
| Return Information |
|
|
|
| Federal Return Data |
|
|
|
| |
|
Filing Status |
Married Filing Separately |
| |
|
Exemptions, Self |
1 |
| |
|
Total Wages, salaries, tips,etc. |
$12,420.00 |
| |
|
Taxable Refunds, credits or offsets of state and local income taxes |
$3,000.00 |
| |
|
Net Income reported in Box 2 on form 1042-S |
$3,500.00 |
| |
|
Adjusted Gross Income |
$18,920.00 |
| |
|
Earned Income Tax Credit |
$0.00 |
| State Return Data |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| FilingStatus |
|
|
|
| MarriedFilingSeparately |
|
|
X |
| SpouseSSNforMFS |
|
Spouse SSN for MFS |
400-XX-7651 |
| |
|
|
|
| Did you file federal extension Form 4868? |
|
|
No |
| |
|
|
|
| Did you take the Standard deduction or itemize? |
|
|
Standard |
| |
|
|
|
| Can someone else claim you (or your spouse) as a dependent? |
|
|
|
| ClaimedAsDependent |
|
|
No |
| |
|
|
|
| Residency Status |
|
|
|
| PrimaryResidencyStatus |
|
|
|
| FullYearNonResident |
|
Full-Year NonResident |
X |
| Country |
|
Country of Residence (if foreign country) |
CA |
| |
|
Irrebutable Presumption of Nonohio Domicile (IT-NRS) |
X |
| |
|
|
|
| Unreimbursed Healthcare Expenses Worksheet |
| UnreimbPremNoEmpPaidOrMedicare |
1 |
Enter amounts paid for unreimbursed dental, vision and health insurance |
$4,000.00 |
| UnreimbLTCPrem |
2 |
Enter amounts paid for unreimbursed long-term care insurance premiums |
$0.00 |
| UnreimbPremEligEmpPaidOrMedicare |
3 |
Enter amounts paid for unreimbursed dental, vision and health insurance |
$0.00 |
| MedCareAmts |
4 |
Enter amounts paid for medical care during the year |
$0.00 |
| UnreimbPremEligAndMedCareAmts |
5 |
Sum of lines 3 and 4 |
$0.00 |
| FederalAdjustedGrossIncome |
6 |
Enter your federal adjusted gross income. If less than zero, enter zero |
$18,920.00 |
| FAGIMul7HalfPer |
7 |
Multiply line 6 by 7.5% (0.075) |
$1,419.00 |
| ElgPremAndCareLessFAGIMul7HalfPer |
8 |
Line 5 minus line 7. If less than zero, enter zero |
$0.00 |
| TotalHealthCareExpDed |
9 |
Add lines 1, 2, and 8. Enter the total here and on Ohio Schedule of Adjustments, line 36 |
$4,000.00 |
| |
|
|
|
| Additional Information |
|
|
|
| IRC168And179AdjDed |
|
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$12,420.00 |
| CharityOrgName |
|
Donation From Taxpayer - Wildlife species |
$15.00 |
| CharityOrgName |
|
Donation From Taxpayer - Military Injury Relief Fund |
$10.00 |
| CharityOrgName |
|
Donation From Taxpayer - Nature Preserves/Scenic Rivers |
$5.00 |
| CharityOrgName |
|
Donation From Taxpayer - Wishes for sick children |
$10.00 |
| |
|
|
|
| SD Return # 1 Information |
|
|
|
| SchoolDistrictNumber |
|
What is the school district number for which you are filing the SD 100? |
2307 |
| TaxType |
|
Tax Type |
Traditional |
| |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| Residency Status |
|
School district residency |
|
| PrimaryResidencyStatus |
|
|
|
| FullYearNonResident |
|
Full-Year NonResident |
X |
| |
|
|
|
| Return |
|
|
|
| IT1040 - Pages 1 & 2 |
| FederalAdjustedGrossIncome |
1 |
Federal Adjusted Gross Income |
$18,920.00 |
| TotalIncomeAddition |
2a |
Additions to federal adjusted gross income |
$0.00 |
| TotalIncomeDeduction |
2b |
Deductions from federal adjusted gross income |
$19,420.00 |
| OhioAdjustedGrossIncome |
3 |
Ohio Adjusted Gross Income (OAGI) |
($500.00) |
| ExemptionDeduction |
4 |
Personal and dependent exemption deduction |
$2,400.00 |
| TaxableIncome |
5 |
Ohio income tax base |
$0.00 |
| TaxableBusinessIncome |
6 |
Taxable business income (Ohio IT BUS, line 13) |
$0.00 |
| TaxableIncomeLessBusinessIncome |
7 |
Line 5 minus line 6 (if less than 0, enter 0) |
$0.00 |
| |
7a |
Amount from line 7 on page 1 |
$0.00 |
| NonBusinessIncomeTaxLiability |
8a |
Nonbusiness income tax liability |
$0.00 |
| BusinessIncomeTaxLiability |
8b |
Business income tax liability (Ohio IT BUS, line 14) |
$0.00 |
| IncomeTaxLiabilityBeforeCredits |
8c |
Income tax liability before credits (line 8a plus 8b) |
$0.00 |
| OhioNonRefundableCredits |
9 |
Ohio nonrefundable credits |
$20.00 |
| TaxLiabAfterNonrefundableCrdt |
10 |
Tax liability after nonrefundable credits |
$0.00 |
| UnderPaymentInterestPenalty |
11 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| UnpaidUseTax |
12 |
Sales and use tax due on Internet, mail order or other out-of-state purchases |
$0.00 |
| TotalTaxLiability |
13 |
Total Ohio tax liability before withholding or estimated payments |
$0.00 |
| TaxWithheld |
14 |
Ohio income tax withheld |
$105.00 |
| InstallmentPayment |
15 |
Add the Ohio estimated & extension payments & credit carryforward from previous year return |
$0.00 |
| RefundableTaxCredits |
16 |
Refundable credits |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
17 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayment |
18 |
Total Ohio Tax Payments |
$105.00 |
| OverpymtRecdOnOrigAmendRtn |
19 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
20 |
Line 18 minus line 19 |
$105.00 |
| AmountUnderpaid |
21 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
22 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
23 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
24 |
Overpayment |
$105.00 |
| OverpymtCreditedNextYear |
25 |
Original return only - amount of line 24 to be carried forward to next year's tax liability |
$0.00 |
| CharityOrgName |
26a |
Amount of line 24 to be donated - Wildlife species |
$15.00 |
| CharityOrgName |
26b |
Amount of line 24 to be donated - Military injury relief |
$10.00 |
| CharityOrgName |
26c |
Amount of line 24 to be donated - Ohio History Fund |
$0.00 |
| CharityOrgName |
26d |
Amount of line 24 to be donated - Nature Preserves/Scenic Rivers |
$5.00 |
| CharityOrgName |
26e |
Amount of line 24 to be donated - Breast/cervical cancer |
$0.00 |
| CharityOrgName |
26f |
Amount of line 24 to be donated - Wishes for sick children |
$10.00 |
| TotalDonation |
26g |
Total |
$40.00 |
| Refund |
27 |
Your Refund |
$65.00 |
| |
|
|
|
| Schedule of Adjustments |
| Additions |
|
|
|
| NonOhioAndLocalGovIntAndDiv |
1 |
Non-Ohio state or local government interest and dividends |
$0.00 |
| PassThruEntityTaxesPaid |
2 |
Certain Ohio pass-through entity and financial institutions taxes paid |
$0.00 |
| TuitionExpenseReimbursement |
3 |
Reimbursement of college tutition expenses and fees deducted in any previous year(s) and noneducation expenditures from a college savings account |
$0.00 |
| SaleAndDispstnLossOfOhioOblig |
4 |
Losses from sale or disposition of Ohio public obligations |
$0.00 |
| NonMedicalWithdrawals |
5 |
Nonmedical withdrawals from a medical savings account |
$0.00 |
| ReimExpPrevDeducted |
6 |
Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if the reimbursement is not in federal adjusted gross income |
$0.00 |
| IRC168And179AdjAdd |
7 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| FederalInterestAndDividends |
8 |
Federal interest and dividends subject to state taxation |
$0.00 |
| FederalConformityAdditions |
9 |
Federal conformity additions |
$0.00 |
| TotalIncomeAddition |
10 |
Total additions |
$0.00 |
| |
|
|
|
| Deductions |
|
|
|
| BusinessIncomeDeduction |
11 |
Business income deduction (attach Ohio Schedule IT BUS, line 11) |
$0.00 |
| OHFullYrEmpCompEarnNeighState |
12 |
Employee compensation earned in Ohio by residents of neighboring states |
$0.00 |
| IRS1040StateMuniIncomeOverpymt |
13 |
State or municipal income tax overpayments shown on the federal 1040, Sch 1, line 1 |
$3,000.00 |
| SocialSecurityBenefits |
14 |
Taxable Social Security benefits |
$0.00 |
| RailroadRetirementBenefits |
15 |
Certain railroad retirement benefits |
$0.00 |
| ObligIntrstPublicServicePay |
16 |
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 state of Ohio or income from a transfer agreement |
$0.00 |
| IndDevAcct |
17 |
Amounts contributed to an individual development account |
$0.00 |
| STABLEAcct |
18 |
Amounts contributed to STABLE account; Ohio's ABLE plan |
$0.00 |
| OutOfStateDisasterWorkIncome |
19 |
Income earned in Ohio by a qualifying out-of-state business or employee for disaster work conducted during a disaster response period |
$0.00 |
| FederalIntAndDivExempt |
20 |
Federal interest and dividends exempt from state taxation |
$0.00 |
| IRC168And179AdjDed |
21 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$12,420.00 |
| IRS1040RefundOrReimbursements |
22 |
Refund or reimbursements shown on the federal 1040, schedule 1 for itemized deductions claimed on a prior year federal income tax return |
$0.00 |
| RepaymentOfIncomeReported |
23 |
Repayment of income reported in a prior year |
$0.00 |
| NotDeductedWageExpense |
24 |
Wage expense not deducted due to claiming the federal work opportunity credit |
$0.00 |
| FederalConformityDeductions |
25 |
Federal conformity deductions |
$0.00 |
| MilitaryPayForResident |
26 |
Military pay for Ohio residents received while the military member was stationed outside Ohio |
$0.00 |
| IncomeErndMilitCivilianNRSpouse |
27 |
Certain income earned by military nonresidents and civilian nonresident spouses |
$0.00 |
| UniformedServcsRetirmtIncome |
28 |
Uniformed services retirement income |
$0.00 |
| MilitaryInjuryReliefFund |
29 |
Military injury relief fund |
$0.00 |
| NationalGuardReimAndBenft |
30 |
Certain Ohio National Guard reimbursements and benefits |
$0.00 |
| CollegeAdvSavAndTuitPurchCred |
31 |
Ohio 529 contributions, tuition credit purchases |
$0.00 |
| PellOhioCollegeOppTaxableGrant |
32 |
Pell/Ohio College Opportunity taxable grant amounts used to pay room and board |
$0.00 |
| OhioEducatorExpenses |
33 |
Ohio educator expenses in excess of federal deduction |
$0.00 |
| DisabilityBenefits |
34 |
Disability benefits |
$0.00 |
| SurvivorBenefits |
35 |
Survivor benefits |
$0.00 |
| UnsubsidizedMedicalExpense |
36 |
Unreimbursed long-term care insurance premiums, unsubsidized health care insurance premiums and excess health care expenses (see instructions for worksheet) |
$4,000.00 |
| HealthCareDepositedFunds |
37 |
Funds deposited into, and earnings of, a medical savings account for eligible health care expenses (see instructions for worksheet) |
$0.00 |
| QualOrganDonorExp |
38 |
Qualified organ donor expenses |
$0.00 |
| TotalIncomeDeduction |
39 |
Total deductions |
$19,420.00 |
| |
|
|
|
| Schedule IT BUS |
|
|
|
| |
|
Part 1 |
|
| BusScheduleB |
1 |
Sch B - Interest and Ordinary Dividends |
$0.00 |
| BusScheduleC |
2 |
Sch C - Profit or Loss From Business (Sole Proprietership) |
$0.00 |
| BusScheduleD |
3 |
Sch D - Capital Gains and Losses |
$0.00 |
| BusScheduleE |
4 |
Sch E - Supplemental Income and Loss |
$0.00 |
| GuaranteedPayments |
5 |
Guranteed payments, compensation and/or wages from each pass-through entity in which you have at least a 20% direct or indirect ownership interest |
$0.00 |
| BusScheduleF |
6 |
Sch F - Profit or Loss From Farming |
$0.00 |
| OtherItemsOfIncome |
7 |
Other items of income and gain separately stated on federal Schedule K-1, federal 4797 gains and/or losses reported on federal 4797 and miscellaneous federal income tax adjustments, if any |
$0.00 |
| TotalOfBusinessIncome |
8 |
Total of business income (add lines 1 through 7) |
$0.00 |
| |
|
Part 2 |
|
| AllBusinessIncome |
9 |
All business income (enter the lesser of line 8 above or Ohio IT1040, line 1). If zero or negative, stop here and do not complete Part 3. |
$0.00 |
| FilingStatusBusIncAmt |
10 |
Enter $250,000 if single or MFJ, enter $125,000 if MFS |
$0.00 |
| LessOfFilStatBusIncAmtOrAllBusInc |
11 |
Lesser of line 9 or line 10. Enter here and on Ohio Schedule of Adjustments, line 11 |
$0.00 |
| |
|
Part 3 |
|
| AllBusIncLessBusIncDeduction |
12 |
Line 9 minus line 11 (if less than -0-, enter -0-) |
$0.00 |
| TaxableBusinessIncome |
13 |
Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5) |
$0.00 |
| BusinessIncomeTaxLiability |
14 |
Business income tax liability. Multiply line 13 by 3%. Enter here and on Ohio IT 1040, line 8b. |
$0.00 |
| |
|
|
|
| Schedule of Credits - Nonrefundable |
| TaxLiabilityBeforeCredits |
1 |
Tax liability before credits (From IT1040, line 8c) |
$0.00 |
| RetireIncomeCredit |
2 |
Retirement income credit (limit $200 per return) |
$0.00 |
| LumpSumRetirementCredit |
3 |
Lump sum retirement credit (include Ohio LS WKS, line 6) |
$0.00 |
| SeniorCitizenCredit |
4 |
Senior citizen credit |
$0.00 |
| LumpSumDistributionCredit |
5 |
Lump sum distribution credit (include Ohio LS WKS, line 3) |
$0.00 |
| ChildAndDependCareCredit |
6 |
Child care and dependent care credit (see the worksheet in the instructions) |
$0.00 |
| DisplacedWorkerTrainingCredit |
7 |
Displaced worker training credit (see the worksheet in the instructions) |
$0.00 |
| CampaignContributionCredit |
8 |
Campaign contribution credit |
$0.00 |
| ExemptionCredit |
9 |
Income-based exemption credit |
$20.00 |
| TotCreditsBeforeJointFiling |
10 |
Total (add lines 2 through 9) |
$20.00 |
| TaxLessCredit |
11 |
Tax less credits (line 1 minus line 10; if less than -0-, enter -0-) |
$0.00 |
| JointFilingCredit |
12 |
Joint filing credit |
$0.00 |
| EarnedIncomeCredit |
13 |
Earned income credit (multiply Fed EITC by 30%) |
$0.00 |
| HomeSchoolExpensesCredit |
14 |
Home school expenses credit |
$0.00 |
| ScholarshipDonationCredit |
15 |
Scholarship donation credit |
$0.00 |
| NonCharterOrPublicSchoolCredit |
16 |
Nonchartered, nonpublic school tuition credit |
$0.00 |
| VocationalJobCredit |
17 |
Vocational job credit |
$0.00 |
| AdoptionCredit |
18 |
Ohio adoption credit |
$0.00 |
| JobRetentionCredit |
19 |
Nonrefundable job retention credit |
$0.00 |
| NewEmpInEntZoneCredit |
20 |
Credit for eligible new employees in an enterprise zone |
$0.00 |
| GrapeProdPropertyPurchCredit |
21 |
Credit for purchases of grape production property |
$0.00 |
| InvestOhioCredit |
22 |
InvestOhio credit |
$0.00 |
| LeadAbatementCredit |
23 |
Lead abatement credit |
$0.00 |
| OpportunityZoneCredit |
24 |
Opportunity zone investment credit |
$0.00 |
| TechInvestCreditCarryfrwd |
25 |
Technology investment credit carryforward |
$0.00 |
| EntZoneDayCareAndTrngCredit |
26 |
Enterprise zone day care and training credits |
$0.00 |
| ResearchAndDevelopmentCredit |
27 |
Research and development credit |
$0.00 |
| OhioHistoricPreservationCredit |
28 |
Nonrefundable Ohio historic preservation credit |
$0.00 |
| TotAdditionalCredits |
29 |
Total (add lines 12 through 28) |
$0.00 |
| TaxLessCrdtMinusTotAddlCrdts |
30 |
Tax less additional credits (line 11 minus line 29; if less than -0-, enter -0-) |
$0.00 |
| |
|
Nonresident Credit |
|
| NonOhioIncome |
31 |
Nonresident Portion of Ohio adjusted gross income |
$0.00 |
| OhioAdjustedGrossIncome |
32 |
Ohio adjusted gross income |
$0.00 |
| NonResIncomeCreditRatio |
33a |
Divide line 31 by line 32 |
0.0000 |
| NonresidentAndPartYearCredit |
33 |
Nonresident credit (line 30 times line 33a) |
$0.00 |
| |
|
Resident Credit |
|
| ResidentTaxCredit |
34 |
Resident Credit - Ohio IT RC, line 7 |
$0.00 |
| TotalNonrefundableCredits |
35 |
Total nonrefundable credits |
$20.00 |
| |
|
|
|
| Schedule of Credits - Refundable |
| HistoricPreservationCredit |
36 |
Refundable Ohio historic preservation credit |
$0.00 |
| JobCreationAndJobRetentionCrd |
37 |
Refundable job creation credit & job retention credit |
$0.00 |
| PassthroughEntityCredit |
38 |
Pass-through entity credit |
$0.00 |
| MotionPictureProductionCredit |
39 |
Motion Picture & Broadway theatrical production credit |
$0.00 |
| VentureCapitalCredit |
40 |
Venture Capital credit |
$0.00 |
| TotalRefundableCredit |
41 |
Total refundable credits |
$0.00 |
| |
|
|
|
| School District Return (#2307) |
|
|
|
| SchoolDistrictTaxableIncome |
1 |
School district taxable income: Traditional or Earned Income tax base |
$0.00 |
| TaxAmount |
2 |
School District Tax .____ times line 1. |
$0.00 |
| SeniorCitizenCredit |
3 |
Senior Citizen Credit |
$0.00 |
| TaxLessCredit |
4 |
School District Income Tax liability |
$0.00 |
| UnderPaymentInterestPenalty |
5 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| TotalTax |
6 |
Total school district income tax liability (line 4 plus line 5) |
$0.00 |
| TotalTax |
6a |
Amount from line 6, page 1 |
$0.00 |
| TaxWithheld |
7 |
School district income tax withheld |
$31.00 |
| InstallmentPayments |
8 |
SD 100 ES & SD 40P, Extension Payments and Credit carryforward from previous year return |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
9 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayments |
10 |
Total school district income tax payments (add lines 7, 8 and 9) |
$31.00 |
| OverpymtRecdOnOrigAmendRtn |
11 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
12 |
Line 10 minus line 11. Place a negative sign ("-") in the box if the amount is less than -0- |
$31.00 |
| AmountUnderpaid |
13 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
14 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
15 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
16 |
Overpayment |
$31.00 |
| OverpymtCreditedNextYear |
17 |
Original return only - amount of line 16 to be carried forward to next year's tax liability |
$0.00 |
| Refund |
18 |
Your Refund |
$31.00 |
| Traditional Tax Base School District Amounts |
|
|
|
| TaxableIncome |
19 |
Ohio income tax base (Ohio IT 1040, line 3 minus line 4) |
($2,900.00) |
| BusinessIncomeDeductionAddback |
20 |
Business income deduction add-back |
$0.00 |
| TotalTraditionalSDIncome |
21 |
Total Traditional Tax Base School District Income (Line 19 + Line 20) |
($2,900.00) |
| NonResidentIncome |
22 |
Amount of traditional tax base school district income that you earned while not a resident |
$0.00 |
| SchoolDistrictTaxableIncome |
23 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| Earned Income Tax Base School District Amounts |
|
|
|
| WagesAndOtherCompensations |
24 |
Wages and other compensation as described in the instructions |
$0.00 |
| SelfEmploymentEarnings |
25 |
Net Earnings from Self Employment |
$0.00 |
| FederalConformityAdjustments |
26 |
Federal Conformity Adjustments |
$0.00 |
| SchoolDistrictTaxableIncome |
27 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| |
|
|
|
| What is Tested? |
If you do not support: |
| IT1040WithSD100 |
|
| First Name - Apostrophe |
|
|
|
| Foreign Address |
Change to Ohio address provided |
| Address Line 2 |
Leave off apartment number |
| Paid Preparer |
Change to Self-Prepared |
| Preparer Contact - Authorized |
|
| MFS status |
|
| Ohio W-2 |
|
| Other Withholding |
|
Do not provide, do not include income or withholding on the return |
|
| |
|
| IT1040 |
|
| Nonresident |
See Alternate Test #1 |
| Nonresident statement (IT NRS) - Primary |
|
|
|
| [$0 - $26,050] tax bracket |
|
| Sch. of Adj - State/municipal income tax overpayments |
Move amount to a Sch. of Adj deduction line you do support |
| Sch. of Adj - Ohio depreciation deduction |
Move amount to a Sch. of Adj deduction line you do support |
| Sch. of Adj - Unsubsidized medical expenses |
|
Move amount to a Sch. of Adj deduction line you do support |
| Amount of line 24 to be donated - Wildlife species |
|
|
| Amount of line 24 to be donated - Military injury relief |
|
|
| Amount of line 24 to be donated - Nature Preserves/Scenic Rivers |
|
|
| Amount of line 24 to be donated - Wishes for sick children |
|
|
| |
|
| SD100 |
|
| Nonresident |
See Alternate Test #1 |
| Traditional school district |
|
| Line 19 - Negative Amount |
|
|
| |
|
| Ohio Alt Test #1 |
|
|
IT1040WithSD100 |
| Taxpayer Information |
|
Description |
|
| TaxpayerSSN |
|
Primary Social Security Number |
400-XX-7601 |
| FirstName |
|
Primary First Name |
I'MA |
| LastName |
|
Primary Last Name |
BUCKEYE |
| DateOfBirth |
|
Date of Birth - Primary |
1959-01-01 |
| |
|
|
|
| USPhone |
|
Taxpayer's Phone Number |
[<=9999999]###-#### |
| EmailAddress |
|
Taxpayer's E-mail Address |
BUCKEYE@OHIO.GOV |
| |
|
|
|
| AddressLine1Txt |
|
Foreign Address Line 1 |
1099 NUTT ST |
| AddressLine2Txt |
|
Foreign Address Line 2 |
APT 2A |
| CityNm |
|
Foreign City |
VICTORIA |
| ProvinceOrStateNm |
|
Foreign Province |
BRITISH COLUMBIA |
| CountryCd |
|
Foreign Country |
CANADA |
| ForeignPostalCd |
|
Foreign Postal Code |
V8X 3X4 |
| |
|
|
|
| Please use the following address if your software does not support a foreign address. |
|
|
|
| AddressLine1 |
|
Address Line 1 |
123 BUCKEYE WAY |
| City |
|
City |
PICKERINGTON |
| State |
|
State |
OH |
| ZIPCode |
|
Zip Code |
43147 |
| |
|
|
|
| MailingAddressCounty |
|
Ohio County |
FRANKLIN |
| SchoolDistrictNumber |
|
Ohio Public School District Number - Resident District |
2307 |
| |
|
|
|
| Preparer Information |
|
|
|
| Paid Preparer |
|
|
|
| PTIN |
|
Paid Preparer's PTIN |
P24682468 |
| PreparerFirmEIN |
|
Paid Preparer's Firm ID Number |
987654321-0000000 |
| BusinessNameLine1Txt |
|
Paid Preparer's Business Name |
TAX INC |
| PreparerPersonNm |
|
Paid Preparer's name |
CARL BROWN |
| |
|
|
|
| AddressLine1Txt |
|
Preparer's US Address |
123 MAIN ST |
| CityNm |
|
City |
TIPP CITY |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
ZIP Code |
45371 |
| |
|
|
|
| PhoneNum |
|
Paid Preparer's US Phone Number |
[<=9999999]###-#### |
| EmailAddressTxt |
|
Paid Preparer's Email Address |
CARLBROWN@TAXINC.COM |
| |
|
|
|
| ContactPreparerAuthorization |
|
Preparer Authorization Check Box |
Yes |
| |
|
|
|
| *IT Waiver Required* |
|
|
|
| Reason |
|
Taxpayer opts not to file electronically |
X |
| |
|
|
|
| Income Statements |
|
|
|
| W-2 #1 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
113456789-####### |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
LOAFER'S SANDWICH SHOPPE |
| |
|
|
|
| Employer Foreign Address |
|
|
|
| AddressLine1Txt |
|
Foreign Address Line 1 |
14A LOAFERS LANE |
| CityNm |
|
Foreign City |
VICTORIA |
| ProvinceOrStateNm |
|
Foreign Province |
BRITISH COLUMBIA |
| CountryCd |
|
Foreign Country |
CA |
| ForeignPostalCd |
|
Foreign Postal Code |
V8X 3X4 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7601 |
| EmployeNm |
|
Employee's Name |
I'MA BUCKEYE |
| |
|
|
|
| AddressLine1Txt |
|
Foreign Address Line 1 |
1099 NUTT ST |
| AddressLine2Txt |
|
Foreign Address Line 2 |
APT 2A |
| CityNm |
|
Foreign City |
VICTORIA |
| ProvinceOrStateNm |
|
Foreign Province |
BRITISH COLUMBIA |
| CountryCd |
|
Foreign Country |
CA |
| ForeignPostalCd |
|
Foreign Postal Code |
V8X 3X4 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$12,420.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$300.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$12,420.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$770.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$12,420.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$180.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
51-345678 |
| StateWagesAmt |
|
State Wages |
$12,420.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$70.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$12,420.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$248.00 |
| LocalityNm |
|
Name of Locality |
TIPP CITY |
| |
|
|
|
| SchoolDistrictWages |
|
School District Wages |
$12,420.00 |
| SchoolDistrictTaxWithheld |
|
School District Tax Withheld |
$31.00 |
| SchoolDistrictNumber |
|
School District # |
2307 |
| |
|
|
|
| Other Withholding Statement |
|
|
|
| |
|
|
|
| FormType |
|
Income Statement Form Type |
1042-S |
| |
|
|
|
| PayerName |
|
Payer's Name |
THE OHIO STATE UNIVERSITY |
| AddressLine1Txt |
|
Payer's Address |
2525 BUCKEYE WAY |
| AddressLine2Txt |
|
|
|
| CityNm |
|
Payer's City |
COLUMBUS |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZipCd |
|
Payer's Zip Code |
43210 |
| |
|
|
|
| PayerEIN |
|
Payer's Identification Number |
976452521-0000000 |
| |
|
|
|
| PayeeName |
|
Payee's Name |
I'MA BUCKEYE |
| AddressLine1Txt |
|
Payee's Address Line 1 Txt |
1099 NUTT ST |
| AddressLine2Txt |
|
Payee's Address Line 2 Txt |
APT 2A |
| CityNm |
|
Payee's City |
VICTORIA |
| ProvinceOrStateNm |
|
Payee's State or Province |
BRITISH COLUMBIA |
| CountryCd |
|
Payee's Country |
CA |
| ForeignPostalCd |
|
Payee's Foreign Zip Code |
V8X 3X4 |
| |
|
|
|
| PayeeSSN |
|
Recipient ID Number |
400-XX-7601 |
| |
|
|
|
| IncomeAmount |
|
Federal Taxable Income |
$3,500.00 |
| WithholdingAmount |
|
Federal Tax Withheld |
$350.00 |
| |
|
|
|
| StateAbbreviationCd |
|
State |
OH |
| PayerStateIDNum |
|
State ID |
54-986565 |
| StateIncomeAmt |
|
State Taxable Income |
$3,500.00 |
| StateIncomeTaxAmt |
|
State Tax Withheld |
$35.00 |
| |
|
|
|
| LocalIncomeAmt |
|
Local Taxable Income |
$3,500.00 |
| LocalIncomeTaxAmt |
|
Local Tax Withheld |
$35.00 |
| LocalityNm |
|
Locality Name |
COLUMBUS |
| |
|
|
|
| Return Information |
|
|
|
| Federal Return Data |
|
|
|
| |
|
Filing Status |
Married Filing Separately |
| |
|
Exemptions, Self |
1 |
| |
|
Total Wages, salaries, tips,etc. |
$12,420.00 |
| |
|
Taxable Refunds, credits or offsets of state and local income taxes |
$3,000.00 |
| |
|
Net profit or (loss) from Schedule C, Schedule C-EZ, and Schedule K1 |
($6,000.00) |
| |
|
Net Income reported in Box 6 on form 1042-S |
$3,500.00 |
| |
|
Adjusted Gross Income |
$12,920.00 |
| |
|
|
|
| State Return Data |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| FilingStatus |
|
|
|
| MarriedFilingSeparately |
|
|
X |
| SpouseSSNforMFS |
|
Spouse SSN for MFS |
400-XX-7651 |
| |
|
|
|
| Did you file federal extension Form 4868? |
|
|
No |
| |
|
|
|
| Did you take the Standard deduction or itemize? |
|
|
Standard |
| |
|
|
|
| Can someone else claim you (or your spouse) as a dependent? |
|
|
|
| ClaimedAsDependent |
|
|
No |
| |
|
|
|
| Residency Status |
|
|
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| Unreimbursed Healthcare Expenses Worksheet |
| UnreimbPremNoEmpPaidOrMedicare |
1 |
Enter amounts paid for unreimbursed dental, vision and health insurance |
$10,000.00 |
| UnreimbLTCPrem |
2 |
Enter amounts paid for unreimbursed long-term care insurance premiums |
$0.00 |
| UnreimbPremEligEmpPaidOrMedicare |
3 |
Enter amounts paid for unreimbursed dental, vision and health insurance |
$0.00 |
| MedCareAmts |
4 |
Enter amounts paid for medical care during the year |
$0.00 |
| UnreimbPremEligAndMedCareAmts |
5 |
Sum of lines 3 and 4 |
$0.00 |
| FederalAdjustedGrossIncome |
6 |
Enter your federal adjusted gross income. If less than zero, enter zero |
$12,920.00 |
| FAGIMul7HalfPer |
7 |
Multiply line 6 by 7.5% (0.075) |
$969.00 |
| ElgPremAndCareLessFAGIMul7HalfPer |
8 |
Line 5 minus line 7. If less than zero, enter zero |
$0.00 |
| TotalHealthCareExpDed |
9 |
Add lines 1, 2, and 8. Enter the total here and on Ohio Schedule of Adjustments, line 36 |
$10,000.00 |
| |
|
|
|
| Additional Information |
|
|
|
| CharityOrgName |
|
Donation From Taxpayer - Wildlife species |
$15.00 |
| CharityOrgName |
|
Donation From Taxpayer - Military Injury Relief Fund |
$10.00 |
| CharityOrgName |
|
Donation From Taxpayer - Nature Preserves/Scenic Rivers |
$5.00 |
| CharityOrgName |
|
Donation From Taxpayer - Wishes for sick children |
$10.00 |
| |
|
|
|
| SD Return # 1 Information |
|
|
|
| SchoolDistrictNumber |
|
What is the school district number for which you are filing the SD 100? |
2307 |
| TaxType |
|
Tax Type |
Traditional |
| |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| Residency Status |
|
School district residency |
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| Return |
|
|
|
| IT1040 - Pages 1 & 2 |
| FederalAdjustedGrossIncome |
1 |
Federal Adjusted Gross Income |
$12,920.00 |
| TotalIncomeAddition |
2a |
Additions to federal adjusted gross income |
$0.00 |
| TotalIncomeDeduction |
2b |
Deductions from federal adjusted gross income |
$13,000.00 |
| OhioAdjustedGrossIncome |
3 |
Ohio Adjusted Gross Income (OAGI) |
($80.00) |
| ExemptionDeduction |
4 |
Personal and dependent exemption deduction |
$2,400.00 |
| TaxableIncome |
5 |
Ohio income tax base |
$0.00 |
| TaxableBusinessIncome |
6 |
Taxable business income (Ohio IT BUS, line 13) |
$0.00 |
| TaxableIncomeLessBusinessIncome |
7 |
Line 5 minus line 6 (if less than 0, enter 0) |
$0.00 |
| |
7a |
Amount from line 7 on page 1 |
$0.00 |
| NonBusinessIncomeTaxLiability |
8a |
Nonbusiness income tax liability |
$0.00 |
| BusinessIncomeTaxLiability |
8b |
Business income tax liability (Ohio IT BUS, line 14) |
$0.00 |
| IncomeTaxLiabilityBeforeCredits |
8c |
Income tax liability before credits (line 8a plus 8b) |
$0.00 |
| OhioNonRefundableCredits |
9 |
Ohio nonrefundable credits |
$20.00 |
| TaxLiabAfterNonrefundableCrdt |
10 |
Tax liability after nonrefundable credits |
$0.00 |
| UnderPaymentInterestPenalty |
11 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| UnpaidUseTax |
12 |
Sales and use tax due on Internet, mail order or other out-of-state purchases |
$0.00 |
| TotalTaxLiability |
13 |
Total Ohio tax liability before withholding or estimated payments |
$0.00 |
| TaxWithheld |
14 |
Ohio income tax withheld |
$105.00 |
| InstallmentPayment |
15 |
Add the Ohio estimated & extension payments & credit carryforward from previous year return |
$0.00 |
| RefundableTaxCredits |
16 |
Refundable credits |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
17 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayment |
18 |
Total Ohio Tax Payments |
$105.00 |
| OverpymtRecdOnOrigAmendRtn |
19 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
20 |
Line 18 minus line 19 |
$105.00 |
| AmountUnderpaid |
21 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
22 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
23 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
24 |
Overpayment |
$105.00 |
| OverpymtCreditedNextYear |
25 |
Original return only - amount of line 24 to be carried forward to next year's tax liability |
$0.00 |
| CharityOrgName |
26a |
Amount of line 24 to be donated - Wildlife species |
$15.00 |
| CharityOrgName |
26b |
Amount of line 24 to be donated - Military injury relief |
$10.00 |
| CharityOrgName |
26c |
Amount of line 24 to be donated - Ohio History Fund |
$0.00 |
| CharityOrgName |
26d |
Amount of line 24 to be donated - Nature Preserves/Scenic Rivers |
$5.00 |
| CharityOrgName |
26e |
Amount of line 24 to be donated - Breast/cervical cancer |
$0.00 |
| CharityOrgName |
26f |
Amount of line 24 to be donated - Wishes for sick children |
$10.00 |
| TotalDonation |
26g |
Total |
$40.00 |
| Refund |
27 |
Your Refund |
$65.00 |
| |
|
|
|
| Schedule of Adjustments |
| Additions |
|
|
|
| NonOhioAndLocalGovIntAndDiv |
1 |
Non-Ohio state or local government interest and dividends |
$0.00 |
| PassThruEntityTaxesPaid |
2 |
Certain Ohio pass-through entity and financial institutions taxes paid |
$0.00 |
| TuitionExpenseReimbursement |
3 |
Reimbursement of college tutition expenses and fees deducted in any previous year(s) and noneducation expenditures from a college savings account |
$0.00 |
| SaleAndDispstnLossOfOhioOblig |
4 |
Losses from sale or disposition of Ohio public obligations |
$0.00 |
| NonMedicalWithdrawals |
5 |
Nonmedical withdrawals from a medical savings account |
$0.00 |
| ReimExpPrevDeducted |
6 |
Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if the reimbursement is not in federal adjusted gross income |
$0.00 |
| IRC168And179AdjAdd |
7 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| FederalInterestAndDividends |
8 |
Federal interest and dividends subject to state taxation |
$0.00 |
| FederalConformityAdditions |
9 |
Federal conformity additions |
$0.00 |
| TotalIncomeAddition |
10 |
Total additions |
$0.00 |
| |
|
|
|
| Deductions |
|
|
|
| BusinessIncomeDeduction |
11 |
Business income deduction (attach Ohio Schedule IT BUS, line 11) |
$0.00 |
| OHFullYrEmpCompEarnNeighState |
12 |
Employee compensation earned in Ohio by residents of neighboring states |
$0.00 |
| IRS1040StateMuniIncomeOverpymt |
13 |
State or municipal income tax overpayments shown on the federal 1040, Sch 1, line 1 |
$3,000.00 |
| SocialSecurityBenefits |
14 |
Taxable Social Security benefits |
$0.00 |
| RailroadRetirementBenefits |
15 |
Certain railroad retirement benefits |
$0.00 |
| ObligIntrstPublicServicePay |
16 |
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 state of Ohio or income from a transfer agreement |
$0.00 |
| IndDevAcct |
17 |
Amounts contributed to an individual development account |
$0.00 |
| STABLEAcct |
18 |
Amounts contributed to STABLE account; Ohio's ABLE plan |
$0.00 |
| OutOfStateDisasterWorkIncome |
19 |
Income earned in Ohio by a qualifying out-of-state business or employee for disaster work conducted during a disaster response period |
$0.00 |
| FederalIntAndDivExempt |
20 |
Federal interest and dividends exempt from state taxation |
$0.00 |
| IRC168And179AdjDed |
21 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| IRS1040RefundOrReimbursements |
22 |
Refund or reimbursements shown on the federal 1040, schedule 1 for itemized deductions claimed on a prior year federal income tax return |
$0.00 |
| RepaymentOfIncomeReported |
23 |
Repayment of income reported in a prior year |
$0.00 |
| NotDeductedWageExpense |
24 |
Wage expense not deducted due to claiming the federal work opportunity credit |
$0.00 |
| FederalConformityDeductions |
25 |
Federal conformity deductions |
$0.00 |
| MilitaryPayForResident |
26 |
Military pay for Ohio residents received while the military member was stationed outside Ohio |
$0.00 |
| IncomeErndMilitCivilianNRSpouse |
27 |
Certain income earned by military nonresidents and civilian nonresident spouses |
$0.00 |
| UniformedServcsRetirmtIncome |
28 |
Uniformed services retirement income |
$0.00 |
| MilitaryInjuryReliefFund |
29 |
Military injury relief fund |
$0.00 |
| NationalGuardReimAndBenft |
30 |
Certain Ohio National Guard reimbursements and benefits |
$0.00 |
| CollegeAdvSavAndTuitPurchCred |
31 |
Ohio 529 contributions, tuition credit purchases |
$0.00 |
| PellOhioCollegeOppTaxableGrant |
32 |
Pell/Ohio College Opportunity taxable grant amounts used to pay room and board |
$0.00 |
| OhioEducatorExpenses |
33 |
Ohio educator expenses in excess of federal deduction |
$0.00 |
| DisabilityBenefits |
34 |
Disability benefits |
$0.00 |
| SurvivorBenefits |
35 |
Survivor benefits |
$0.00 |
| UnsubsidizedMedicalExpense |
36 |
Unreimbursed long-term care insurance premiums, unsubsidized health care insurance premiums and excess health care expenses (see instructions for worksheet) |
$10,000.00 |
| HealthCareDepositedFunds |
37 |
Funds deposited into, and earnings of, a medical savings account for eligible health care expenses (see instructions for worksheet) |
$0.00 |
| QualOrganDonorExp |
38 |
Qualified organ donor expenses |
$0.00 |
| TotalIncomeDeduction |
39 |
Total deductions |
$13,000.00 |
| |
|
|
|
| Schedule IT BUS |
|
|
|
| |
|
Part 1 |
|
| BusScheduleB |
1 |
Sch B - Interest and Ordinary Dividends |
$0.00 |
| BusScheduleC |
2 |
Sch C - Profit or Loss From Business (Sole Proprietership) |
($6,000.00) |
| BusScheduleD |
3 |
Sch D - Capital Gains and Losses |
$0.00 |
| BusScheduleE |
4 |
Sch E - Supplemental Income and Loss |
$0.00 |
| GuaranteedPayments |
5 |
Guranteed payments, compensation and/or wages from each pass-through entity in which you have at least a 20% direct or indirect ownership interest |
$0.00 |
| BusScheduleF |
6 |
Sch F - Profit or Loss From Farming |
$0.00 |
| OtherItemsOfIncome |
7 |
Other items of income and gain separately stated on federal Schedule K-1, federal 4797 gains and/or losses reported on federal 4797 and miscellaneous federal income tax adjustments, if any |
$0.00 |
| TotalOfBusinessIncome |
8 |
Total of business income (add lines 1 through 7) |
($6,000.00) |
| |
|
Part 2 |
|
| AllBusinessIncome |
9 |
All business income (enter the lesser of line 8 above or Ohio IT1040, line 1). If zero or negative, stop here and do not complete Part 3. |
$0.00 |
| FilingStatusBusIncAmt |
10 |
Enter $250,000 if single or MFJ, enter $125,000 if MFS |
$0.00 |
| LessOfFilStatBusIncAmtOrAllBusInc |
11 |
Lesser of line 9 or line 10. Enter here and on Ohio Schedule of Adjustments, line 11 |
$0.00 |
| |
|
Part 3 |
|
| AllBusIncLessBusIncDeduction |
12 |
Line 9 minus line 11 (if less than -0-, enter -0-) |
$0.00 |
| TaxableBusinessIncome |
13 |
Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5) |
$0.00 |
| BusinessIncomeTaxLiability |
14 |
Business income tax liability. Multiply line 13 by 3%. Enter here and on Ohio IT 1040, line 8b. |
$0.00 |
| |
|
Part 4 |
|
| NameOfEntity |
|
Name of Entity |
ACROSS THE FIELD |
| FEINOrSSN |
|
FEIN/SS# |
400-XX-7601 |
| PercentageOfOwnership |
|
Percentage of Ownership |
100% |
| Income Earned By Primary |
|
Primary |
X |
| |
|
|
|
| Schedule of Credits - Nonrefundable |
| TaxLiabilityBeforeCredits |
1 |
Tax liability before credits (From IT1040, line 8c) |
$0.00 |
| RetireIncomeCredit |
2 |
Retirement income credit (limit $200 per return) |
$0.00 |
| LumpSumRetirementCredit |
3 |
Lump sum retirement credit (include Ohio LS WKS, line 6) |
$0.00 |
| SeniorCitizenCredit |
4 |
Senior citizen credit |
$0.00 |
| LumpSumDistributionCredit |
5 |
Lump sum distribution credit (include Ohio LS WKS, line 3) |
$0.00 |
| ChildAndDependCareCredit |
6 |
Child care and dependent care credit (see the worksheet in the instructions) |
$0.00 |
| DisplacedWorkerTrainingCredit |
7 |
Displaced worker training credit (see the worksheet in the instructions) |
$0.00 |
| CampaignContributionCredit |
8 |
Campaign contribution credit |
$0.00 |
| ExemptionCredit |
9 |
Income-based exemption credit |
$20.00 |
| TotCreditsBeforeJointFiling |
10 |
Total (add lines 2 through 9) |
$20.00 |
| TaxLessCredit |
11 |
Tax less credits (line 1 minus line 10; if less than -0-, enter -0-) |
$0.00 |
| JointFilingCredit |
12 |
Joint filing credit |
$0.00 |
| EarnedIncomeCredit |
13 |
Earned income credit (multiply Fed EITC by 30%) |
$0.00 |
| HomeSchoolExpensesCredit |
14 |
Home school expenses credit |
$0.00 |
| ScholarshipDonationCredit |
15 |
Scholarship donation credit |
$0.00 |
| NonCharterOrPublicSchoolCredit |
16 |
Nonchartered, nonpublic school tuition credit |
$0.00 |
| VocationalJobCredit |
17 |
Vocational job credit |
$0.00 |
| AdoptionCredit |
18 |
Ohio adoption credit |
$0.00 |
| JobRetentionCredit |
19 |
Nonrefundable job retention credit |
$0.00 |
| NewEmpInEntZoneCredit |
20 |
Credit for eligible new employees in an enterprise zone |
$0.00 |
| GrapeProdPropertyPurchCredit |
21 |
Credit for purchases of grape production property |
$0.00 |
| InvestOhioCredit |
22 |
InvestOhio credit |
$0.00 |
| LeadAbatementCredit |
23 |
Lead abatement credit |
$0.00 |
| OpportunityZoneCredit |
24 |
Opportunity zone investment credit |
$0.00 |
| TechInvestCreditCarryfrwd |
25 |
Technology investment credit carryforward |
$0.00 |
| EntZoneDayCareAndTrngCredit |
26 |
Enterprise zone day care and training credits |
$0.00 |
| ResearchAndDevelopmentCredit |
27 |
Research and development credit |
$0.00 |
| OhioHistoricPreservationCredit |
28 |
Nonrefundable Ohio historic preservation credit |
$0.00 |
| TotAdditionalCredits |
29 |
Total (add lines 12 through 28) |
$0.00 |
| TaxLessCrdtMinusTotAddlCrdts |
30 |
Tax less additional credits (line 11 minus line 29; if less than -0-, enter -0-) |
$0.00 |
| |
|
Nonresident Credit |
|
| NonOhioIncome |
31 |
Nonresident Portion of Ohio adjusted gross income |
$0.00 |
| OhioAdjustedGrossIncome |
32 |
Ohio adjusted gross income |
$0.00 |
| NonResIncomeCreditRatio |
33a |
Divide line 31 by line 32 |
0.0000 |
| NonresidentAndPartYearCredit |
33 |
Nonresident credit (line 30 times line 33a) |
$0.00 |
| |
|
Resident Credit |
|
| ResidentTaxCredit |
34 |
Resident Credit - Ohio IT RC, line 7 |
$0.00 |
| TotalNonrefundableCredits |
35 |
Total nonrefundable credits |
$20.00 |
| |
|
|
|
| Schedule of Credits - Refundable |
| HistoricPreservationCredit |
36 |
Refundable Ohio historic preservation credit |
$0.00 |
| JobCreationAndJobRetentionCrd |
37 |
Refundable job creation credit & job retention credit |
$0.00 |
| PassthroughEntityCredit |
38 |
Pass-through entity credit |
$0.00 |
| MotionPictureProductionCredit |
39 |
Motion Picture & Broadway theatrical production credit |
$0.00 |
| VentureCapitalCredit |
40 |
Venture Capital credit |
$0.00 |
| TotalRefundableCredit |
41 |
Total refundable credits |
$0.00 |
| |
|
|
|
| School District Return (#2307) |
|
|
|
| SchoolDistrictTaxableIncome |
1 |
School district taxable income: Traditional or Earned Income tax base |
$0.00 |
| TaxAmount |
2 |
School District Tax .____ times line 1. |
$0.00 |
| SeniorCitizenCredit |
3 |
Senior Citizen Credit |
$0.00 |
| TaxLessCredit |
4 |
School District Income Tax liability |
$0.00 |
| UnderPaymentInterestPenalty |
5 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| TotalTax |
6 |
Total school district income tax liability (line 4 plus line 5) |
$0.00 |
| TotalTax |
6a |
Amount from line 6, page 1 |
$0.00 |
| TaxWithheld |
7 |
School district income tax withheld |
$31.00 |
| InstallmentPayments |
8 |
SD 100 ES & SD 40P, Extension Payments and Credit carryforward from previous year return |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
9 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayments |
10 |
Total school district income tax payments (add lines 7, 8 and 9) |
$31.00 |
| OverpymtRecdOnOrigAmendRtn |
11 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
12 |
Line 10 minus line 11. Place a negative sign ("-") in the box if the amount is less than -0- |
$31.00 |
| AmountUnderpaid |
13 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
14 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
15 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
16 |
Overpayment |
$31.00 |
| OverpymtCreditedNextYear |
17 |
Original return only - amount of line 16 to be carried forward to next year's tax liability |
$0.00 |
| Refund |
18 |
Your Refund |
$31.00 |
| Traditional Tax Base School District Amounts |
|
|
|
| TaxableIncome |
19 |
Ohio income tax base (Ohio IT 1040, line 3 minus line 4) |
($2,480.00) |
| BusinessIncomeDeductionAddback |
20 |
Business income deduction add-back |
$0.00 |
| TotalTraditionalSDIncome |
21 |
Total Traditional Tax Base School District Income (Line 19 + Line 20) |
($2,480.00) |
| NonResidentIncome |
22 |
Amount of traditional tax base school district income that you earned while not a resident |
$0.00 |
| SchoolDistrictTaxableIncome |
23 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| Earned Income Tax Base School District Amounts |
|
|
|
| WagesAndOtherCompensations |
24 |
Wages and other compensation as described in the instructions |
$0.00 |
| SelfEmploymentEarnings |
25 |
Net Earnings from Self Employment |
$0.00 |
| FederalConformityAdjustments |
26 |
Federal Conformity Adjustments |
$0.00 |
| SchoolDistrictTaxableIncome |
27 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| |
|
|
|
| What is Tested? |
If you do not support: |
| IT1040WithSD100 |
|
| First Name - Apostrophe |
|
|
|
| Foreign Address |
Change to Ohio address provided |
| Address Line 2 |
Leave off apartment number |
| Paid Preparer |
Change to Self-Prepared |
| Preparer Contact - Authorized |
|
| MFS status |
|
| Ohio W-2 |
|
| Other Withholding |
|
Do not provide, do not include income or withholding on the return |
|
| |
|
| IT1040 |
|
| Full Year Resident |
|
| [$0 - $26,050] tax bracket |
|
| Sch. of Adj - State/municipal income tax overpayments |
Move amount to a Sch. of Adj deduction line you do support |
| Sch. of Adj - Unsubsidized medical expenses |
|
Move amount to a Sch. of Adj deduction line you do support |
| Amount of line 24 to be donated - Wildlife species |
|
|
| Amount of line 24 to be donated - Military injury relief |
|
|
| Amount of line 24 to be donated - Nature Preserves/Scenic Rivers |
|
|
| Amount of line 24 to be donated - Wishes for sick children |
|
|
| |
|
| SD100 |
|
| Full Year Resident |
|
| Line 19 - Negative Amount |
|
|
| Traditional school district |
|
| |
|
| Ohio Test #2 |
|
|
IT1040WithSD100 |
| Taxpayer Information |
|
Description |
|
| TaxpayerSSN |
|
Primary Social Security Number |
400-XX-7602 |
| FirstName |
|
Primary First Name |
GOOFY |
| LastName |
|
Primary Last Name |
GOOF |
| DateOfBirth |
|
Date of Birth - Primary |
1962-01-01 |
| |
|
|
|
| USPhone |
|
Taxpayer's Phone Number |
[<=9999999]###-#### |
| EmailAddress |
|
Taxpayer's E-mail Address |
GOOFY@GOOF.COM |
| |
|
|
|
| AddressLine1Txt |
|
US Address - Address Line 1 |
8484 1/2 BLUE TENNIS SHOE SOLE AVE |
| AddressLine2Txt |
|
Address Line 2 |
APT 355 |
| CityNm |
|
City |
DUCKBERG |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43337 |
| |
|
|
|
| MailingAddressCounty |
|
Ohio County |
MARION |
| SchoolDistrictNumber |
|
Ohio Public School District Number - Resident District |
5104 |
| |
|
|
|
| Preparer Information |
|
|
|
| Non-Paid Preparer |
|
|
|
| PreparerName |
|
NonPaid Preparer's name |
HANNAH GREEN |
| PhoneNumber |
|
NonPaid Preparer's phone number |
[<=9999999]###-#### |
| EmailAddress |
|
NonPaid Preparer's Email Address |
HANNAH@GREENCO.COM |
| PTIN |
|
NonPaid Preparer's PTIN |
P97533579 |
| AddressLine1Txt |
|
NonPaid Preparer's US Address |
45 W 2ND ST |
| CityNm |
|
City |
MINSTER |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
ZIPCode |
45865 |
| |
|
|
|
| ContactPreparerAuthorization |
|
Preparer Authorization Check Box |
Yes |
| |
|
|
|
| Income Statements |
|
|
|
| W-2 #1 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
139876543-####### |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
DUCKBERG PUBLIC SCHOOLS |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
7 QUACKY DRIVE |
| CityNm |
|
City |
DUCKBERG |
| StateAbbreviationCd |
|
State |
OHIO |
| ZIPCd |
|
Zip Code |
43457 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7602 |
| EmployeNm |
|
Employee's Name |
GOOFY GOOF |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
8484 1/2 BLUE TENNIS SHOE SOLE AVE |
| AddressLine2Txt |
|
Employee Address Line 2 |
APT 355 |
| CityNm |
|
City |
DUCKBERG |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43337 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$13,250.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$75.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$13,250.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$822.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$13,250.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$192.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
52456789-000000 |
| StateWagesAmt |
|
State Wages |
$13,250.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$106.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$13,250.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$195.00 |
| LocalityNm |
|
Name of Locality |
MORRAL |
| |
|
|
|
| 1099-NEC |
|
|
|
| PayerName / BusinessNameLine1Txt |
|
Payer's Name |
THE PERFECT CAST |
| BusinessNameLine2Txt |
|
|
|
| AddressLine1Txt |
|
Payer's US Address |
23256 DUCKBERG WAY |
| AddressLine2Txt |
|
|
|
| CityNm |
|
Payer's City |
DUCKBERG |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZIPCd |
|
Payer's Zip Code |
43229 |
| |
|
|
|
| PayerEIN |
|
Payer's Identification Number |
857442361-0000000 |
| |
|
|
|
| IndividualRecipient / SSN |
|
Recipient's SSN |
400-XX-7602 |
| IndividualRecipient / Name |
|
Recipient's Name |
GOOFY GOOF |
| AddressLine1Txt |
|
Recipient's US Address Line 1 Text |
8484 1/2 BLUE TENNIS SHOE SOLE AVE |
| AddressLine2Txt |
|
Recipient's Address Line 2 Text |
APT 355 |
| CityNm |
|
Recipient's City |
DUCKBERG |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
43337 |
| |
|
|
|
| NonemployeeCompensation |
|
Box 1 Nonemployee Compensation |
$4,000.00 |
| |
|
|
|
| FederalTaxWithheld |
|
Box 4 Federal Income tax withheld |
$40.00 |
| StateTaxWithheldAmt |
|
Box 5 State tax withheld |
$16.00 |
| StateAbbreviationCd |
|
Box 6 State |
OH |
| PayerStateIdNumber |
|
Box 6 State/Payer's no |
52942537-000000 |
| StateDistributionAmt |
|
Box 7 State income |
$4,000.00 |
| |
|
|
|
| Return Information |
|
|
|
| Federal Return Data |
|
|
|
| |
|
Filing Status |
Single |
| |
|
Exemptions, Self |
4 |
| |
|
Total Wages, salaries, tips,etc. |
$13,250.00 |
| |
|
Taxable Refunds, credits or offsets of state and local income taxes |
$0.00 |
| |
|
Total Business loss |
$0.00 |
| |
|
Net profit or (loss) from Schedule C, Schedule C-EZ, and Schedule K1 |
$4,000.00 |
| |
|
Educator Expenses |
($300.00) |
| |
|
Self Employment Tax Deduction |
($283.00) |
| |
|
Adjusted Gross Income |
$16,667.00 |
| |
|
Earned Income Tax Credit |
$6,935.00 |
| State Return Data |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| FilingStatus |
|
|
|
| Single |
|
|
X |
| |
|
|
|
| Did you file federal extension Form 4868? |
|
|
No |
| |
|
|
|
| Did you take the Standard deduction or itemize? |
|
|
Standard |
| |
|
|
|
| Can someone else claim you (or your spouse) as a dependent? |
|
|
|
| ClaimedAsDependent |
|
|
No |
| |
|
|
|
| Schedule of Dependents |
|
Total Exemptions |
4 |
| NumberOfDependents |
|
|
3 |
| SSN |
|
|
400-XX-8602 |
| DateOfBirth |
|
|
2007-04-01 |
| Relationship |
|
|
SON |
| FirstName |
|
|
MAXIMILLION |
| MiddleInitial |
|
|
A |
| LastName |
|
|
GOOF |
| |
|
|
|
| SSN |
|
|
400-XX-8603 |
| DateOfBirth |
|
|
2006-04-30 |
| Relationship |
|
|
DAUGHTER |
| FirstName |
|
|
GEORGINA |
| LastName |
|
|
GOOF |
| |
|
|
|
| SSN |
|
|
400-XX-8604 |
| DateOfBirth |
|
|
2004-05-20 |
| Relationship |
|
|
DAUGHTER |
| FirstName |
|
|
GEORGETTE |
| LastName |
|
|
GOOF |
| |
|
|
|
| Residency Status |
|
|
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| Unpaid Use Tax Worksheet |
|
|
|
| a. |
|
Did you make any out of state purchases |
Yes |
| b. |
|
Did the retailer charge you any sales tax |
No |
| c. |
|
Amount of Purchases that you did not pay sales tax |
$1,683.00 |
| d. |
|
County sales tax rate |
7.25% |
| Additional Information |
|
|
|
| OhioEducatorExpenses |
|
Educator Expenses in excess of those claimed on the federal return |
$55.00 |
| |
|
|
|
| SD Return # 1 Information |
|
|
|
| SchoolDistrictNumber |
|
What is the school district number for which you are filing the SD 100? |
5104 |
| TaxType |
|
Tax Type |
Earned Income Only |
| |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| Residency Status |
|
School district residency |
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| Additional Information - SD |
|
|
|
| SelfEmploymentEarnings |
|
Net Earnings from Self Employment |
$4,000.00 |
| |
|
Note: This amount must be reduced in order to limit School District Taxable Income to the extent included in modified adjusted gross income |
|
| |
|
|
|
| Voucher Info |
|
|
|
| EstimatedPayment #1 |
|
|
X |
| PaymentAmount |
|
Amount |
$500.00 |
| AccountHolderName |
|
Account Name |
GOOFY GOOF |
| RequestedPaymentDate |
|
Payment Date |
2023-06-15 |
| |
|
|
|
| EstimatedPayment #1 - SD |
|
|
X |
| PaymentAmount |
|
Amount |
$350.00 |
| AccountHolderName |
|
Account Name |
GOOFY GOOF |
| RequestedPaymentDate |
|
Payment Date |
2023-04-18 |
| |
|
|
|
| Return |
|
|
|
| IT1040 - Pages 1 & 2 |
| FederalAdjustedGrossIncome |
1 |
Federal Adjusted Gross Income |
$16,667.00 |
| TotalIncomeAddition |
2a |
Additions to federal adjusted gross income |
$0.00 |
| TotalIncomeDeduction |
2b |
Deductions from federal adjusted gross income |
$4,055.00 |
| OhioAdjustedGrossIncome |
3 |
Ohio Adjusted Gross Income (OAGI) |
$12,612.00 |
| ExemptionDeduction |
4 |
Personal and dependent exemption deduction |
$9,600.00 |
| TaxableIncome |
5 |
Ohio income tax base |
$3,012.00 |
| TaxableBusinessIncome |
6 |
Taxable business income (Ohio IT BUS, line 13) |
$0.00 |
| TaxableIncomeLessBusinessIncome |
7 |
Line 5 minus line 6 (if less than 0, enter 0) |
$3,012.00 |
| |
7a |
Amount from line 7 on page 1 |
$3,012.00 |
| NonBusinessIncomeTaxLiability |
8a |
Nonbusiness income tax liability |
$0.00 |
| BusinessIncomeTaxLiability |
8b |
Business income tax liability (Ohio IT BUS, line 14) |
$0.00 |
| IncomeTaxLiabilityBeforeCredits |
8c |
Income tax liability before credits (line 8a plus 8b) |
$0.00 |
| OhioNonRefundableCredits |
9 |
Ohio nonrefundable credits |
$2,161.00 |
| TaxLiabAfterNonrefundableCrdt |
10 |
Tax liability after nonrefundable credits |
$0.00 |
| UnderPaymentInterestPenalty |
11 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| UnpaidUseTax |
12 |
Sales and use tax due on Internet, mail order or other out-of-state purchases |
$122.00 |
| TotalTaxLiability |
13 |
Total Ohio tax liability before withholding or estimated payments |
$122.00 |
| TaxWithheld |
14 |
Ohio income tax withheld |
$122.00 |
| InstallmentPayment |
15 |
Add the Ohio estimated & extension payments & credit carryforward from previous year return |
$0.00 |
| RefundableTaxCredits |
16 |
Refundable credits |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
17 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayment |
18 |
Total Ohio Tax Payments |
$122.00 |
| OverpymtRecdOnOrigAmendRtn |
19 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
20 |
Line 18 minus line 19 |
$122.00 |
| AmountUnderpaid |
21 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
22 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
23 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
24 |
Overpayment |
$0.00 |
| OverpymtCreditedNextYear |
25 |
Original return only - amount of line 24 to be carried forward to next year's tax liability |
$0.00 |
| CharityOrgName |
26a |
Amount of line 24 to be donated - Wildlife species |
$0.00 |
| CharityOrgName |
26b |
Amount of line 24 to be donated - Military injury relief |
$0.00 |
| CharityOrgName |
26c |
Amount of line 24 to be donated - Ohio History Fund |
$0.00 |
| CharityOrgName |
26d |
Amount of line 24 to be donated - Nature Preserves/Scenic Rivers |
$0.00 |
| CharityOrgName |
26e |
Amount of line 24 to be donated - Breast/cervical cancer |
$0.00 |
| CharityOrgName |
26f |
Amount of line 24 to be donated - Wishes for sick children |
$0.00 |
| TotalDonation |
26g |
Total |
$0.00 |
| Refund |
27 |
Your Refund |
$0.00 |
| |
|
|
|
| Schedule of Adjustments |
| Additions |
|
|
|
| NonOhioAndLocalGovIntAndDiv |
1 |
Non-Ohio state or local government interest and dividends |
$0.00 |
| PassThruEntityTaxesPaid |
2 |
Certain Ohio pass-through entity and financial institutions taxes paid |
$0.00 |
| TuitionExpenseReimbursement |
3 |
Reimbursement of college tutition expenses and fees deducted in any previous year(s) and noneducation expenditures from a college savings account |
$0.00 |
| SaleAndDispstnLossOfOhioOblig |
4 |
Losses from sale or disposition of Ohio public obligations |
$0.00 |
| NonMedicalWithdrawals |
5 |
Nonmedical withdrawals from a medical savings account |
$0.00 |
| ReimExpPrevDeducted |
6 |
Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if the reimbursement is not in federal adjusted gross income |
$0.00 |
| IRC168And179AdjAdd |
7 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| FederalInterestAndDividends |
8 |
Federal interest and dividends subject to state taxation |
$0.00 |
| FederalConformityAdditions |
9 |
Federal conformity additions |
$0.00 |
| TotalIncomeAddition |
10 |
Total additions |
$0.00 |
| |
|
|
|
| Deductions |
|
|
|
| BusinessIncomeDeduction |
11 |
Business income deduction (attach Ohio Schedule IT BUS, line 11) |
$4,000.00 |
| OHFullYrEmpCompEarnNeighState |
12 |
Employee compensation earned in Ohio by residents of neighboring states |
$0.00 |
| IRS1040StateMuniIncomeOverpymt |
13 |
State or municipal income tax overpayments shown on the federal 1040, Sch 1, line 1 |
$0.00 |
| SocialSecurityBenefits |
14 |
Taxable Social Security benefits |
$0.00 |
| RailroadRetirementBenefits |
15 |
Certain railroad retirement benefits |
$0.00 |
| ObligIntrstPublicServicePay |
16 |
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 state of Ohio or income from a transfer agreement |
$0.00 |
| IndDevAcct |
17 |
Amounts contributed to an individual development account |
$0.00 |
| STABLEAcct |
18 |
Amounts contributed to STABLE account; Ohio's ABLE plan |
$0.00 |
| OutOfStateDisasterWorkIncome |
19 |
Income earned in Ohio by a qualifying out-of-state business or employee for disaster work conducted during a disaster response period |
$0.00 |
| FederalIntAndDivExempt |
20 |
Federal interest and dividends exempt from state taxation |
$0.00 |
| IRC168And179AdjDed |
21 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| IRS1040RefundOrReimbursements |
22 |
Refund or reimbursements shown on the federal 1040, schedule 1 for itemized deductions claimed on a prior year federal income tax return |
$0.00 |
| RepaymentOfIncomeReported |
23 |
Repayment of income reported in a prior year |
$0.00 |
| NotDeductedWageExpense |
24 |
Wage expense not deducted due to claiming the federal work opportunity credit |
$0.00 |
| FederalConformityDeductions |
25 |
Federal conformity deductions |
$0.00 |
| MilitaryPayForResident |
26 |
Military pay for Ohio residents received while the military member was stationed outside Ohio |
$0.00 |
| IncomeErndMilitCivilianNRSpouse |
27 |
Certain income earned by military nonresidents and civilian nonresident spouses |
$0.00 |
| UniformedServcsRetirmtIncome |
28 |
Uniformed services retirement income |
$0.00 |
| MilitaryInjuryReliefFund |
29 |
Military injury relief fund |
$0.00 |
| NationalGuardReimAndBenft |
30 |
Certain Ohio National Guard reimbursements and benefits |
$0.00 |
| CollegeAdvSavAndTuitPurchCred |
31 |
Ohio 529 contributions, tuition credit purchases |
$0.00 |
| PellOhioCollegeOppTaxableGrant |
32 |
Pell/Ohio College Opportunity taxable grant amounts used to pay room and board |
$0.00 |
| OhioEducatorExpenses |
33 |
Ohio educator expenses in excess of federal deduction |
$55.00 |
| DisabilityBenefits |
34 |
Disability benefits |
$0.00 |
| SurvivorBenefits |
35 |
Survivor benefits |
$0.00 |
| UnsubsidizedMedicalExpense |
36 |
Unreimbursed long-term care insurance premiums, unsubsidized health care insurance premiums and excess health care expenses (see instructions for worksheet) |
$0.00 |
| HealthCareDepositedFunds |
37 |
Funds deposited into, and earnings of, a medical savings account for eligible health care expenses (see instructions for worksheet) |
$0.00 |
| QualOrganDonorExp |
38 |
Qualified organ donor expenses |
$0.00 |
| TotalIncomeDeduction |
39 |
Total deductions |
$4,055.00 |
| |
|
|
|
| Schedule IT BUS |
|
|
|
| |
|
Part 1 |
|
| BusScheduleB |
1 |
Sch B - Interest and Ordinary Dividends |
$0.00 |
| BusScheduleC |
2 |
Sch C - Profit or Loss From Business (Sole Proprietership) |
$4,000.00 |
| BusScheduleD |
3 |
Sch D - Capital Gains and Losses |
$0.00 |
| BusScheduleE |
4 |
Sch E - Supplemental Income and Loss |
$0.00 |
| GuaranteedPayments |
5 |
Guranteed payments, compensation and/or wages from each pass-through entity in which you have at least a 20% direct or indirect ownership interest |
$0.00 |
| BusScheduleF |
6 |
Sch F - Profit or Loss From Farming |
$0.00 |
| OtherItemsOfIncome |
7 |
Other items of income and gain separately stated on federal Schedule K-1, federal 4797 gains and/or losses reported on federal 4797 and miscellaneous federal income tax adjustments, if any |
$0.00 |
| TotalOfBusinessIncome |
8 |
Total of business income (add lines 1 through 7) |
$4,000.00 |
| |
|
Part 2 |
|
| AllBusinessIncome |
9 |
All business income (enter the lesser of line 8 above or Ohio IT1040, line 1). If zero or negative, stop here and do not complete Part 3. |
$4,000.00 |
| FilingStatusBusIncAmt |
10 |
Enter $250,000 if single or MFJ, enter $125,000 if MFS |
$250,000.00 |
| LessOfFilStatBusIncAmtOrAllBusInc |
11 |
Lesser of line 9 or line 10. Enter here and on Ohio Schedule of Adjustments, line 11 |
$4,000.00 |
| |
|
Part 3 |
|
| AllBusIncLessBusIncDeduction |
12 |
Line 9 minus line 11 (if less than -0-, enter -0-) |
$0.00 |
| TaxableBusinessIncome |
13 |
Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5) |
$0.00 |
| BusinessIncomeTaxLiability |
14 |
Business income tax liability. Multiply line 13 by 3%. Enter here and on Ohio IT 1040, line 8b. |
$0.00 |
| |
|
Part 4 |
|
| NameOfEntity |
1 |
Name of Entity |
GOOFY GOOF |
| FEINOrSSN |
|
FEIN/SS# |
400-XX-7602 |
| PercentageOfOwnership |
|
Percentage of Ownership |
1.0000 |
| Income Earned By Primary |
|
Primary |
X |
| |
|
|
|
| Schedule of Credits - Nonrefundable |
| TaxLiabilityBeforeCredits |
1 |
Tax liability before credits (From IT1040, line 8c) |
$0.00 |
| RetireIncomeCredit |
2 |
Retirement income credit (limit $200 per return) |
$0.00 |
| LumpSumRetirementCredit |
3 |
Lump sum retirement credit (include Ohio LS WKS, line 6) |
$0.00 |
| SeniorCitizenCredit |
4 |
Senior citizen credit |
$0.00 |
| LumpSumDistributionCredit |
5 |
Lump sum distribution credit (include Ohio LS WKS, line 3) |
$0.00 |
| ChildAndDependCareCredit |
6 |
Child care and dependent care credit (see the worksheet in the instructions) |
$0.00 |
| DisplacedWorkerTrainingCredit |
7 |
Displaced worker training credit (see the worksheet in the instructions) |
$0.00 |
| CampaignContributionCredit |
8 |
Campaign contribution credit |
$0.00 |
| ExemptionCredit |
9 |
Income-based exemption credit |
$80.00 |
| TotCreditsBeforeJointFiling |
10 |
Total (add lines 2 through 9) |
$80.00 |
| TaxLessCredit |
11 |
Tax less credits (line 1 minus line 10; if less than -0-, enter -0-) |
$0.00 |
| JointFilingCredit |
12 |
Joint filing credit |
$0.00 |
| EarnedIncomeCredit |
13 |
Earned income credit (multiply Fed EITC by 30%) |
$2,081.00 |
| HomeSchoolExpensesCredit |
14 |
Home school expenses credit |
$0.00 |
| ScholarshipDonationCredit |
15 |
Scholarship donation credit |
$0.00 |
| NonCharterOrPublicSchoolCredit |
16 |
Nonchartered, nonpublic school tuition credit |
$0.00 |
| VocationalJobCredit |
17 |
Vocational job credit |
$0.00 |
| AdoptionCredit |
18 |
Ohio adoption credit |
$0.00 |
| JobRetentionCredit |
19 |
Nonrefundable job retention credit |
$0.00 |
| NewEmpInEntZoneCredit |
20 |
Credit for eligible new employees in an enterprise zone |
$0.00 |
| GrapeProdPropertyPurchCredit |
21 |
Credit for purchases of grape production property |
$0.00 |
| InvestOhioCredit |
22 |
InvestOhio credit |
$0.00 |
| LeadAbatementCredit |
23 |
Lead abatement credit |
$0.00 |
| OpportunityZoneCredit |
24 |
Opportunity zone investment credit |
$0.00 |
| TechInvestCreditCarryfrwd |
25 |
Technology investment credit carryforward |
$0.00 |
| EntZoneDayCareAndTrngCredit |
26 |
Enterprise zone day care and training credits |
$0.00 |
| ResearchAndDevelopmentCredit |
27 |
Research and development credit |
$0.00 |
| OhioHistoricPreservationCredit |
28 |
Nonrefundable Ohio historic preservation credit |
$0.00 |
| TotAdditionalCredits |
29 |
Total (add lines 12 through 28) |
$2,081.00 |
| TaxLessCrdtMinusTotAddlCrdts |
30 |
Tax less additional credits (line 11 minus line 29; if less than -0-, enter -0-) |
$0.00 |
| |
|
Nonresident Credit |
|
| NonOhioIncome |
31 |
Nonresident Portion of Ohio adjusted gross income |
$0.00 |
| OhioAdjustedGrossIncome |
32 |
Ohio adjusted gross income |
$0.00 |
| NonResIncomeCreditRatio |
33a |
Divide line 31 by line 32 |
0.0000 |
| NonresidentAndPartYearCredit |
33 |
Nonresident credit (line 30 times line 33a) |
$0.00 |
| |
|
Resident Credit |
|
| ResidentTaxCredit |
34 |
Resident Credit - Ohio IT RC, line 7 |
$0.00 |
| TotalNonrefundableCredits |
35 |
Total nonrefundable credits |
$2,161.00 |
| |
|
|
|
| Schedule of Credits - Refundable |
| HistoricPreservationCredit |
36 |
Refundable Ohio historic preservation credit |
$0.00 |
| JobCreationAndJobRetentionCrd |
37 |
Refundable job creation credit & job retention credit |
$0.00 |
| PassthroughEntityCredit |
38 |
Pass-through entity credit |
$0.00 |
| MotionPictureProductionCredit |
39 |
Motion Picture & Broadway theatrical production credit |
$0.00 |
| VentureCapitalCredit |
40 |
Venture Capital credit |
$0.00 |
| TotalRefundableCredit |
41 |
Total refundable credits |
$0.00 |
| |
|
|
|
| School District Return (#5104) |
|
|
|
| SchoolDistrictTaxableIncome |
1 |
School district taxable income: Traditional or Earned Income tax base |
$16,612.00 |
| TaxAmount |
2 |
School District Tax .____ times line 1. |
$166.00 |
| SeniorCitizenCredit |
3 |
Senior Citizen Credit |
$0.00 |
| TaxLessCredit |
4 |
School District Income Tax liability |
$166.00 |
| UnderPaymentInterestPenalty |
5 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| TotalTax |
6 |
Total school district income tax liability (line 4 plus line 5) |
$166.00 |
| TotalTax |
6a |
Amount from line 6, page 1 |
$166.00 |
| TaxWithheld |
7 |
School district income tax withheld |
$0.00 |
| InstallmentPayments |
8 |
SD 100 ES & SD 40P, Extension Payments and Credit carryforward from previous year return |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
9 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayments |
10 |
Total school district income tax payments (add lines 7, 8 and 9) |
$0.00 |
| OverpymtRecdOnOrigAmendRtn |
11 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
12 |
Line 10 minus line 11. Place a negative sign ("-") in the box if the amount is less than -0- |
$0.00 |
| AmountUnderpaid |
13 |
Tax due |
$166.00 |
| InterestDueOnLatePayment |
14 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
15 |
Total Amount Due |
$166.00 |
| AmountOverpaid |
16 |
Overpayment |
$0.00 |
| OverpymtCreditedNextYear |
17 |
Original return only - amount of line 16 to be carried forward to next year's tax liability |
$0.00 |
| Refund |
18 |
Your Refund |
$0.00 |
| Traditional Tax Base School District Amounts |
|
|
|
| TaxableIncome |
19 |
Ohio income tax base (Ohio IT 1040, line 3 minus line 4) |
$0.00 |
| BusinessIncomeDeductionAddback |
20 |
Business income deduction add-back |
$0.00 |
| TotalTraditionalSDIncome |
21 |
Total Traditional Tax Base School District Income (Line 19 + Line 20) |
$0.00 |
| NonResidentIncome |
22 |
Amount of traditional tax base school district income that you earned while not a resident |
$0.00 |
| SchoolDistrictTaxableIncome |
23 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| Earned Income Tax Base School District Amounts |
|
|
|
| WagesAndOtherCompensations |
24 |
Wages and other compensation as described in the instructions |
$13,250.00 |
| SelfEmploymentEarnings |
25 |
Net Earnings from Self Employment |
$3,362.00 |
| FederalConformityAdjustments |
26 |
Federal Conformity Adjustments |
$0.00 |
| SchoolDistrictTaxableIncome |
27 |
School District Taxable Income (Enter here and on line 1) |
$16,662.00 |
| |
|
|
|
| What is Tested? |
If you do not support: |
|
| IT1040WithSD100 |
|
|
| Address Line 2 |
|
|
|
| Non-paid Preparer |
Change to self-prepared |
| Preparer Interaction - In person only |
|
Do not provide |
|
| Preparer Contact - Authorized |
|
| Single status |
|
| Ohio W-2 |
|
| 1099-NEC |
|
Change to 1099-R with a distribution code of 1 (early distribution). This will not create a retirement income credit. |
| Single Next Year Estimated Payment - IT |
Do not provide |
| Single Next Year Estimated Payment - SD |
Do not provide |
| |
|
|
|
| IT1040 |
|
| Full year resident |
|
| [$0 - $26,050] tax bracket |
|
| Earned Income Credit - 3 qualifying children |
Remove Earned Income Credit |
| Use Tax |
|
| Zero balance |
|
| |
|
| SD100 |
|
| Earned Income - Full year resident |
|
| Mail in - Payment |
|
| Ohio Test #3 |
|
|
IT1040WithSD100 |
| Taxpayer Information |
|
Description |
|
| TaxpayerSSN |
|
Primary Social Security Number |
400-XX-7603 |
| FirstName |
|
Primary First Name |
NADA |
| LastName |
|
Primary Last Name |
WOLVERINE |
| DateOfBirth |
|
Date of Birth - Primary |
1947-08-13 |
| DateOfDeath |
|
Date of Death - Primary |
2022-11-27 |
| |
|
|
|
| TaxpayerSSN |
|
Spouse's Social Security Number |
400-XX-7653 |
| FirstName |
|
Spouse First Name |
NORA |
| LastName |
|
Spouse Last Name |
BADGER |
| DateOfBirth |
|
Date of Birth - Spouse |
1949-02-02 |
| DateOfDeath |
|
Date of Death - Spouse |
2022-01-15 |
| |
|
|
|
| USPhone |
|
Taxpayer's Phone Number |
[<=9999999]###-#### |
| EmailAddress |
|
Taxpayer's E-mail Address |
GOPHER@HOTMAIL.COM |
| |
|
|
|
| InCareOfNm |
|
In Care Of Name |
% BUD E GOPHER |
| |
|
|
|
| AddressLine1Txt |
|
US Address - Address Line 1 |
75 S ANIMAL DR |
| AddressLine2Txt |
|
Address Line 2 |
APT 2 |
| CityNm |
|
City |
CLYDE |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43410 |
| |
|
|
|
| MailingAddressCounty |
|
Ohio County |
SANDUSKY |
| SchoolDistrictNumber |
|
Ohio Public School District Number - Resident District |
7201 |
| |
|
|
|
| Preparer Information |
|
|
|
| Self-Prepared |
|
|
|
| SelfPrepared |
|
Return is self-prepared |
X |
| |
|
|
|
| Income Statements |
|
|
|
| W-2 #1 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
143456789-####### |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
GMRZ INC |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
25 SOUTH BLVD |
| CityNm |
|
City |
DETROIT |
| StateAbbreviationCd |
|
State |
MI |
| ZIPCd |
|
Zip Code |
48201 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7603 |
| EmployeNm |
|
Employee's Name |
NADA WOLVERINE |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
75 S ANIMAL DR |
| AddressLine2Txt |
|
Employee Address Line 2 |
APT 2 |
| CityNm |
|
City |
CLYDE |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43410 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$23,750.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$300.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$23,750.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$1,473.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$23,750.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$344.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
51567890-000000 |
| StateWagesAmt |
|
State Wages |
$23,750.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$122.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$23,750.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$293.00 |
| LocalityNm |
|
Name of Locality |
CLYDE |
| |
|
|
|
| SchoolDistrictWages |
|
School District Wages |
$12,420.00 |
| SchoolDistrictTaxWithheld |
|
School District Tax Withheld |
$31.00 |
| SchoolDistrictNumber |
|
School District # |
0604 |
| |
|
|
|
| SchoolDistrictWages |
|
School District Wages |
$11,330.00 |
| SchoolDistrictTaxWithheld |
|
School District Tax Withheld |
$170.00 |
| SchoolDistrictNumber |
|
School District # |
7201 |
| |
|
|
|
| W-2 #2 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
143456789-####### |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
GMRZ INC |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
25 SOUTH BLVD |
| CityNm |
|
City |
DETROIT |
| StateAbbreviationCd |
|
State |
MI |
| ZIPCd |
|
Zip Code |
48201 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7653 |
| EmployeeNm |
|
Employee's Name |
NORA BADGER |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
75 S ANIMAL DR |
| AddressLine2Txt |
|
Employee Address Line 2 |
APT 2 |
| CityNm |
|
City |
CLYDE |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43410 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$500.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$40.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$500.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$31.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$500.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$7.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
51567890-000000 |
| StateWagesAmt |
|
State Wages |
$500.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$10.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$500.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$5.00 |
| LocalityNm |
|
Name of Locality |
CLYDE |
| |
|
|
|
| 1099R #1 |
|
|
|
| PayerEIN |
|
Payer's Identification Number |
923456789-0000000 |
| PayerName / BusinessNameLine1Txt |
|
Payer's Name |
OHIO PUBLIC EMPLOYEE RETIREMENT SYSTEM |
| |
|
|
|
| AddressLine1Txt |
|
Payer's Address |
277 E TOWN ST |
| CityNm |
|
Payer's City |
COLUMBUS |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZIPCd |
|
Payer's Zip Code |
43215 |
| |
|
|
|
| RecipientSSN |
|
Recipient's Social Security Number |
400-XX-7603 |
| RecipientNm |
|
Recipient's Name |
NADA WOLVERINE |
| AddressLine1Txt |
|
Recipient's Address Line 1 |
75 S ANIMAL DR |
| AddressLine2Txt |
|
Recipient's Address Line 2 |
APT 2 |
| CityNm |
|
Recipient's City |
CLYDE |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
43410 |
| |
|
|
|
| GrossDistributionAmt |
|
Gross Distribution Amount |
$35,000.00 |
| TaxableAmt |
|
Taxable Amount |
$35,000.00 |
| TotalDistributionInd |
|
Total Distribution Indicator |
|
| F1099RDistributionCd |
|
Distribution Code |
4 |
| |
|
|
|
| 1099R #2 |
|
|
|
| PayerEIN |
|
Payer's Identification Number |
263457291-0000000 |
| PayerName / BusinessNameLine1Txt |
|
Payer's Name |
STATE STREET RETIREMENT SERVICES |
| |
|
|
|
| AddressLine1Txt |
|
Payer's Address |
76 S ANIMAL DR |
| CityNm |
|
Payer's City |
SAINT MARYS |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZIPCd |
|
Payer's Zip Code |
45885 |
| |
|
|
|
| RecipientSSN |
|
Recipient's Social Security Number |
400-XX-7603 |
| RecipientNm |
|
Recipient's Name |
NADA WOLVERINE |
| AddressLine1Txt |
|
Recipient's Address Line 1 |
75 S ANIMAL DR |
| AddressLine2Txt |
|
Recipient's Address Line 2 |
APT 2 |
| CityNm |
|
Recipient's City |
CLYDE |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
43410 |
| |
|
|
|
| GrossDistributionAmt |
|
Gross Distribution Amount |
$2,000.00 |
| TaxableAmt |
|
Taxable Amount |
$2,000.00 |
| TotalDistributionInd |
|
Total Distribution Indicator |
|
| F1099RDistributionCd |
|
Distribution Code |
7 |
| |
|
|
|
| 1099-K |
|
|
|
| FilerName / BusinessNameLine1Txt |
|
Filer Name |
DRIVE INC |
| AddressLine1Txt |
|
Filer Address Line 1 Text |
25 SOUTH BLVD |
| AddressLine2Txt |
|
Address Line 2 Text |
APT 2 |
| CityNm |
|
Filer City |
SAN FRANCISCO |
| StateAbbreviationCd |
|
Filer State |
CA |
| ZIPCd |
|
Filer Zip Code |
94103 |
| |
|
|
|
| FilerEIN |
|
Filer Identification Number |
142333444-0000000 |
| PaymentSettlementEntity |
|
Payment Settlement Entity (PSE) |
X |
| PaymentCard |
|
Payment Card |
X |
| |
|
|
|
| IndividualPayee / SSN |
|
Individual Payee's Social Security Number |
400-XX-7603 |
| Name |
|
Individual Payee's Name |
NADA WOLVERINE |
| PayeeUSAddress / AddressLine1Txt |
|
Payee Address Line 1 |
75 S ANIMAL DR |
| AddressLine2Txt |
|
Address Line 2 |
APT 2 |
| CityNm |
|
Payee City |
CLYDE |
| StateAbbreviationCd |
|
Payee State |
OH |
| ZIPCd |
|
Payee Zip Code |
43410 |
| |
|
|
|
| GrossPayments |
|
Box 1a Gross amount of payment card/third party network transactions |
$500.00 |
| NumberOfPaymentTransactions |
|
Box 3 Number of payment transactions |
10 |
| March |
|
Box 5c March |
$500.00 |
| |
|
|
|
| StateTaxWithheldAmt |
|
State Tax Withheld |
$5.00 |
| StateAbbreviationCd |
|
State abbreviation code |
OH |
| PayerStateIdNum |
|
State ID Number |
51555222-000000 |
| StateDistributionAmt |
|
State Wages |
$500.00 |
| |
|
|
|
| 1099-OID |
|
|
|
| PayersName - BusinessNameLine1Txt |
|
Payer's Name |
FIRST BANK |
| AddressLine1Txt |
|
Payer's US Address |
500 MONEY LN |
| CityNm |
|
Payer's City |
BASCOM |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZIPCd |
|
Payer's Zip Code |
44809 |
| PayerFederalIdNumber |
|
Payer's Federal Identification Number |
163456789-0000000 |
| |
|
|
|
| RecipientsIdNumber |
|
Recipient's Identification Number |
400-XX-7653 |
| RecipientsName |
|
Recipient's Name |
NORA BADGER |
| |
|
|
|
| AddressLine1Txt |
|
Recipient's US Address Line 1 Text |
75 S ANIMAL DR |
| AddressLine2Txt |
|
Recipient's Address Line 2 Text |
APT 2 |
| CityNm |
|
Recipient's City |
CLYDE |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
43410 |
| |
|
|
|
| OrigIssueDiscount |
|
Box 1 Original Issue Discount |
$1,500 |
| FedIncomeTaxWithheld |
|
Federal Income Tax Withheld |
$100 |
| |
|
|
|
| StateTaxWithheldAmt |
|
Box 12 State Tax Withheld |
$52 |
| StateAbbreviationCd |
|
Box 10 State |
OH |
| PayersStateIdNumber |
|
Box 11 State Identification no |
51789012-000000 |
| StateDistributionAmt |
|
State Distribution Amount |
$1,500 |
| |
|
|
|
| Return Information |
|
|
|
| Federal Return Data |
|
|
|
| |
|
Filing Status |
Married Filing Joint |
| |
|
Exemptions, Self |
2 |
| |
|
Total wages, salaries, tips, etc. |
$24,250.00 |
| |
|
Taxable Interest |
$1,500.00 |
| |
|
IRAs, pensions, and annuities Taxable Amount |
$37,000.00 |
| |
|
Taxable Refunds, credits or offsets of state and local income taxes |
$125.00 |
| |
|
Net profit or (loss) from Schedule C, Schedule C-EZ, and Schedule K1 |
$250,000.00 |
| |
|
Self Employment Tax Deduction |
($10,989.00) |
| |
|
Adjusted Gross Income |
$301,886.00 |
| |
|
Earned Income Tax Credit |
$0.00 |
| |
|
|
|
| State Return Data |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| FilingStatus |
|
|
|
| MarriedFilingJointly |
|
|
X |
| |
|
|
|
| Did you file federal extension Form 4868? |
|
|
No |
| |
|
|
|
| Did you take the Standard deduction or itemize? |
|
|
Standard |
| |
|
|
|
| Can someone else claim you (or your spouse) as a dependent? |
|
|
|
| ClaimedAsDependent |
|
|
No |
| |
|
|
|
| Residency Status |
|
|
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| SpouseResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| JointFilingCredit |
|
Eligible for JFC? |
Yes |
| |
|
|
|
| Unpaid Ohio Use Tax Worksheet |
|
|
|
| |
a. |
Did you make any out of state purchases |
Yes |
| |
b. |
Did the retailer charge you any sales tax |
No |
| |
c. |
Amount of Purchases that you did not pay sales tax |
$100.00 |
| |
d. |
County sales tax rate |
7.25% |
| |
|
|
|
| Additional Information |
|
|
|
| SurvivorBenefits |
|
Survivorship Benefits |
$35,000.00 |
| LumpSumRetirementCredit |
|
Lump Sum Retirement Credit - Carryforward from prior year |
$20.00 |
| InstallmentPayment |
|
Estimated Payment made for 2022 |
$200.00 |
| |
|
|
|
| CharityOrgName |
|
Donation From Taxpayer - Ohio History Fund |
$5.00 |
| |
|
|
|
| SD Return # 1 Information |
|
|
|
| SchoolDistrictNumber |
|
What is the school district number for which you are filing the SD 100? |
7201 |
| TaxType |
|
Tax Type |
Earned Income Only |
| |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| Residency Status |
|
School district residency |
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| Additional Information - SD |
|
|
|
| SelfEmploymentEarnings |
|
Net Earnings from Self Employment |
$250,000.00 |
| |
|
Note: This amount must be reduced in order to limit School District Taxable Income to the extent included in modified adjusted gross income |
|
| |
|
|
|
| SD Return # 2 Information |
|
|
|
| SchoolDistrictNumber |
|
What is the school district number for which you are filing the SD 100? |
0604 |
| TaxType |
|
Tax Type |
Earned Income Only |
| |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| Residency Status |
|
School district residency |
|
| PrimaryResidencyStatus |
|
|
|
| FullYearNonResident |
|
Full-Year NonResident |
X |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| FullYearNonResident |
|
Full-Year NonResident |
X |
| |
|
|
|
| Return |
|
|
|
| IT1040 - Pages 1 & 2 |
| FederalAdjustedGrossIncome |
1 |
Federal Adjusted Gross Income |
$301,886.00 |
| TotalIncomeAddition |
2a |
Additions to federal adjusted gross income |
$0.00 |
| TotalIncomeDeduction |
2b |
Deductions from federal adjusted gross income |
$285,125.00 |
| OhioAdjustedGrossIncome |
3 |
Ohio Adjusted Gross Income (OAGI) |
$16,761.00 |
| ExemptionDeduction |
4 |
Personal and dependent exemption deduction |
$3,800.00 |
| TaxableIncome |
5 |
Ohio income tax base |
$12,961.00 |
| TaxableBusinessIncome |
6 |
Taxable business income (Ohio IT BUS, line 13) |
$0.00 |
| TaxableIncomeLessBusinessIncome |
7 |
Line 5 minus line 6 (if less than 0, enter 0) |
$12,961.00 |
| |
7a |
Amount from line 7 on page 1 |
$12,961.00 |
| NonBusinessIncomeTaxLiability |
8a |
Nonbusiness income tax liability |
$0.00 |
| BusinessIncomeTaxLiability |
8b |
Business income tax liability (Ohio IT BUS, line 14) |
$0.00 |
| IncomeTaxLiabilityBeforeCredits |
8c |
Income tax liability before credits (line 8a plus 8b) |
$0.00 |
| OhioNonRefundableCredits |
9 |
Ohio nonrefundable credits |
$20.00 |
| TaxLiabAfterNonrefundableCrdt |
10 |
Tax liability after nonrefundable credits |
$0.00 |
| UnderPaymentInterestPenalty |
11 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| UnpaidUseTax |
12 |
Sales and use tax due on Internet, mail order or other out-of-state purchases |
$7.00 |
| TotalTaxLiability |
13 |
Total Ohio tax liability before withholding or estimated payments |
$7.00 |
| TaxWithheld |
14 |
Ohio income tax withheld |
$189.00 |
| InstallmentPayment |
15 |
Add the Ohio estimated & extension payments & credit carryforward from previous year return |
$200.00 |
| RefundableTaxCredits |
16 |
Refundable credits |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
17 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayment |
18 |
Total Ohio Tax Payments |
$389.00 |
| OverpymtRecdOnOrigAmendRtn |
19 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
20 |
Line 18 minus line 19 |
$389.00 |
| AmountUnderpaid |
21 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
22 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
23 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
24 |
Overpayment |
$382.00 |
| OverpymtCreditedNextYear |
25 |
Original return only - amount of line 24 to be carried forward to next year's tax liability |
$0.00 |
| CharityOrgName |
26a |
Amount of line 24 to be donated - Wildlife species |
$0.00 |
| CharityOrgName |
26b |
Amount of line 24 to be donated - Military injury relief |
$0.00 |
| CharityOrgName |
26c |
Amount of line 24 to be donated - Ohio History Fund |
$5.00 |
| CharityOrgName |
26d |
Amount of line 24 to be donated - Nature Preserves/Scenic Rivers |
$0.00 |
| CharityOrgName |
26e |
Amount of line 24 to be donated - Breast/cervical cancer |
$0.00 |
| CharityOrgName |
26f |
Amount of line 24 to be donated - Wishes for sick children |
$0.00 |
| TotalDonation |
26g |
Total |
$5.00 |
| Refund |
27 |
Your Refund |
$377.00 |
| |
|
|
|
| Schedule of Adjustments |
| Additions |
|
|
|
| NonOhioAndLocalGovIntAndDiv |
1 |
Non-Ohio state or local government interest and dividends |
$0.00 |
| PassThruEntityTaxesPaid |
2 |
Certain Ohio pass-through entity and financial institutions taxes paid |
$0.00 |
| TuitionExpenseReimbursement |
3 |
Reimbursement of college tutition expenses and fees deducted in any previous year(s) and noneducation expenditures from a college savings account |
$0.00 |
| SaleAndDispstnLossOfOhioOblig |
4 |
Losses from sale or disposition of Ohio public obligations |
$0.00 |
| NonMedicalWithdrawals |
5 |
Nonmedical withdrawals from a medical savings account |
$0.00 |
| ReimExpPrevDeducted |
6 |
Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if the reimbursement is not in federal adjusted gross income |
$0.00 |
| IRC168And179AdjAdd |
7 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| FederalInterestAndDividends |
8 |
Federal interest and dividends subject to state taxation |
$0.00 |
| FederalConformityAdditions |
9 |
Federal conformity additions |
$0.00 |
| TotalIncomeAddition |
10 |
Total additions |
$0.00 |
| |
|
|
|
| Deductions |
|
|
|
| BusinessIncomeDeduction |
11 |
Business income deduction (attach Ohio Schedule IT BUS, line 11) |
$250,000.00 |
| OHFullYrEmpCompEarnNeighState |
12 |
Employee compensation earned in Ohio by residents of neighboring states |
$0.00 |
| IRS1040StateMuniIncomeOverpymt |
13 |
State or municipal income tax overpayments shown on the federal 1040, Sch 1, line 1 |
$125.00 |
| SocialSecurityBenefits |
14 |
Taxable Social Security benefits |
$0.00 |
| RailroadRetirementBenefits |
15 |
Certain railroad retirement benefits |
$0.00 |
| ObligIntrstPublicServicePay |
16 |
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 state of Ohio or income from a transfer agreement |
$0.00 |
| IndDevAcct |
17 |
Amounts contributed to an individual development account |
$0.00 |
| STABLEAcct |
18 |
Amounts contributed to STABLE account; Ohio's ABLE plan |
$0.00 |
| OutOfStateDisasterWorkIncome |
19 |
Income earned in Ohio by a qualifying out-of-state business or employee for disaster work conducted during a disaster response period |
$0.00 |
| FederalIntAndDivExempt |
20 |
Federal interest and dividends exempt from state taxation |
$0.00 |
| IRC168And179AdjDed |
21 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| IRS1040RefundOrReimbursements |
22 |
Refund or reimbursements shown on the federal 1040, schedule 1 for itemized deductions claimed on a prior year federal income tax return |
$0.00 |
| RepaymentOfIncomeReported |
23 |
Repayment of income reported in a prior year |
$0.00 |
| NotDeductedWageExpense |
24 |
Wage expense not deducted due to claiming the federal work opportunity credit |
$0.00 |
| FederalConformityDeductions |
25 |
Federal conformity deductions |
$0.00 |
| MilitaryPayForResident |
26 |
Military pay for Ohio residents received while the military member was stationed outside Ohio |
$0.00 |
| IncomeErndMilitCivilianNRSpouse |
27 |
Certain income earned by military nonresidents and civilian nonresident spouses |
$0.00 |
| UniformedServcsRetirmtIncome |
28 |
Uniformed services retirement income |
$0.00 |
| MilitaryInjuryReliefFund |
29 |
Military injury relief fund |
$0.00 |
| NationalGuardReimAndBenft |
30 |
Certain Ohio National Guard reimbursements and benefits |
$0.00 |
| CollegeAdvSavAndTuitPurchCred |
31 |
Ohio 529 contributions, tuition credit purchases |
$0.00 |
| PellOhioCollegeOppTaxableGrant |
32 |
Pell/Ohio College Opportunity taxable grant amounts used to pay room and board |
$0.00 |
| OhioEducatorExpenses |
33 |
Ohio educator expenses in excess of federal deduction |
$0.00 |
| DisabilityBenefits |
34 |
Disability benefits |
$0.00 |
| SurvivorBenefits |
35 |
Survivor benefits |
$35,000.00 |
| UnsubsidizedMedicalExpense |
36 |
Unreimbursed long-term care insurance premiums, unsubsidized health care insurance premiums and excess health care expenses (see instructions for worksheet) |
$0.00 |
| HealthCareDepositedFunds |
37 |
Funds deposited into, and earnings of, a medical savings account for eligible health care expenses (see instructions for worksheet) |
$0.00 |
| QualOrganDonorExp |
38 |
Qualified organ donor expenses |
$0.00 |
| TotalIncomeDeduction |
39 |
Total deductions |
$285,125.00 |
| |
|
|
|
| Schedule IT BUS |
|
|
|
| |
|
Part 1 |
|
| BusScheduleB |
1 |
Sch B - Interest and Ordinary Dividends |
$0.00 |
| BusScheduleC |
2 |
Sch C - Profit or Loss From Business (Sole Proprietership) |
$250,000.00 |
| BusScheduleD |
3 |
Sch D - Capital Gains and Losses |
$0.00 |
| BusScheduleE |
4 |
Sch E - Supplemental Income and Loss |
$0.00 |
| GuaranteedPayments |
5 |
Guranteed payments, compensation and/or wages from each pass-through entity in which you have at least a 20% direct or indirect ownership interest |
$0.00 |
| BusScheduleF |
6 |
Sch F - Profit or Loss From Farming |
$0.00 |
| OtherItemsOfIncome |
7 |
Other items of income and gain separately stated on federal Schedule K-1, federal 4797 gains and/or losses reported on federal 4797 and miscellaneous federal income tax adjustments, if any |
$0.00 |
| TotalOfBusinessIncome |
8 |
Total of business income (add lines 1 through 7) |
$250,000.00 |
| |
|
Part 2 |
|
| AllBusinessIncome |
9 |
All business income (enter the lesser of line 8 above or Ohio IT1040, line 1). If zero or negative, stop here and do not complete Part 3. |
$250,000.00 |
| FilingStatusBusIncAmt |
10 |
Enter $250,000 if single or MFJ, enter $125,000 if MFS |
$250,000.00 |
| LessOfFilStatBusIncAmtOrAllBusInc |
11 |
Lesser of line 9 or line 10. Enter here and on Ohio Schedule of Adjustments, line 11 |
$250,000.00 |
| |
|
Part 3 |
|
| AllBusIncLessBusIncDeduction |
12 |
Line 9 minus line 11 (if less than -0-, enter -0-) |
$0.00 |
| TaxableBusinessIncome |
13 |
Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5) |
$0.00 |
| BusinessIncomeTaxLiability |
14 |
Business income tax liability. Multiply line 13 by 3%. Enter here and on Ohio IT 1040, line 8b. |
$0.00 |
| |
|
Part 4 |
|
| NameOfEntity |
1 |
Name of Entity |
NADA'S BAKED GOODS |
| FEINOrSSN |
|
FEIN/SS# |
682543287-####### |
| PercentageOfOwnership |
|
Percentage of Ownership |
0.0025 |
| Income Earned By Primary |
|
Primary |
X |
| |
|
|
|
| Schedule of Credits - Nonrefundable |
| TaxLiabilityBeforeCredits |
1 |
Tax liability before credits (From IT1040, line 8c) |
$0.00 |
| RetireIncomeCredit |
2 |
Retirement income credit (limit $200 per return) |
$0.00 |
| LumpSumRetirementCredit |
3 |
Lump sum retirement credit (include Ohio LS WKS, line 6) |
$20.00 |
| SeniorCitizenCredit |
4 |
Senior citizen credit |
$0.00 |
| LumpSumDistributionCredit |
5 |
Lump sum distribution credit (include Ohio LS WKS, line 3) |
$0.00 |
| ChildAndDependCareCredit |
6 |
Child care and dependent care credit (see the worksheet in the instructions) |
$0.00 |
| DisplacedWorkerTrainingCredit |
7 |
Displaced worker training credit (see the worksheet in the instructions) |
$0.00 |
| CampaignContributionCredit |
8 |
Campaign contribution credit |
$0.00 |
| ExemptionCredit |
9 |
Income-based exemption credit |
$0.00 |
| TotCreditsBeforeJointFiling |
10 |
Total (add lines 2 through 9) |
$20.00 |
| TaxLessCredit |
11 |
Tax less credits (line 1 minus line 10; if less than -0-, enter -0-) |
$0.00 |
| JointFilingCredit |
12 |
Joint filing credit |
$0.00 |
| EarnedIncomeCredit |
13 |
Earned income credit (multiply Fed EITC by 30%) |
$0.00 |
| HomeSchoolExpensesCredit |
14 |
Home school expenses credit |
$0.00 |
| ScholarshipDonationCredit |
15 |
Scholarship donation credit |
$0.00 |
| NonCharterOrPublicSchoolCredit |
16 |
Nonchartered, nonpublic school tuition credit |
$0.00 |
| VocationalJobCredit |
17 |
Vocational job credit |
$0.00 |
| AdoptionCredit |
18 |
Ohio adoption credit |
$0.00 |
| JobRetentionCredit |
19 |
Nonrefundable job retention credit |
$0.00 |
| NewEmpInEntZoneCredit |
20 |
Credit for eligible new employees in an enterprise zone |
$0.00 |
| GrapeProdPropertyPurchCredit |
21 |
Credit for purchases of grape production property |
$0.00 |
| InvestOhioCredit |
22 |
InvestOhio credit |
$0.00 |
| LeadAbatementCredit |
23 |
Lead abatement credit |
$0.00 |
| OpportunityZoneCredit |
24 |
Opportunity zone investment credit |
$0.00 |
| TechInvestCreditCarryfrwd |
25 |
Technology investment credit carryforward |
$0.00 |
| EntZoneDayCareAndTrngCredit |
26 |
Enterprise zone day care and training credits |
$0.00 |
| ResearchAndDevelopmentCredit |
27 |
Research and development credit |
$0.00 |
| OhioHistoricPreservationCredit |
28 |
Nonrefundable Ohio historic preservation credit |
$0.00 |
| TotAdditionalCredits |
29 |
Total (add lines 12 through 28) |
$0.00 |
| TaxLessCrdtMinusTotAddlCrdts |
30 |
Tax less additional credits (line 11 minus line 29; if less than -0-, enter -0-) |
$0.00 |
| |
|
Nonresident Credit |
|
| NonOhioIncome |
31 |
Nonresident Portion of Ohio adjusted gross income |
$0.00 |
| OhioAdjustedGrossIncome |
32 |
Ohio adjusted gross income |
$0.00 |
| NonResIncomeCreditRatio |
33a |
Divide line 31 by line 32 |
0.0000 |
| NonresidentAndPartYearCredit |
33 |
Nonresident credit (line 30 times line 33a) |
$0.00 |
| |
|
Resident Credit |
|
| ResidentTaxCredit |
34 |
Resident Credit - Ohio IT RC, line 7 |
$0.00 |
| TotalNonrefundableCredits |
35 |
Total nonrefundable credits |
$20.00 |
| |
|
|
|
| Schedule of Credits - Refundable |
| HistoricPreservationCredit |
36 |
Refundable Ohio historic preservation credit |
$0.00 |
| JobCreationAndJobRetentionCrd |
37 |
Refundable job creation credit & job retention credit |
$0.00 |
| PassthroughEntityCredit |
38 |
Pass-through entity credit |
$0.00 |
| MotionPictureProductionCredit |
39 |
Motion Picture & Broadway theatrical production credit |
$0.00 |
| VentureCapitalCredit |
40 |
Venture Capital credit |
$0.00 |
| TotalRefundableCredit |
41 |
Total refundable credits |
$0.00 |
| |
|
|
|
| School District Return (#7201) |
|
|
|
| SchoolDistrictTaxableIncome |
1 |
School district taxable income: Traditional or Earned Income tax base |
$266,761.00 |
| TaxAmount |
2 |
School District Tax .____ times line 1. |
$4,001.00 |
| SeniorCitizenCredit |
3 |
Senior Citizen Credit |
$50.00 |
| TaxLessCredit |
4 |
School District Income Tax liability |
$3,951.00 |
| UnderPaymentInterestPenalty |
5 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| TotalTax |
6 |
Total school district income tax liability (line 4 plus line 5) |
$3,951.00 |
| TotalTax |
6a |
Amount from line 6, page 1 |
$3,951.00 |
| TaxWithheld |
7 |
School district income tax withheld |
$170.00 |
| InstallmentPayments |
8 |
SD 100 ES & SD 40P, Extension Payments and Credit carryforward from previous year return |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
9 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayments |
10 |
Total school district income tax payments (add lines 7, 8 and 9) |
$170.00 |
| OverpymtRecdOnOrigAmendRtn |
11 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
12 |
Line 10 minus line 11. Place a negative sign ("-") in the box if the amount is less than -0- |
$170.00 |
| AmountUnderpaid |
13 |
Tax due |
$3,781.00 |
| InterestDueOnLatePayment |
14 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
15 |
Total Amount Due |
$3,781.00 |
| AmountOverpaid |
16 |
Overpayment |
$0.00 |
| OverpymtCreditedNextYear |
17 |
Original return only - amount of line 16 to be carried forward to next year's tax liability |
$0.00 |
| Refund |
18 |
Your Refund |
$0.00 |
| Traditional Tax Base School District Amounts |
|
|
|
| TaxableIncome |
19 |
Ohio income tax base (Ohio IT 1040, line 3 minus line 4) |
$0.00 |
| BusinessIncomeDeductionAddback |
20 |
Business income deduction add-back |
$0.00 |
| TotalTraditionalSDIncome |
21 |
Total Traditional Tax Base School District Income (Line 19 + Line 20) |
$0.00 |
| NonResidentIncome |
22 |
Amount of traditional tax base school district income that you earned while not a resident |
$0.00 |
| SchoolDistrictTaxableIncome |
23 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| Earned Income Tax Base School District Amounts |
|
|
|
| WagesAndOtherCompensations |
24 |
Wages and other compensation as described in the instructions |
$24,250.00 |
| SelfEmploymentEarnings |
25 |
Net Earnings from Self Employment |
$242,511.00 |
| FederalConformityAdjustments |
26 |
Federal Conformity Adjustments |
$0.00 |
| SchoolDistrictTaxableIncome |
27 |
School District Taxable Income (Enter here and on line 1) |
$266,761.00 |
| |
|
|
|
| School District Return #2 Information (Nonresident #0604) |
|
| SchoolDistrictTaxableIncome |
1 |
School district taxable income: Traditional or Earned Income tax base |
$0.00 |
| TaxAmount |
2 |
School District Tax .____ times line 1. |
$0.00 |
| SeniorCitizenCredit |
3 |
Senior Citizen Credit |
$50.00 |
| TaxLessCredit |
4 |
School District Income Tax liability |
$0.00 |
| UnderPaymentInterestPenalty |
5 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| TotalTax |
6 |
Total school district income tax liability (line 4 plus line 5) |
$0.00 |
| TotalTax |
6a |
Amount from line 6, page 1 |
$0.00 |
| TaxWithheld |
7 |
School district income tax withheld |
$31.00 |
| InstallmentPayments |
8 |
SD 100 ES & SD 40P, Extension Payments and Credit carryforward from previous year return |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
9 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayments |
10 |
Total school district income tax payments (add lines 7, 8 and 9) |
$31.00 |
| OverpymtRecdOnOrigAmendRtn |
11 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
12 |
Line 10 minus line 11. Place a negative sign ("-") in the box if the amount is less than -0- |
$31.00 |
| AmountUnderpaid |
13 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
14 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
15 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
16 |
Overpayment |
$31.00 |
| OverpymtCreditedNextYear |
17 |
Original return only - amount of line 16 to be carried forward to next year's tax liability |
$0.00 |
| Refund |
18 |
Your Refund |
$31.00 |
| Traditional Tax Base School District Amounts |
|
|
|
| TaxableIncome |
19 |
Ohio income tax base (Ohio IT 1040, line 3 minus line 4) |
$0.00 |
| BusinessIncomeDeductionAddback |
20 |
Business income deduction add-back |
$0.00 |
| TotalTraditionalSDIncome |
21 |
Total Traditional Tax Base School District Income (Line 19 + Line 20) |
$0.00 |
| NonResidentIncome |
22 |
Amount of traditional tax base school district income that you earned while not a resident |
$0.00 |
| SchoolDistrictTaxableIncome |
23 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| Earned Income Tax Base School District Amounts |
|
|
|
| WagesAndOtherCompensations |
24 |
Wages and other compensation as described in the instructions |
$0.00 |
| SelfEmploymentEarnings |
25 |
Net Earnings from Self Employment |
$0.00 |
| FederalConformityAdjustments |
26 |
Federal Conformity Adjustments |
$0.00 |
| SchoolDistrictTaxableIncome |
27 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| |
|
|
|
| What is Tested? |
If you do not support: |
|
| IT1040WithSD100 |
|
| Self-Prepared |
|
| MFJ status |
|
| Deceased primary |
Remove date of death |
| Deceased spouse |
|
Remove date of death |
| In care of - Address |
|
|
|
| W-2 |
|
| 1099-R |
|
|
|
| 1099-K |
Remove 1099-K. This will not affect the Federal Schedule C. Do not include in total withhholding |
| 1099-OID |
Change to 1099-R with a distribution code of 1 (early distribution). This will not create a retirement income credit. |
| |
|
| IT1040 |
|
| Full year resident |
|
| [$0 - $26,050] tax bracket |
|
| Personal Exemptions - MAGI Bracket > OAGI Bracket |
|
|
| Use tax |
|
| Sch. of Adj - Business Income Deduction |
|
|
|
| Sch. of Adj - State/municipal income tax overpayments |
Move amount to a Sch. of Adj deduction line you do support |
| Sch. of Adj - Survivorship Benefits |
|
Move amount to a Sch. of Adj deduction line you do support |
|
| IT BUS - Schedule C |
|
|
|
| Sch. of Credits - Lump Sum Retirement Credit - Carryforward from prior year |
|
| Amount of line 24 to be donated - Ohio History Fund |
|
| |
|
| SD100 |
|
| Income to the extent included in MAGI |
|
|
|
| Tax due |
|
| Ohio Test #4 |
|
|
IT1040WithSD100 |
| Taxpayer Information |
|
Description |
|
| TaxpayerSSN |
|
Primary Social Security Number |
400-XX-7604 |
| FirstName |
|
Primary First Name |
EMMA |
| LastName |
|
Primary Last Name |
CHAMP |
| DateOfBirth |
|
Date of Birth - Primary |
1961-05-20 |
| |
|
|
|
| TaxpayerSSN |
|
Spouse's Social Security Number |
400-XX-7654 |
| FirstName |
|
Spouse First Name |
WILL |
| MiddleInitial |
|
Spouse Middle Initial |
B |
| LastName |
|
Spouse Last Name |
CHAMP |
| DateOfBirth |
|
Date of Birth - Spouse |
1964-02-21 |
| |
|
|
|
| USPhone |
|
Taxpayer's Phone Number |
[<=9999999]###-#### |
| EmailAddress |
|
Taxpayer's E-mail Address |
EMMA@EMMA.NET |
| |
|
|
|
| AddressLine1Txt |
|
US Address - Address Line 1 |
123 TROPHY LN |
| CityNm |
|
City |
WOOSTER |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
44691 |
| |
|
|
|
| MailingAddressCounty |
|
Ohio County |
WAYNE |
| SchoolDistrictNumber |
|
Ohio Public School District Number - Resident District |
8509 |
| |
|
|
|
| Preparer Information |
|
|
|
| Paid Preparer |
|
|
|
| PTIN |
|
Paid Preparer's PTIN |
P13579135 |
| PreparerFirmEIN |
|
Paid Preparer's Firm ID Number |
123456789-0000000 |
| BusinessNameLine1Txt |
|
Paid Preparer's Business Name |
WE FILE TAXES |
| PreparerPersonNm |
|
Paid Preparer's name |
JAKE HOWARD |
| |
|
|
|
| AddressLine1Txt |
|
Preparer's US Address |
500 NORTH ST |
| CityNm |
|
City |
ANSONIA |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
ZIP Code |
45303 |
| PhoneNum |
|
Paid Preparer's US Phone Number |
[<=9999999]###-#### |
| EmailAddressTxt |
|
Paid Preparer's Email Address |
JAKEH@WEFILETAXES.COM |
| ContactPreparerAuthorization |
|
Preparer Authorization Check Box |
No |
| |
|
|
|
| *IT Waiver Required* |
|
|
|
| Reason |
|
Taxpayer is a victim of Identiy theft |
X |
| |
|
|
|
| Income Statements |
|
|
|
| W-2 #1 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
319876555-####### |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
NATIONAL GUARD |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
25 S BUNKER DR |
| CityNm |
|
City |
SOLON |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
44139 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7604 |
| EmployeNm |
|
Employee's Name |
EMMA CHAMP |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
123 TROPHY LN |
| CityNm |
|
City |
WOOSTER |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
44691 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$5,600.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$50.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$5,600.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$347.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$5,600.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$81.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
52-890123 |
| StateWagesAmt |
|
State Wages |
$5,600.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$36.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$5,600.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$100.00 |
| LocalityNm |
|
Name of Locality |
ANSONIA |
| |
|
|
|
| W-2 #2 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
383838196-####### |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
DOCTORS AND ASSOCIATES |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
75 LIBERTY ST |
| CityNm |
|
City |
OBERLIN |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
44074 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7654 |
| EmployeeNm |
|
Employee's Name |
WILL B CHAMP |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
123 TROPHY LN |
| CityNm |
|
City |
WOOSTER |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
44691 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$45,777.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$9,000.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$45,777.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$2,838.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$45,777.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$664.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
51-901234 |
| StateWagesAmt |
|
State Wages |
$45,777.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$488.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$45,777.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$189.00 |
| LocalityNm |
|
Name of Locality |
ANSONIA |
| |
|
|
|
| SchoolDistrictWages |
|
School District Wages |
$45,777.00 |
| SchoolDistrictTaxWithheld |
|
School District Tax Withheld |
$458.00 |
| SchoolDistrictNumber |
|
School District # |
8509 |
| |
|
|
|
| W-2 #3 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
209876543-####### |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
LITTLE LULU'S CAFE |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
6 S HIGH ST |
| CityNm |
|
City |
TULSA |
| StateAbbreviationCd |
|
State |
OK |
| ZIPCd |
|
Zip Code |
74103 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7654 |
| EmployeNm |
|
Employee's Name |
WILL B CHAMP |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
123 TROPHY LN |
| CityNm |
|
City |
WOOSTER |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
44691 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$6,000.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$300.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$6,000.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$372.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$6,000.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$87.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
SC |
| EmployerStateIdNum |
|
State ID Number |
118A46C |
| StateWagesAmt |
|
State Wages |
$6,000.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$150.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$6,000.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$75.00 |
| LocalityNm |
|
Name of Locality |
SPRINGVILLE |
| |
|
|
|
| 1099R #1 |
|
|
|
| PayerEIN |
|
Payer's Identification Number |
203456789-0000000 |
| PayerName / BusinessNameLine1Txt |
|
Payer's Name |
US ARMY |
| |
|
|
|
| AddressLine1Txt |
|
Payer's Address |
100 N BUNKER DR |
| CityNm |
|
Payer's City |
SOLON |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZIPCd |
|
Payer's Zip Code |
44139 |
| |
|
|
|
| RecipientSSN |
|
Recipient's Social Security Number |
400-XX-7604 |
| RecipientNm |
|
Recipient's Name |
EMMA CHAMP |
| AddressLine1Txt |
|
Recipient's Address Line 1 |
123 TROPHY LN |
| CityNm |
|
Recipient's City |
WOOSTER |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
44691 |
| |
|
|
|
| GrossDistributionAmt |
|
Gross Distribution Amount |
$2,100.00 |
| TaxableAmt |
|
Taxable Amount |
$2,100.00 |
| TotalDistributionInd |
|
Total Distribution Indicator |
|
| F1099RDistributionCd |
|
Distribution Code |
7 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| PayerStateIdNum |
|
State Payer ID |
51-123456 |
| StateDistributionAmt |
|
State Distribution |
$2,100.00 |
| StateTaxWithheldAmt |
|
State Income Tax Withheld |
$17.00 |
| |
|
|
|
| 1099R #2 |
|
|
|
| PayerEIN |
|
Payer's Identification Number |
219876543-0000000 |
| PayerName / BusinessNameLine1Txt |
|
Payer's Name |
SUNSET INC |
| |
|
|
|
| AddressLine1Txt |
|
Payer's Address |
98 N OBERLIN DR |
| CityNm |
|
Payer's City |
OBERLIN |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZIPCd |
|
Payer's Zip Code |
44074 |
| |
|
|
|
| RecipientSSN |
|
Recipient's Social Security Number |
400-XX-7604 |
| RecipientNm |
|
Recipient's Name |
EMMA CHAMP |
| AddressLine1Txt |
|
Recipient's Address Line 1 |
123 TROPHY LN |
| CityNm |
|
Recipient's City |
WOOSTER |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
44691 |
| |
|
|
|
| GrossDistributionAmt |
|
Gross Distribution Amount |
$5,900.00 |
| TaxableAmt |
|
Taxable Amount |
$5,900.00 |
| TotalDistributionInd |
|
Total Distribution Indicator |
|
| F1099RDistributionCd |
|
Distribution Code |
7 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| PayerStateIdNum |
|
State Payer ID |
52-234567 |
| StateDistributionAmt |
|
State Distribution |
$5,900.00 |
| StateTaxWithheldAmt |
|
State Income Tax Withheld |
$160.00 |
| |
|
|
|
| Return Information |
|
|
|
| Federal Return Data |
|
|
|
| |
|
Filing Status |
Married Filing Joint |
| |
|
Exemptions, Self |
2 |
| |
|
Total wages, salaries, tips, etc. |
$57,377.00 |
| |
|
Taxable Pensions and Annuities |
$8,000.00 |
| |
|
Adjusted Gross Income (Includes $400 of the taxable portion of a Pell Grant, $500 for Military Injury Relief Fund and $279 for Ohio National Guard Reimbursements and Benefits) |
$66,556.00 |
| |
|
Earned Income Tax Credit |
$0.00 |
| State Return Data |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| FilingStatus |
|
|
|
| MarriedFilingJointly |
|
|
X |
| |
|
|
|
| Did you file federal extension Form 4868? |
|
|
No |
| |
|
|
|
| Did you take the Standard deduction or itemize? |
|
|
Standard |
| |
|
|
|
| Can someone else claim you (or your spouse) as a dependent? |
|
|
|
| ClaimedAsDependent |
|
|
No |
| |
|
|
|
| Residency Status |
|
|
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| JointFilingCredit |
|
Eligible for JFC? |
Yes |
| |
|
|
|
| IRS Pell Grant Worksheet 1-1 |
|
|
|
| |
|
Line 1 Amount of Pell Grant |
$5,000.00 |
| |
|
Line 2 Portion used to pay qualified expenses |
$4,600.00 |
| |
|
Line 4 Portion of line 3 reported as a taxable amount on IRS form 1040 |
$400.00 |
| |
|
Line 5 Portion of line 4 applied to room and board expenses |
$400.00 |
| |
|
|
|
| IT RC - Resident Credit |
|
|
|
| OtherStateFiled |
|
Enter the two-letter state abbreviation for each state in which income was subject to tax |
SC |
| OtheStateTaxableIncome |
A |
Portion of OAGI subjected to tax by other state or DC while an OH resident |
$6,000.00 |
| OtheStateTaxPaid |
B |
Tax Paid to other state or DC while an OH resident |
$150.00 |
| |
|
|
|
| OtherStatesSubjectedTax |
1 |
Total portion of OAGI subjected to tax by other states or DC while an OH resident |
$6,000.00 |
| CurYearIncTaxLessOtherCred |
2 |
Total tax liability after credits paid to another state or DC |
$150.00 |
| OhioAdjustedGrossIncome |
3 |
Ohio adjusted gross income |
$57,677.00 |
| OtherStatesCreditRatio |
4 |
Divide line 1 by line 3 |
0.1040 |
| TotAddlCredLessNonRes |
5 |
Tax less additional credits (Schedule of Credits Line 30) less Nonresident credit (Schedule of Credits Line 33) |
$1,035.00 |
| OtherStatesCredit |
6 |
Line 4 times line 5 |
$108.00 |
| ResidentTaxCredit |
7 |
Enter the lesser of line 2 or line 6. This is your Ohio resident tax credit. |
$108.00 |
| |
|
|
|
| Additional Information |
|
|
|
| InstallmentPayment |
|
Estimated Payment made for 2022 |
$760.00 |
| MilitaryPayForResident |
|
Military pay for Ohio Residents Stationed Outside Ohio |
$5,600.00 |
| UniformedServicesRetirementIncome |
|
Uniformed Services Retirement |
$2,100.00 |
| MilitaryInjuryReliefFund |
|
Military Injury Relief Fund |
$500.00 |
| NationalGuardReimAndBenft |
|
Ohio National Guard Reimbursements and Benefits |
$279.00 |
| RetireIncomeCredit |
|
Eligible for Retirement Income Credit? |
No - Taxpayers claimed the Lump Sum Retirement Credit in a prior year |
| |
|
Eligible for JFC? |
Yes |
| OtherStatesSubjectedTax |
|
Enter the Portion of Line 3 Subjected to tax by Other States or the District of Columbia While an Ohio Resident |
$6,000.00 |
| |
|
2022 income tax less all credits other than withholding and estimated payment and overpayment credit carryforward from previous year paid to the other state(s) or the District of Columbia |
$150.00 |
| OverpymtCreditedNextYear |
|
Amount Credited to Next Year's Tax Liability |
$500.00 |
| |
|
|
|
| SD Return # 1 Information |
|
|
|
| SchoolDistrictNumber |
|
What is the school district number for which you are filing the SD 100? |
8509 |
| TaxType |
|
Tax Type |
Earned Income Only |
| |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| Residency Status |
|
School district residency |
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| SD Return # 1 Additional Information |
|
|
|
| InstallmentPayments |
|
Estimated Payments Paid |
$50.00 |
| WagesAndOtherCompensations |
|
Wages Earned in SD #8509 |
$51,777.00 |
| |
|
|
|
| Return |
|
|
|
| IT1040 - Pages 1 & 2 |
| FederalAdjustedGrossIncome |
1 |
Federal Adjusted Gross Income |
$66,556.00 |
| TotalIncomeAddition |
2a |
Additions to federal adjusted gross income |
$0.00 |
| TotalIncomeDeduction |
2b |
Deductions from federal adjusted gross income |
$8,879.00 |
| OhioAdjustedGrossIncome |
3 |
Ohio Adjusted Gross Income (OAGI) |
$57,677.00 |
| ExemptionDeduction |
4 |
Personal and dependent exemption deduction |
$4,300.00 |
| TaxableIncome |
5 |
Ohio income tax base |
$53,377.00 |
| TaxableBusinessIncome |
6 |
Taxable business income (Ohio IT BUS, line 13) |
$0.00 |
| TaxableIncomeLessBusinessIncome |
7 |
Line 5 minus line 6 (if less than 0, enter 0) |
$53,377.00 |
| |
7a |
Amount from line 7 on page 1 |
$53,377.00 |
| NonBusinessIncomeTaxLiability |
8a |
Nonbusiness income tax liability |
$1,150.00 |
| BusinessIncomeTaxLiability |
8b |
Business income tax liability (Ohio IT BUS, line 14) |
$0.00 |
| IncomeTaxLiabilityBeforeCredits |
8c |
Income tax liability before credits (line 8a plus 8b) |
$1,150.00 |
| OhioNonRefundableCredits |
9 |
Ohio nonrefundable credits |
$223.00 |
| TaxLiabAfterNonrefundableCrdt |
10 |
Tax liability after nonrefundable credits |
$927.00 |
| UnderPaymentInterestPenalty |
11 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| UnpaidUseTax |
12 |
Sales and use tax due on Internet, mail order or other out-of-state purchases |
$0.00 |
| TotalTaxLiability |
13 |
Total Ohio tax liability before withholding or estimated payments |
$927.00 |
| TaxWithheld |
14 |
Ohio income tax withheld |
$701.00 |
| InstallmentPayment |
15 |
Add the Ohio estimated & extension payments & credit carryforward from previous year return |
$760.00 |
| RefundableTaxCredits |
16 |
Refundable credits |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
17 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayment |
18 |
Total Ohio Tax Payments |
$1,461.00 |
| OverpymtRecdOnOrigAmendRtn |
19 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
20 |
Line 18 minus line 19 |
$1,461.00 |
| AmountUnderpaid |
21 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
22 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
23 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
24 |
Overpayment |
$534.00 |
| OverpymtCreditedNextYear |
25 |
Original return only - amount of line 24 to be carried forward to next year's tax liability |
$500.00 |
| CharityOrgName |
26a |
Amount of line 24 to be donated - Wildlife species |
$0.00 |
| CharityOrgName |
26b |
Amount of line 24 to be donated - Military injury relief |
$0.00 |
| CharityOrgName |
26c |
Amount of line 24 to be donated - Ohio History Fund |
$0.00 |
| CharityOrgName |
26d |
Amount of line 24 to be donated - Nature Preserves/Scenic Rivers |
$0.00 |
| CharityOrgName |
26e |
Amount of line 24 to be donated - Breast/cervical cancer |
$0.00 |
| CharityOrgName |
26f |
Amount of line 24 to be donated - Wishes for sick children |
$0.00 |
| TotalDonation |
26g |
Total |
$0.00 |
| Refund |
27 |
Your Refund |
$34.00 |
| |
|
|
|
| Schedule of Adjustments |
| Additions |
|
|
|
| NonOhioAndLocalGovIntAndDiv |
1 |
Non-Ohio state or local government interest and dividends |
$0.00 |
| PassThruEntityTaxesPaid |
2 |
Certain Ohio pass-through entity and financial institutions taxes paid |
$0.00 |
| TuitionExpenseReimbursement |
3 |
Reimbursement of college tutition expenses and fees deducted in any previous year(s) and noneducation expenditures from a college savings account |
$0.00 |
| SaleAndDispstnLossOfOhioOblig |
4 |
Losses from sale or disposition of Ohio public obligations |
$0.00 |
| NonMedicalWithdrawals |
5 |
Nonmedical withdrawals from a medical savings account |
$0.00 |
| ReimExpPrevDeducted |
6 |
Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if the reimbursement is not in federal adjusted gross income |
$0.00 |
| IRC168And179AdjAdd |
7 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| FederalInterestAndDividends |
8 |
Federal interest and dividends subject to state taxation |
$0.00 |
| FederalConformityAdditions |
9 |
Federal conformity additions |
$0.00 |
| TotalIncomeAddition |
10 |
Total additions |
$0.00 |
| |
|
|
|
| Deductions |
|
|
|
| BusinessIncomeDeduction |
11 |
Business income deduction (attach Ohio Schedule IT BUS, line 11) |
$0.00 |
| OHFullYrEmpCompEarnNeighState |
12 |
Employee compensation earned in Ohio by residents of neighboring states |
$0.00 |
| IRS1040StateMuniIncomeOverpymt |
13 |
State or municipal income tax overpayments shown on the federal 1040, Sch 1, line 1 |
$0.00 |
| SocialSecurityBenefits |
14 |
Taxable Social Security benefits |
$0.00 |
| RailroadRetirementBenefits |
15 |
Certain railroad retirement benefits |
$0.00 |
| ObligIntrstPublicServicePay |
16 |
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 state of Ohio or income from a transfer agreement |
$0.00 |
| IndDevAcct |
17 |
Amounts contributed to an individual development account |
$0.00 |
| STABLEAcct |
18 |
Amounts contributed to STABLE account; Ohio's ABLE plan |
$0.00 |
| OutOfStateDisasterWorkIncome |
19 |
Income earned in Ohio by a qualifying out-of-state business or employee for disaster work conducted during a disaster response period |
$0.00 |
| FederalIntAndDivExempt |
20 |
Federal interest and dividends exempt from state taxation |
$0.00 |
| IRC168And179AdjDed |
21 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| IRS1040RefundOrReimbursements |
22 |
Refund or reimbursements shown on the federal 1040, schedule 1 for itemized deductions claimed on a prior year federal income tax return |
$0.00 |
| RepaymentOfIncomeReported |
23 |
Repayment of income reported in a prior year |
$0.00 |
| NotDeductedWageExpense |
24 |
Wage expense not deducted due to claiming the federal work opportunity credit |
$0.00 |
| FederalConformityDeductions |
25 |
Federal conformity deductions |
$0.00 |
| MilitaryPayForResident |
26 |
Military pay for Ohio residents received while the military member was stationed outside Ohio |
$5,600.00 |
| IncomeErndMilitCivilianNRSpouse |
27 |
Certain income earned by military nonresidents and civilian nonresident spouses |
$0.00 |
| UniformedServcsRetirmtIncome |
28 |
Uniformed services retirement income |
$2,100.00 |
| MilitaryInjuryReliefFund |
29 |
Military injury relief fund |
$500.00 |
| NationalGuardReimAndBenft |
30 |
Certain Ohio National Guard reimbursements and benefits |
$279.00 |
| CollegeAdvSavAndTuitPurchCred |
31 |
Ohio 529 contributions, tuition credit purchases |
$0.00 |
| PellOhioCollegeOppTaxableGrant |
32 |
Pell/Ohio College Opportunity taxable grant amounts used to pay room and board |
$400.00 |
| OhioEducatorExpenses |
33 |
Ohio educator expenses in excess of federal deduction |
$0.00 |
| DisabilityBenefits |
34 |
Disability benefits |
$0.00 |
| SurvivorBenefits |
35 |
Survivor benefits |
$0.00 |
| UnsubsidizedMedicalExpense |
36 |
Unreimbursed long-term care insurance premiums, unsubsidized health care insurance premiums and excess health care expenses (see instructions for worksheet) |
$0.00 |
| HealthCareDepositedFunds |
37 |
Funds deposited into, and earnings of, a medical savings account for eligible health care expenses (see instructions for worksheet) |
$0.00 |
| QualOrganDonorExp |
38 |
Qualified organ donor expenses |
$0.00 |
| TotalIncomeDeduction |
39 |
Total deductions |
$8,879.00 |
| |
|
|
|
| Schedule IT BUS |
|
|
|
| |
|
Part 1 |
|
| BusScheduleB |
1 |
Sch B - Interest and Ordinary Dividends |
$0.00 |
| BusScheduleC |
2 |
Sch C - Profit or Loss From Business (Sole Proprietership) |
$0.00 |
| BusScheduleD |
3 |
Sch D - Capital Gains and Losses |
$0.00 |
| BusScheduleE |
4 |
Sch E - Supplemental Income and Loss |
$0.00 |
| GuaranteedPayments |
5 |
Guranteed payments, compensation and/or wages from each pass-through entity in which you have at least a 20% direct or indirect ownership interest |
$0.00 |
| BusScheduleF |
6 |
Sch F - Profit or Loss From Farming |
$0.00 |
| OtherItemsOfIncome |
7 |
Other items of income and gain separately stated on federal Schedule K-1, federal 4797 gains and/or losses reported on federal 4797 and miscellaneous federal income tax adjustments, if any |
$0.00 |
| TotalOfBusinessIncome |
8 |
Total of business income (add lines 1 through 7) |
$0.00 |
| |
|
Part 2 |
|
| AllBusinessIncome |
9 |
All business income (enter the lesser of line 8 above or Ohio IT1040, line 1). If zero or negative, stop here and do not complete Part 3. |
$0.00 |
| FilingStatusBusIncAmt |
10 |
Enter $250,000 if single or MFJ, enter $125,000 if MFS |
$0.00 |
| LessOfFilStatBusIncAmtOrAllBusInc |
11 |
Lesser of line 9 or line 10. Enter here and on Ohio Schedule of Adjustments, line 11 |
$0.00 |
| |
|
Part 3 |
|
| AllBusIncLessBusIncDeduction |
12 |
Line 9 minus line 11 (if less than -0-, enter -0-) |
$0.00 |
| TaxableBusinessIncome |
13 |
Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5) |
$0.00 |
| BusinessIncomeTaxLiability |
14 |
Business income tax liability. Multiply line 13 by 3%. Enter here and on Ohio IT 1040, line 8b. |
$0.00 |
| |
|
|
|
| Schedule of Credits - Nonrefundable |
| TaxLiabilityBeforeCredits |
1 |
Tax liability before credits (From IT1040, line 8c) |
$1,150.00 |
| RetireIncomeCredit |
2 |
Retirement income credit (limit $200 per return) |
$0.00 |
| LumpSumRetirementCredit |
3 |
Lump sum retirement credit (include Ohio LS WKS, line 6) |
$0.00 |
| SeniorCitizenCredit |
4 |
Senior citizen credit |
$0.00 |
| LumpSumDistributionCredit |
5 |
Lump sum distribution credit (include Ohio LS WKS, line 3) |
$0.00 |
| ChildAndDependCareCredit |
6 |
Child care and dependent care credit (see the worksheet in the instructions) |
$0.00 |
| DisplacedWorkerTrainingCredit |
7 |
Displaced worker training credit (see the worksheet in the instructions) |
$0.00 |
| CampaignContributionCredit |
8 |
Campaign contribution credit |
$0.00 |
| ExemptionCredit |
9 |
Income-based exemption credit |
$0.00 |
| TotCreditsBeforeJointFiling |
10 |
Total (add lines 2 through 9) |
$0.00 |
| TaxLessCredit |
11 |
Tax less credits (line 1 minus line 10; if less than -0-, enter -0-) |
$1,150.00 |
| JointFilingCredit |
12 |
Joint filing credit |
$115.00 |
| EarnedIncomeCredit |
13 |
Earned income credit (multiply Fed EITC by 30%) |
$0.00 |
| HomeSchoolExpensesCredit |
14 |
Home school expenses credit |
$0.00 |
| ScholarshipDonationCredit |
15 |
Scholarship donation credit |
$0.00 |
| NonCharterOrPublicSchoolCredit |
16 |
Nonchartered, nonpublic school tuition credit |
$0.00 |
| VocationalJobCredit |
17 |
Vocational job credit |
$0.00 |
| AdoptionCredit |
18 |
Ohio adoption credit |
$0.00 |
| JobRetentionCredit |
19 |
Nonrefundable job retention credit |
$0.00 |
| NewEmpInEntZoneCredit |
20 |
Credit for eligible new employees in an enterprise zone |
$0.00 |
| GrapeProdPropertyPurchCredit |
21 |
Credit for purchases of grape production property |
$0.00 |
| InvestOhioCredit |
22 |
InvestOhio credit |
$0.00 |
| LeadAbatementCredit |
23 |
Lead abatement credit |
$0.00 |
| OpportunityZoneCredit |
24 |
Opportunity zone investment credit |
$0.00 |
| TechInvestCreditCarryfrwd |
25 |
Technology investment credit carryforward |
$0.00 |
| EntZoneDayCareAndTrngCredit |
26 |
Enterprise zone day care and training credits |
$0.00 |
| ResearchAndDevelopmentCredit |
27 |
Research and development credit |
$0.00 |
| OhioHistoricPreservationCredit |
28 |
Nonrefundable Ohio historic preservation credit |
$0.00 |
| TotAdditionalCredits |
29 |
Total (add lines 12 through 28) |
$115.00 |
| TaxLessCrdtMinusTotAddlCrdts |
30 |
Tax less additional credits (line 11 minus line 29; if less than -0-, enter -0-) |
$1,035.00 |
| |
|
Nonresident Credit |
|
| NonOhioIncome |
31 |
Nonresident Portion of Ohio adjusted gross income |
$0.00 |
| OhioAdjustedGrossIncome |
32 |
Ohio adjusted gross income |
$0.00 |
| NonResIncomeCreditRatio |
33a |
Divide line 31 by line 32 |
0.0000 |
| NonresidentAndPartYearCredit |
33 |
Nonresident credit (line 30 times line 33a) |
$0.00 |
| |
|
Resident Credit |
|
| ResidentTaxCredit |
34 |
Resident Credit - Ohio IT RC, line 7 |
$108.00 |
| TotalNonrefundableCredits |
35 |
Total nonrefundable credits |
$223.00 |
| |
|
|
|
| Schedule of Credits - Refundable |
| HistoricPreservationCredit |
36 |
Refundable Ohio historic preservation credit |
$0.00 |
| JobCreationAndJobRetentionCrd |
37 |
Refundable job creation credit & job retention credit |
$0.00 |
| PassthroughEntityCredit |
38 |
Pass-through entity credit |
$0.00 |
| MotionPictureProductionCredit |
39 |
Motion Picture & Broadway theatrical production credit |
$0.00 |
| VentureCapitalCredit |
40 |
Venture Capital credit |
$0.00 |
| TotalRefundableCredit |
41 |
Total refundable credits |
$0.00 |
| |
|
|
|
| School District Return (#8509) |
|
|
|
| SchoolDistrictTaxableIncome |
1 |
School district taxable income: Traditional or Earned Income tax base |
$51,777.00 |
| TaxAmount |
2 |
School District Tax .____ times line 1. |
$518.00 |
| SeniorCitizenCredit |
3 |
Senior Citizen Credit |
$0.00 |
| TaxLessCredit |
4 |
School District Income Tax liability |
$518.00 |
| UnderPaymentInterestPenalty |
5 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| TotalTax |
6 |
Total school district income tax liability (line 4 plus line 5) |
$518.00 |
| TotalTax |
6a |
Amount from line 6, page 1 |
$518.00 |
| TaxWithheld |
7 |
School district income tax withheld |
$458.00 |
| InstallmentPayments |
8 |
SD 100 ES & SD 40P, Extension Payments and Credit carryforward from previous year return |
$50.00 |
| AmtPrevPaidWithOrigAmendRtn |
9 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayments |
10 |
Total school district income tax payments (add lines 7, 8 and 9) |
$508.00 |
| OverpymtRecdOnOrigAmendRtn |
11 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
12 |
Line 10 minus line 11. Place a negative sign ("-") in the box if the amount is less than -0- |
$508.00 |
| AmountUnderpaid |
13 |
Tax due |
$10.00 |
| InterestDueOnLatePayment |
14 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
15 |
Total Amount Due |
$10.00 |
| AmountOverpaid |
16 |
Overpayment |
$0.00 |
| OverpymtCreditedNextYear |
17 |
Original return only - amount of line 16 to be carried forward to next year's tax liability |
$0.00 |
| Refund |
18 |
Your Refund |
$0.00 |
| Traditional Tax Base School District Amounts |
|
|
|
| TaxableIncome |
19 |
Ohio income tax base (Ohio IT 1040, line 3 minus line 4) |
$0.00 |
| BusinessIncomeDeductionAddback |
20 |
Business income deduction add-back |
$0.00 |
| TotalTraditionalSDIncome |
21 |
Total Traditional Tax Base School District Income (Line 19 + Line 20) |
$0.00 |
| NonResidentIncome |
22 |
Amount of traditional tax base school district income that you earned while not a resident |
$0.00 |
| SchoolDistrictTaxableIncome |
23 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| Earned Income Tax Base School District Amounts |
|
|
|
| WagesAndOtherCompensations |
24 |
Wages and other compensation as described in the instructions |
$51,777.00 |
| SelfEmploymentEarnings |
25 |
Net Earnings from Self Employment |
$0.00 |
| FederalConformityAdjustments |
26 |
Federal Conformity Adjustments |
$0.00 |
| SchoolDistrictTaxableIncome |
27 |
School District Taxable Income (Enter here and on line 1) |
$51,777.00 |
| |
|
|
|
| What is Tested? |
If you do not support: |
|
| IT1040WithSD100 |
|
| Paid Preparer |
|
|
| Preparer Contact - Declined |
|
|
| MFJ status |
|
|
| W-2 |
|
|
|
| 1099-R |
|
|
| |
|
|
| IT1040 |
|
|
| Full year resident |
|
| [$46,100 - $92,150] tax bracket |
|
| Sch. of Adj Military pay outside Ohio |
Move amount to a Sch. of Adj deduction line you do support |
| Sch. of Adj Uniformed services retirement income |
Move amount to a Sch. of Adj deduction line you do support |
| Sch. of Adj Military injury relief fund |
Move amount to a Sch. of Adj deduction line you do support |
| Sch. of Adj Ohio Nat Guard reimbursement/benefit |
Move amount to a Sch. of Adj deduction line you do support |
| Sch. of Adj Pell/Ohio college opportunity taxable grant |
Remove deduction and increase the wages on W-2 #1 by $400 to maintain the same Federal Adjust Gross Income |
| Sch of Credits - Ohio resident credit |
Remove Ohio resident credit |
| Refund/credit carryforward split |
Change to refund the full overpayment |
| |
|
|
|
| SD100 |
|
|
| Earned Income school district |
|
| Full year resident |
|
| School district estimated payments |
Remove the amount |
| Tax due |
|
| Ohio Test #5 |
|
|
IT1040WithSD100 |
| Taxpayer Information |
|
Description |
|
| TaxpayerSSN |
|
Primary Social Security Number |
400-XX-7605 |
| FirstName |
|
Primary First Name |
JAMES |
| MiddleInitial |
|
Primary Middle Initial |
T |
| LastName |
|
Primary Last Name |
PRIDE |
| DateOfBirth |
|
Date of Birth - Primary |
1951-06-30 |
| |
|
|
|
| TaxpayerSSN |
|
Spouse's Social Security Number |
400-XX-7655 |
| FirstName |
|
Spouse First Name |
AUTUMN |
| MiddleInitial |
|
Spouse Middle Initial |
C |
| LastName |
|
Spouse Last Name |
PRIDE |
| DateOfBirth |
|
Date of Birth - Spouse |
1949-08-08 |
| DateOfDeath |
|
Date of Death - Spouse |
|
| |
|
|
|
| USPhone |
|
Taxpayer's Phone Number |
[<=9999999]###-#### |
| EmailAddress |
|
Taxpayer's E-mail Address |
PRIDE@GMAIL.COM |
| |
|
|
|
| AddressLine1Txt |
|
Address Line 1 |
78 PUMP-KIN DR |
| CityNm |
|
City |
SIDNEY |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
45365 |
| |
|
|
|
| MailingAddressCounty |
|
Ohio County |
SHELBY |
| SchoolDistrictNumber |
|
Ohio Public School District Number - Resident District |
7508 |
| |
|
|
|
| Preparer Information |
|
|
|
| Self-Prepared |
|
|
|
| SelfPrepared |
|
Return is self-prepared |
X |
| |
|
|
|
| Income Statements |
|
|
|
| W-2 #1 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
223456789-0000000 |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
PRIDE CONSTRUCTION |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
30 NORTH AVE |
| CityNm |
|
City |
CIRCLEVILLE |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43113 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7605 |
| EmployeNm |
|
Employee's Name |
JAMES T PRIDE |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
78 PUMP-KIN DR |
| CityNm |
|
City |
SIDNEY |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
45365 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$21,720.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$2,072.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$21,720.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$1,347.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$21,720.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$315.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
51-876543 |
| StateWagesAmt |
|
State Wages |
$21,720.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$40.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$16,720.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$197.00 |
| LocalityNm |
|
Name of Locality |
CIRCLEVILLE |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$5,000.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$125.00 |
| LocalityNm |
|
Name of Locality |
COLUMBUS |
| |
|
|
|
| SchoolDistrictWages |
|
School District Wages |
$21,720.00 |
| SchoolDistrictTaxWithheld |
|
School District Tax Withheld |
$163.00 |
| SchoolDistrictNumber |
|
School District # |
7508 |
| |
|
|
|
| W-2 #2 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
239876543-0000000 |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
BUCKEYE CANDY |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
270 STRING ST |
| CityNm |
|
City |
CIRCLEVILLE |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43113 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7655 |
| EmployeeNm |
|
Employee's Name |
AUTUMN C PRIDE |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
78 PUMP-KIN DR |
| AddressLine2Txt |
|
Employee Address Line 2 |
|
| CityNm |
|
City |
SIDNEY |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
45365 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$16,280.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$1,309.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$16,280.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$1,009.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$16,280.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$236.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
52-765432 |
| StateWagesAmt |
|
State Wages |
$16,280.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$37.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$16,280.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$204.00 |
| LocalityNm |
|
Name of Locality |
CIRCLEVILLE |
| |
|
|
|
| SchoolDistrictWages |
|
School District Wages |
$16,280.00 |
| SchoolDistrictTaxWithheld |
|
School District Tax Withheld |
$122.00 |
| SchoolDistrictNumber |
|
School District # |
7508 |
| |
|
|
|
| W-2 #3 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
243456789-0000000 |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
BUCK'S PRIDE |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
15 S MAIN ST |
| CityNm |
|
City |
CIRCLEVILLE |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43113 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7655 |
| EmployeNm |
|
Employee's Name |
AUTUMN C PRIDE |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
78 PUMP-KIN DR |
| CityNm |
|
City |
SIDNEY |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
45365 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$25,000.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$2,400.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$25,000.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$1,550.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$25,000.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$363.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
51-654322 |
| StateWagesAmt |
|
State Wages |
$25,000.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$115.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$25,000.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$250.00 |
| LocalityNm |
|
Name of Locality |
CIRCLEVILLE |
| |
|
|
|
| 1099-G |
|
|
|
| PayerName / BusinessNameLine1Txt |
|
Payer's Name |
STATE OF OHIO |
| AddressLine1Txt |
|
Payer's US Address Line 1 Text |
1030 E BROAD ST |
| CityNm |
|
Payer's City |
COLUMBUS |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZIPCd |
|
Payer's Zip Code |
43229 |
| PayerEIN |
|
Payer's Federal Identification Number |
359876543-0000000 |
| |
|
|
|
| RecipientSSN |
|
Recipient's SSN |
400-XX-7655 |
| RecipientName |
|
Recipient's Name |
AUTUMN C PRIDE |
| AddressLine1Txt |
|
Recipient's Address Line 1 Text |
78 PUMP-KIN DR |
| CityNm |
|
Recipient's City |
SIDNEY |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
45365 |
| |
|
|
|
| UnemploymentCompensation |
|
Box 1 Unemployment compensation |
$5,000.00 |
| TaxYear |
|
Tax Year |
2022 |
| FederalTaxWithheld |
|
Federal Income Tax Withheld |
$500.00 |
| |
|
|
|
| StateTaxWithheldAmt |
|
Box 11 State income tax withheld |
$16.00 |
| StateAbbreviationCd |
|
Box 10a State |
OH |
| PayersStateIdNumber |
|
Box 10b State identification no. |
51-234999 |
| StateDistributionAmt |
|
State Distribution Amount |
$5,000.00 |
| |
|
|
|
| 1099-INT |
|
|
|
| PayerEIN |
|
Payer's Identification Number |
259876543-0000000 |
| PayerName |
|
Payer's Name |
INVESTMENT LTD |
| AddressLine1Txt |
|
Payer's Address Line 1 Text |
123 MAIN ST |
| CityNm |
|
Payer's City |
SOLON |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZIPCd |
|
Payer's Zip Code |
44139 |
| |
|
|
|
| RecipientSSN |
|
Recipient's Social Security Number |
400-XX-7605 |
| RecipientName |
|
Recipient's Name |
JAMES T PRIDE |
| AddressLine1Txt |
|
Recipient's Address Line 1 Text |
78 PUMP-KIN DR |
| CityNm |
|
Recipient's City |
SIDNEY |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
45365 |
| |
|
|
|
| InterestIncome |
|
Interest Income |
$1,000.00 |
| |
|
|
|
| StateTaxWithheldAmt |
|
Box 13 State income tax withheld |
$10.00 |
| StateAbbreviationCd |
|
Box 11 State |
OH |
| PayersStateIdNumber |
|
Box 12 State identification no. |
51-237777 |
| StateDistributionAmt |
|
Interest Income |
$1,000.00 |
| |
|
|
|
| Return Information |
|
|
|
| Federal Return Data |
|
|
|
| |
|
Filing Status |
Married Filing Jointly |
| |
|
Exemptions, Self |
3 |
| |
|
Total wages, salaries, tips, etc. |
$63,000.00 |
| |
|
Taxable Interest |
$6,000.00 |
| |
|
Interest income from 1099-INT ($1000) |
|
| |
|
Interest income HH Bond ($5000) |
|
| |
|
Net profit or (loss) from Schedule C, Schedule C-EZ, and Schedule K1 |
($31,000.00) |
| |
|
Unemployment compensation |
$5,000.00 |
| |
|
Other Income - Refund or Reimbursement for itemized deduction |
$500.00 |
| |
|
Earned Income Tax Credit |
$0.00 |
| |
|
|
|
| |
|
Adjusted Gross Income |
$43,500.00 |
| |
|
|
|
| Form 2441 - Child & Dependent Care Expenses |
|
|
|
| |
|
Was your principal place of abode in the United States for more than half of tax year 2022? |
Yes |
| |
Part 1 |
|
|
| |
a |
Providers Name |
CARING PLACE |
| |
b |
Address |
16 STRAIGHT ST |
| |
|
|
CIRCLEVILLE, OH 43113 |
| |
c. |
Identifying Number |
324567893-0000000 |
| |
d. |
Amount Paid |
$1,555.00 |
| |
Part 2 |
|
|
| |
a. |
Qualifying Person's Name |
GRANDDAUGHTER J PRIDE |
| |
b. |
Qualifying Person's SSN |
400-XX-7680 |
| |
c. |
Qualified Expenses |
$1,555.00 |
| |
|
|
|
| |
|
Line 6 |
$1,555.00 |
| |
|
Line 11 |
$311.00 |
| |
|
|
|
| State Return Data |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| FilingStatus |
|
|
|
| MarriedFilingJointly |
|
|
X |
| |
|
|
|
| Did you file federal extension Form 4868? |
|
|
No |
| |
|
|
|
| Did you take the Standard deduction or itemize? |
|
|
Itemized |
| |
|
|
|
| Can someone else claim you (or your spouse) as a dependent? |
|
|
|
| ClaimedAsDependent |
|
|
No |
| |
|
|
|
| Schedule of Dependents |
|
Total Exemptions |
3 |
| NumberOfDependents |
|
|
1 |
| SSN |
|
|
400-XX-7680 |
| DateOfBirth |
|
|
2012-12-14 |
| Relationship |
|
|
GRANDCHILD |
| FirstName |
|
|
GRANDDAUGHTER |
| MiddleInitial |
|
|
J |
| LastName |
|
|
PRIDE |
| |
|
|
|
| Residency Status |
|
|
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| JointFilingCredit |
|
Eligible for JFC? |
Yes |
| |
|
|
|
| Child and Dependent Care Worksheet |
|
|
|
| |
|
Line 9 Federal Form 2441 |
$311.00 |
| |
|
Line 11 Federal Form 2441 |
$311.00 |
| |
|
|
|
| Additional Information |
|
|
|
| SaleAndDispstnLossOfOhioOblig |
|
Losses from the Sale or disposition of Ohio Public Obligations |
$3,950.00 |
| NonMedicalWithdrawals |
|
Non-Medical Withdrawals from a Medical Savings Account |
$4,863.00 |
| IRC168And179AdjAdd |
|
Add back 5/6ths of the Depreciation Expense Adjustment for IRC Section 168 (k) 179 Bonus Depreciation |
$1,000.00 |
| ObligIntrstPublicServicePay |
|
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 state of Ohio or income from a transfer agreement |
$1,000.00 |
| IndDevAcct |
|
Amounts Contributed to an Individual Development Account |
$300.00 |
| STABLEAcct |
|
Amounts contributed to STABLE account; Ohio's ABLE plan |
$4,000.00 |
| FederalIntAndDivExempt |
|
Federal Interest and Dividends Exempt from State Taxation |
$5,000.00 |
| IRC168And179AdjDed |
|
Adjustment for IRC section 168 (k) 179 Depreciation Expense |
$400.00 |
| IRS1040RefundOrReimbursements |
|
Refund or Reimbursements of Prior Year Federal Itemized Deductions |
$500.00 |
| RepaymentOfIncomeReported |
|
Repayment of income Reported in a prior year |
$3,250.00 |
| NotDeductedWageExpense |
|
Wage/Salary Expense not Deducted Due to the Work Opportunity Tax Credits |
$100.00 |
| CollegeAdvSavAndTuitPurchCred |
|
Contributions to a College Advantage 529 Savings Account and/or purchases of tuition credits |
$3,000.00 |
| QualOrganDonorExpAndIndDevAcct |
|
Qualified Organ Donor Expenses |
$500.00 |
| HomeSchoolExpensesCredit |
|
Expenses incurred for at home education |
$40.00 |
| |
|
|
|
| SD Return # 1 Information |
|
|
|
| SchoolDistrictNumber |
|
What is the school district number for which you are filing the SD 100? |
0908 |
| TaxType |
|
Tax Type |
Earned Income Only |
| |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| Residency Status |
|
School district residency |
|
| PrimaryResidencyStatus |
|
|
|
| PartYearResident |
|
Part-Year Resident |
X |
| ResidentFromDate |
|
First date you were a resident |
2022-01-01 |
| ResidentToDate |
|
Last date you were a resident |
2022-04-30 |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| PartYearResident |
|
Part-Year Resident |
X |
| ResidentFromDate |
|
First date you were a resident |
2022-01-01 |
| ResidentToDate |
|
Last date you were a resident |
2022-04-30 |
| |
|
|
|
| SD Return # 1 - Additional Information |
|
|
|
| |
|
Wages Earned in SD #0908 |
$25,000.00 |
| |
|
Sch C Business Loss Occurred in SD #0908 |
($31,000.00) |
| |
|
|
|
| SD Return # 2 Information |
|
|
|
| SchoolDistrictNumber |
|
What is the school district number for which you are filing the SD 100? |
7508 |
| TaxType |
|
Tax Type |
Earned Income Only |
| |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| Residency Status |
|
School district residency |
|
| PrimaryResidencyStatus |
|
|
|
| PartYearResident |
|
Part-Year Resident |
X |
| ResidentFromDate |
|
First date you were a resident |
2022-05-01 |
| ResidentToDate |
|
Last date you were a resident |
2022-12-31 |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| PartYearResident |
|
Part-Year Resident |
X |
| ResidentFromDate |
|
First date you were a resident |
2022-05-01 |
| ResidentToDate |
|
Last date you were a resident |
2022-12-31 |
| |
|
|
|
| SD Return # 2 - Additional Information |
|
|
|
| |
|
Wages Earned in SD #7508 |
$38,000.00 |
| |
|
Note: This amount must be reduced in order to limit School District Taxable Income to the extent included in modified adjusted gross income |
|
| |
|
|
|
| Return |
|
|
|
| IT1040 - Pages 1 & 2 |
| FederalAdjustedGrossIncome |
1 |
Federal Adjusted Gross Income |
$43,500.00 |
| TotalIncomeAddition |
2a |
Additions to federal adjusted gross income |
$9,813.00 |
| TotalIncomeDeduction |
2b |
Deductions from federal adjusted gross income |
$18,050.00 |
| OhioAdjustedGrossIncome |
3 |
Ohio Adjusted Gross Income (OAGI) |
$35,263.00 |
| ExemptionDeduction |
4 |
Personal and dependent exemption deduction |
$7,200.00 |
| TaxableIncome |
5 |
Ohio income tax base |
$28,063.00 |
| TaxableBusinessIncome |
6 |
Taxable business income (Ohio IT BUS, line 13) |
$0.00 |
| TaxableIncomeLessBusinessIncome |
7 |
Line 5 minus line 6 (if less than 0, enter 0) |
$28,063.00 |
| |
7a |
Amount from line 7 on page 1 |
$28,063.00 |
| NonBusinessIncomeTaxLiability |
8a |
Nonbusiness income tax liability |
$416.00 |
| BusinessIncomeTaxLiability |
8b |
Business income tax liability (Ohio IT BUS, line 14) |
$0.00 |
| IncomeTaxLiabilityBeforeCredits |
8c |
Income tax liability before credits (line 8a plus 8b) |
$416.00 |
| OhioNonRefundableCredits |
9 |
Ohio nonrefundable credits |
$262.00 |
| TaxLiabAfterNonrefundableCrdt |
10 |
Tax liability after nonrefundable credits |
$154.00 |
| UnderPaymentInterestPenalty |
11 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| UnpaidUseTax |
12 |
Sales and use tax due on Internet, mail order or other out-of-state purchases |
$0.00 |
| TotalTaxLiability |
13 |
Total Ohio tax liability before withholding or estimated payments |
$154.00 |
| TaxWithheld |
14 |
Ohio income tax withheld |
$202.00 |
| InstallmentPayment |
15 |
Add the Ohio estimated & extension payments & credit carryforward from previous year return |
$0.00 |
| RefundableTaxCredits |
16 |
Refundable credits |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
17 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayment |
18 |
Total Ohio Tax Payments |
$202.00 |
| OverpymtRecdOnOrigAmendRtn |
19 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
20 |
Line 18 minus line 19 |
$202.00 |
| AmountUnderpaid |
21 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
22 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
23 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
24 |
Overpayment |
$48.00 |
| OverpymtCreditedNextYear |
25 |
Original return only - amount of line 24 to be carried forward to next year's tax liability |
$0.00 |
| CharityOrgName |
26a |
Amount of line 24 to be donated - Wildlife species |
$0.00 |
| CharityOrgName |
26b |
Amount of line 24 to be donated - Military injury relief |
$0.00 |
| CharityOrgName |
26c |
Amount of line 24 to be donated - Ohio History Fund |
$0.00 |
| CharityOrgName |
26d |
Amount of line 24 to be donated - Nature Preserves/Scenic Rivers |
$0.00 |
| CharityOrgName |
26e |
Amount of line 24 to be donated - Breast/cervical cancer |
$0.00 |
| CharityOrgName |
26f |
Amount of line 24 to be donated - Wishes for sick children |
$0.00 |
| TotalDonation |
26g |
Total |
$0.00 |
| Refund |
27 |
Your Refund |
$48.00 |
| |
|
|
|
| Schedule of Adjustments |
| Additions |
|
|
|
| NonOhioAndLocalGovIntAndDiv |
1 |
Non-Ohio state or local government interest and dividends |
$0.00 |
| PassThruEntityTaxesPaid |
2 |
Certain Ohio pass-through entity and financial institutions taxes paid |
$0.00 |
| TuitionExpenseReimbursement |
3 |
Reimbursement of college tutition expenses and fees deducted in any previous year(s) and noneducation expenditures from a college savings account |
$0.00 |
| SaleAndDispstnLossOfOhioOblig |
4 |
Losses from sale or disposition of Ohio public obligations |
$3,950.00 |
| NonMedicalWithdrawals |
5 |
Nonmedical withdrawals from a medical savings account |
$4,863.00 |
| ReimExpPrevDeducted |
6 |
Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if the reimbursement is not in federal adjusted gross income |
$0.00 |
| IRC168And179AdjAdd |
7 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$1,000.00 |
| FederalInterestAndDividends |
8 |
Federal interest and dividends subject to state taxation |
$0.00 |
| FederalConformityAdditions |
9 |
Federal conformity additions |
$0.00 |
| TotalIncomeAddition |
10 |
Total additions |
$9,813.00 |
| |
|
|
|
| Deductions |
|
|
|
| BusinessIncomeDeduction |
11 |
Business income deduction (attach Ohio Schedule IT BUS, line 11) |
$0.00 |
| OHFullYrEmpCompEarnNeighState |
12 |
Employee compensation earned in Ohio by residents of neighboring states |
$0.00 |
| IRS1040StateMuniIncomeOverpymt |
13 |
State or municipal income tax overpayments shown on the federal 1040, Sch 1, line 1 |
$0.00 |
| SocialSecurityBenefits |
14 |
Taxable Social Security benefits |
$0.00 |
| RailroadRetirementBenefits |
15 |
Certain railroad retirement benefits |
$0.00 |
| ObligIntrstPublicServicePay |
16 |
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 state of Ohio or income from a transfer agreement |
$1,000.00 |
| IndDevAcct |
17 |
Amounts contributed to an individual development account |
$300.00 |
| STABLEAcct |
18 |
Amounts contributed to STABLE account; Ohio's ABLE plan |
$4,000.00 |
| OutOfStateDisasterWorkIncome |
19 |
Income earned in Ohio by a qualifying out-of-state business or employee for disaster work conducted during a disaster response period |
$0.00 |
| FederalIntAndDivExempt |
20 |
Federal interest and dividends exempt from state taxation |
$5,000.00 |
| IRC168And179AdjDed |
21 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$400.00 |
| IRS1040RefundOrReimbursements |
22 |
Refund or reimbursements shown on the federal 1040, schedule 1 for itemized deductions claimed on a prior year federal income tax return |
$500.00 |
| RepaymentOfIncomeReported |
23 |
Repayment of income reported in a prior year |
$3,250.00 |
| NotDeductedWageExpense |
24 |
Wage expense not deducted due to claiming the federal work opportunity credit |
$100.00 |
| FederalConformityDeductions |
25 |
Federal conformity deductions |
$0.00 |
| MilitaryPayForResident |
26 |
Military pay for Ohio residents received while the military member was stationed outside Ohio |
$0.00 |
| IncomeErndMilitCivilianNRSpouse |
27 |
Certain income earned by military nonresidents and civilian nonresident spouses |
$0.00 |
| UniformedServcsRetirmtIncome |
28 |
Uniformed services retirement income |
$0.00 |
| MilitaryInjuryReliefFund |
29 |
Military injury relief fund |
$0.00 |
| NationalGuardReimAndBenft |
30 |
Certain Ohio National Guard reimbursements and benefits |
$0.00 |
| CollegeAdvSavAndTuitPurchCred |
31 |
Ohio 529 contributions, tuition credit purchases |
$3,000.00 |
| PellOhioCollegeOppTaxableGrant |
32 |
Pell/Ohio College Opportunity taxable grant amounts used to pay room and board |
$0.00 |
| OhioEducatorExpenses |
33 |
Ohio educator expenses in excess of federal deduction |
$0.00 |
| DisabilityBenefits |
34 |
Disability benefits |
$0.00 |
| SurvivorBenefits |
35 |
Survivor benefits |
$0.00 |
| UnsubsidizedMedicalExpense |
36 |
Unreimbursed long-term care insurance premiums, unsubsidized health care insurance premiums and excess health care expenses (see instructions for worksheet) |
$0.00 |
| HealthCareDepositedFunds |
37 |
Funds deposited into, and earnings of, a medical savings account for eligible health care expenses (see instructions for worksheet) |
$0.00 |
| QualOrganDonorExp |
38 |
Qualified organ donor expenses |
$500.00 |
| TotalIncomeDeduction |
39 |
Total deductions |
$18,050.00 |
| |
|
|
|
| Schedule IT BUS |
|
|
|
| |
|
Part 1 |
|
| BusScheduleB |
1 |
Sch B - Interest and Ordinary Dividends |
$0.00 |
| BusScheduleC |
2 |
Sch C - Profit or Loss From Business (Sole Proprietership) |
($31,000.00) |
| BusScheduleD |
3 |
Sch D - Capital Gains and Losses |
|
| BusScheduleE |
4 |
Sch E - Supplemental Income and Loss |
$0.00 |
| GuaranteedPayments |
5 |
Guranteed payments, compensation and/or wages from each pass-through entity in which you have at least a 20% direct or indirect ownership interest |
$0.00 |
| BusScheduleF |
6 |
Sch F - Profit or Loss From Farming |
$0.00 |
| OtherItemsOfIncome |
7 |
Other items of income and gain separately stated on federal Schedule K-1, federal 4797 gains and/or losses reported on federal 4797 and miscellaneous federal income tax adjustments, if any |
$0.00 |
| TotalOfBusinessIncome |
8 |
Total of business income (add lines 1 through 7) |
($31,000.00) |
| |
|
Part 2 |
|
| AllBusinessIncome |
9 |
All business income (enter the lesser of line 8 above or Ohio IT1040, line 1). If zero or negative, stop here and do not complete Part 3. |
$0.00 |
| FilingStatusBusIncAmt |
10 |
Enter $250,000 if single or MFJ, enter $125,000 if MFS |
$0.00 |
| LessOfFilStatBusIncAmtOrAllBusInc |
11 |
Lesser of line 9 or line 10. Enter here and on Ohio Schedule of Adjustments, line 11 |
$0.00 |
| |
|
Part 3 |
|
| AllBusIncLessBusIncDeduction |
12 |
Line 9 minus line 11 (if less than -0-, enter -0-) |
$0.00 |
| TaxableBusinessIncome |
13 |
Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5) |
$0.00 |
| BusinessIncomeTaxLiability |
14 |
Business income tax liability. Multiply line 13 by 3%. Enter here and on Ohio IT 1040, line 8b. |
$0.00 |
| |
|
Part 4 |
|
| NameOfEntity |
1 |
Name of Entity |
PRIDE CONSTRUCTION |
| FEINOrSSN |
|
FEIN/SS# |
223456789-0000000 |
| PercentageOfOwnership |
|
Percentage of Ownership |
15% |
| Income Earned By Spouse |
|
Spouse |
X |
| |
|
|
|
| Schedule of Credits - Nonrefundable |
| TaxLiabilityBeforeCredits |
1 |
Tax liability before credits (From IT1040, line 8c) |
$416.00 |
| RetireIncomeCredit |
2 |
Retirement income credit (limit $200 per return) |
$0.00 |
| LumpSumRetirementCredit |
3 |
Lump sum retirement credit (include Ohio LS WKS, line 6) |
$0.00 |
| SeniorCitizenCredit |
4 |
Senior citizen credit |
$50.00 |
| LumpSumDistributionCredit |
5 |
Lump sum distribution credit (include Ohio LS WKS, line 3) |
$0.00 |
| ChildAndDependCareCredit |
6 |
Child care and dependent care credit (see the worksheet in the instructions) |
$78.00 |
| DisplacedWorkerTrainingCredit |
7 |
Displaced worker training credit (see the worksheet in the instructions) |
$0.00 |
| CampaignContributionCredit |
8 |
Campaign contribution credit |
$0.00 |
| ExemptionCredit |
9 |
Income-based exemption credit |
$60.00 |
| TotCreditsBeforeJointFiling |
10 |
Total (add lines 2 through 9) |
$188.00 |
| TaxLessCredit |
11 |
Tax less credits (line 1 minus line 10; if less than -0-, enter -0-) |
$228.00 |
| JointFilingCredit |
12 |
Joint filing credit |
$34.00 |
| EarnedIncomeCredit |
13 |
Earned income credit (multiply Fed EITC by 30%) |
$0.00 |
| HomeSchoolExpensesCredit |
14 |
Home school expenses credit |
$40.00 |
| ScholarshipDonationCredit |
15 |
Scholarship donation credit |
$0.00 |
| NonCharterOrPublicSchoolCredit |
16 |
Nonchartered, nonpublic school tuition credit |
$0.00 |
| VocationalJobCredit |
17 |
Vocational job credit |
$0.00 |
| AdoptionCredit |
18 |
Ohio adoption credit |
$0.00 |
| JobRetentionCredit |
19 |
Nonrefundable job retention credit |
$0.00 |
| NewEmpInEntZoneCredit |
20 |
Credit for eligible new employees in an enterprise zone |
$0.00 |
| GrapeProdPropertyPurchCredit |
21 |
Credit for purchases of grape production property |
$0.00 |
| InvestOhioCredit |
22 |
InvestOhio credit |
$0.00 |
| LeadAbatementCredit |
23 |
Lead abatement credit |
$0.00 |
| OpportunityZoneCredit |
24 |
Opportunity zone investment credit |
$0.00 |
| TechInvestCreditCarryfrwd |
25 |
Technology investment credit carryforward |
$0.00 |
| EntZoneDayCareAndTrngCredit |
26 |
Enterprise zone day care and training credits |
$0.00 |
| ResearchAndDevelopmentCredit |
27 |
Research and development credit |
$0.00 |
| OhioHistoricPreservationCredit |
28 |
Nonrefundable Ohio historic preservation credit |
$0.00 |
| TotAdditionalCredits |
29 |
Total (add lines 12 through 28) |
$74.00 |
| TaxLessCrdtMinusTotAddlCrdts |
30 |
Tax less additional credits (line 11 minus line 29; if less than -0-, enter -0-) |
$154.00 |
| |
|
Nonresident Credit |
|
| NonOhioIncome |
31 |
Nonresident Portion of Ohio adjusted gross income |
$0.00 |
| OhioAdjustedGrossIncome |
32 |
Ohio adjusted gross income |
$0.00 |
| NonResIncomeCreditRatio |
33a |
Divide line 31 by line 32 |
0.0000 |
| NonresidentAndPartYearCredit |
33 |
Nonresident credit (line 30 times line 33a) |
$0.00 |
| |
|
Resident Credit |
|
| ResidentTaxCredit |
34 |
Resident Credit - Ohio IT RC, line 7 |
$0.00 |
| TotalNonrefundableCredits |
35 |
Total nonrefundable credits |
$262.00 |
| |
|
|
|
| Schedule of Credits - Refundable |
| HistoricPreservationCredit |
36 |
Refundable Ohio historic preservation credit |
$0.00 |
| JobCreationAndJobRetentionCrd |
37 |
Refundable job creation credit & job retention credit |
$0.00 |
| PassthroughEntityCredit |
38 |
Pass-through entity credit |
$0.00 |
| MotionPictureProductionCredit |
39 |
Motion Picture & Broadway theatrical production credit |
$0.00 |
| VentureCapitalCredit |
40 |
Venture Capital credit |
$0.00 |
| TotalRefundableCredit |
41 |
Total refundable credits |
$0.00 |
| |
|
|
|
| School District Return (#0908) |
|
|
|
| SchoolDistrictTaxableIncome |
1 |
School district taxable income: Traditional or Earned Income tax base |
$0.00 |
| TaxAmount |
2 |
School District Tax .____ times line 1. |
$0.00 |
| SeniorCitizenCredit |
3 |
Senior Citizen Credit |
$50.00 |
| TaxLessCredit |
4 |
School District Income Tax liability |
$0.00 |
| UnderPaymentInterestPenalty |
5 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| TotalTax |
6 |
Total school district income tax liability (line 4 plus line 5) |
$0.00 |
| TotalTax |
6a |
Amount from line 6, page 1 |
$0.00 |
| TaxWithheld |
7 |
School district income tax withheld |
$0.00 |
| InstallmentPayments |
8 |
SD 100 ES & SD 40P, Extension Payments and Credit carryforward from previous year return |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
9 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayments |
10 |
Total school district income tax payments (add lines 7, 8 and 9) |
$0.00 |
| OverpymtRecdOnOrigAmendRtn |
11 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
12 |
Line 10 minus line 11. Place a negative sign ("-") in the box if the amount is less than -0- |
$0.00 |
| AmountUnderpaid |
13 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
14 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
15 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
16 |
Overpayment |
$0.00 |
| OverpymtCreditedNextYear |
17 |
Original return only - amount of line 16 to be carried forward to next year's tax liability |
$0.00 |
| Refund |
18 |
Your Refund |
$0.00 |
| Traditional Tax Base School District Amounts |
|
|
|
| TaxableIncome |
19 |
Ohio income tax base (Ohio IT 1040, line 3 minus line 4) |
$0.00 |
| BusinessIncomeDeductionAddback |
20 |
Business income deduction add-back |
$0.00 |
| TotalTraditionalSDIncome |
21 |
Total Traditional Tax Base School District Income (Line 19 + Line 20) |
$0.00 |
| NonResidentIncome |
22 |
Amount of traditional tax base school district income that you earned while not a resident |
$0.00 |
| SchoolDistrictTaxableIncome |
23 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| Earned Income Tax Base School District Amounts |
|
|
|
| WagesAndOtherCompensations |
24 |
Wages and other compensation as described in the instructions |
$25,000.00 |
| SelfEmploymentEarnings |
25 |
Net Earnings from Self Employment |
($31,000.00) |
| FederalConformityAdjustments |
26 |
Federal Conformity Adjustments |
$0.00 |
| SchoolDistrictTaxableIncome |
27 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| |
|
|
|
| School District Return #2 Information (PartYearResident #7508) |
|
| SchoolDistrictTaxableIncome |
1 |
School district taxable income: Traditional or Earned Income tax base |
$35,263.00 |
| TaxAmount |
2 |
School District Tax .____ times line 1. |
$264.00 |
| SeniorCitizenCredit |
3 |
Senior Citizen Credit |
$50.00 |
| TaxLessCredit |
4 |
School District Income Tax liability |
$214.00 |
| UnderPaymentInterestPenalty |
5 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| TotalTax |
6 |
Total school district income tax liability (line 4 plus line 5) |
$214.00 |
| TotalTax |
6a |
Amount from line 6, page 1 |
$214.00 |
| TaxWithheld |
7 |
School district income tax withheld |
$285.00 |
| InstallmentPayments |
8 |
SD 100 ES & SD 40P, Extension Payments and Credit carryforward from previous year return |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
9 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayments |
10 |
Total school district income tax payments (add lines 7, 8 and 9) |
$285.00 |
| OverpymtRecdOnOrigAmendRtn |
11 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
12 |
Line 10 minus line 11. Place a negative sign ("-") in the box if the amount is less than -0- |
$285.00 |
| AmountUnderpaid |
13 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
14 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
15 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
16 |
Overpayment |
$71.00 |
| OverpymtCreditedNextYear |
17 |
Original return only - amount of line 16 to be carried forward to next year's tax liability |
$0.00 |
| Refund |
18 |
Your Refund |
$71.00 |
| Traditional Tax Base School District Amounts |
|
|
|
| TaxableIncome |
19 |
Ohio income tax base (Ohio IT 1040, line 3 minus line 4) |
$0.00 |
| BusinessIncomeDeductionAddback |
20 |
Business income deduction add-back |
$0.00 |
| TotalTraditionalSDIncome |
21 |
Total Traditional Tax Base School District Income (Line 19 + Line 20) |
$0.00 |
| NonResidentIncome |
22 |
Amount of traditional tax base school district income that you earned while not a resident |
$0.00 |
| SchoolDistrictTaxableIncome |
23 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| Earned Income Tax Base School District Amounts |
|
|
|
| WagesAndOtherCompensations |
24 |
Wages and other compensation as described in the instructions |
$35,263.00 |
| SelfEmploymentEarnings |
25 |
Net Earnings from Self Employment |
$0.00 |
| FederalConformityAdjustments |
26 |
Federal Conformity Adjustments |
$0.00 |
| SchoolDistrictTaxableIncome |
27 |
School District Taxable Income (Enter here and on line 1) |
$35,263.00 |
| |
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| What is Tested? |
If you do not support: |
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| IT1040WithSD100 |
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| Self-Prepared |
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| MFJ status |
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| W-2 |
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| 1099-G |
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Remove 1099G and add Ohio withholding to W-2 #2 |
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| 1099-INT |
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Change to 1099-R with a distribution code of 1 (early distribution). This will not create a retirement income credit. |
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| IT1040 |
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| Full year resident |
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| Schedule of Dependents |
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| [$26,050 -$46,100] tax bracket |
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| 15% joint filing credit |
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| Sch. of Adj - Losses from sale & disp of OH pub oblig. |
Move amount to a Sch. of Adj addition line you do support |
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| Sch. of Adj - Non-medical withdrawal |
Move amount to a Sch. of Adj addition line you do support |
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| Sch. of Adj - Adjust IRC for 168(k) and 179 depr exp |
Move amount to a Sch. of Adj addition line you do support |
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| Sch. of Adj - Ohio oblig. int/gains & pub svc pymt |
Move amount to a Sch. of Adj deduction line you do support |
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| Sch. of Adj - Contributions to indiv. development account |
Move amount to a Sch. of Adj deduction line you do support |
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| Sch. of Adj - Contributions to STABLE account |
Move amount to a Sch. of Adj deduction line you do support |
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| Sch. of Adj - Federal interest/dividends exempt |
Move amount to a Sch. of Adj deduction line you do support |
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| Sch. of Adj - Adjustment for depreciation expense |
Move amount to a Sch. of Adj deduction line you do support |
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| Sch. of Adj - Refund or reimbursements |
Move amount to a Sch. of Adj deduction line you do support |
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| Sch. of Adj - Repayment of income |
Move amount to a Sch. of Adj deduction line you do support |
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| Sch. of Adj - Wage expense not deducted |
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Move amount to a Sch. of Adj deduction line you do support |
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| Sch. of Adj - Ohio 529 plan contributions |
Move amount to a Sch. of Adj deduction line you do support |
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| Sch. of Adj - Organ donor expense |
Move amount to a Sch. of Adj deduction line you do support |
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| Sch of Credits - Senior Citizen Credit |
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| Sch of Credits - Child & Dependent Care Credit |
Remove the credit amount |
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| Sch of Credits - Home school expense credit |
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Remove the credit amount |
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| SD100 |
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| Part-year resident 2 School districts |
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Change to full-year resident, send SD return #2 only |
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| Zero return |
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| Earned Income Tax Base - Negative Amount |
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| Ohio Test #6 |
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IT1040WithSD100 |
| Taxpayer Information |
|
Description |
|
| TaxpayerSSN |
|
Primary Social Security Number |
400-XX-7606 |
| FirstName |
|
Primary First Name |
MIKE-MELVIN |
| LastName |
|
Primary Last Name |
MERMAID |
| DateOfBirth |
|
Date of Birth - Primary |
1951-12-02 |
| |
|
|
|
| TaxpayerSSN |
|
Spouse's Social Security Number |
400-XX-7656 |
| FirstName |
|
Spouse First Name |
MARTHA |
| LastName |
|
Spouse Last Name |
MERMAID-UNDERTHESEAS |
| DateOfBirth |
|
Date of Birth - Spouse |
1951-11-01 |
| |
|
|
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| EmailAddress |
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Taxpayer's E-mail Address |
MERMAID@MAIL.NET |
| |
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| AddressLine1Txt |
|
Foreign Address Line 1 |
123 SLIPPERY ROCK DR UNIT 234567 SW |
| CityNm |
|
Foreign City |
CARLISLE |
| CountryCd |
|
Foreign Country |
UNITED KINGDOM |
| ForeignPostalCd |
|
Foreign Postal Code |
CA2 7ET |
| |
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| Please use the following address if your software does not support a foreign address. |
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| AddressLine1 |
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Address Line 1 |
123 BUCKEYE WAY |
| City |
|
City |
DELPHOS |
| State |
|
State |
OH |
| ZIPCode |
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Zip Code |
45833 |
| |
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| MailingAddressCounty |
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Ohio County |
ALLEN |
| SchoolDistrictNumber |
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Ohio Public School District Number - Resident District |
0204 |
| |
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| Preparer Information |
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| Paid Preparer |
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| PTIN |
|
Paid Preparer's PTIN |
P12457812 |
| PreparerFirmEIN |
|
Paid Preparer's Firm ID Number |
123789456-0000000 |
| BusinessNameLine1Txt |
|
Paid Preparer's Business Name |
GRAY TAXES |
| PreparerPersonNm |
|
Paid Preparer's name |
LYDIANN GRAY |
| |
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| AddressLine1 |
|
Address Line 1 |
500 W BROAD ST |
| City |
|
City |
COLUMBUS |
| State |
|
State |
OH |
| ZIPCode |
|
Zip Code |
43215 |
| |
|
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|
| PhoneNum |
|
Paid Preparer's Phone Number |
614-554-1234 |
| |
|
|
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| ContactPreparerAuthorization |
|
Preparer Authorization Check Box |
Yes |
| |
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| *IT Waiver Required* |
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|
|
| Reason |
|
Taxpayer cannot file electronically: MeF Rejection error code: IND-515-01 |
X |
| |
|
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| Income Statements |
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|
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| W-2 #1 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
263456789-0000000 |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
RONS RIB BACK ON THE RIVER |
| |
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| Employer Foreign Address |
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| AddressLine1Txt |
|
Foreign Address Line 1 |
15 RIVERFRONT RD |
| CityNm |
|
Foreign City |
CARLISLE |
| CountryCd |
|
Foreign Country |
UNITED KINGDOM |
| ForeignPostalCd |
|
Foreign Postal Code |
CA2 7ET |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7606 |
| EmployeNm |
|
Employee's Name |
MIKE-MELVIN MERMAID |
| |
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|
| AddressLine1Txt |
|
Foreign Address Line 1 |
123 SLIPPERY ROCK DR UNIT 234567 SW |
| AddressLine2Txt |
|
Foreign Address Line 2 |
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| CityNm |
|
Foreign City |
CARLISLE |
| ProvinceOrStateNm |
|
Foreign Province |
|
| CountryCd |
|
Foreign Country |
UNITED KINGDOM |
| ForeignPostalCd |
|
Foreign Postal Code |
CA2 7ET |
| |
|
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| WagesAmt |
|
Box 1 Wages, Tips, etc |
$18,148.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$0.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$0.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$0.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$0.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$0.00 |
| |
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| Return Information |
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| Federal Return Data |
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| |
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Filing Status |
Married Filing Jointly |
| |
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Exemptions, Self |
3 |
| |
|
Total wages, salaries, tips, etc. |
$18,148.00 |
| |
|
Taxable Pensions and Annuities |
$0.00 |
| |
|
Schedule C: Total Business Income or (loss) |
($75,000.00) |
| |
|
Adjusted Gross Income |
($56,852.00) |
| |
|
Earned Income Tax Credit |
$0.00 |
| |
|
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| State Return Data |
|
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| AmendedReturn |
|
Is this an amended return? |
No |
| |
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| FilingStatus |
|
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| MarriedFilingJointly |
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|
X |
| |
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| Did you file federal extension Form 4868? |
|
|
No |
| |
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| Did you take the Standard deduction or itemize? |
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|
Standard |
| |
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| Can someone else claim you (or your spouse) as a dependent? |
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| ClaimedAsDependent |
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|
No |
| |
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| Schedule of Dependents |
|
Total Exemptions |
3 |
| NumberOfDependents |
|
|
1 |
| SSN |
|
|
400-XX-8606 |
| DateOfBirth |
|
|
2011-04-21 |
| Relationship |
|
|
SON |
| FirstName |
|
|
SEBASTIAN |
| LastName |
|
|
MERMAID |
| |
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| Residency Status |
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| PrimaryResidencyStatus |
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| FullYearResident |
|
Full-Year Resident |
X |
| |
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| SpouseResidencyStatus |
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|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| JointFilingCredit |
|
Eligible for JFC? |
No |
| |
|
|
|
| Unpaid Ohio Use Tax |
|
|
|
| |
a. |
Did you make any out of state purchases |
Yes |
| |
b. |
Did the retailer charge you any sales tax |
No |
| |
c. |
Amount of Purchases that you did not pay sales tax |
$4,000.00 |
| |
d. |
County sales tax rate |
6.85% |
| Medical Savings Account Worksheet |
|
|
|
| |
|
Line 1 Amount you contributed during 2022 |
$5,215.00 |
| |
|
Line 2 Amount your spouse contributed during 2022 |
$0.00 |
| |
|
Line 5 2022 withdrawals from the account for nonmedical purposes |
$0.00 |
| |
|
|
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| Additional Information |
|
|
|
| NonOhioAndLocalGovIntAndDiv |
|
Non-Ohio State or Local Government Interest & Dividends |
$100,000.00 |
| PassThruEntityTaxesPaid |
|
Pass-Through Entity Addback and ORC section 5733.40 (A) PTE Adjustment |
$11,000.00 |
| TuitionExpenseReimbursement |
|
Reimbursement of College Tuition Expenses and Fees Deducted in any Previous Year(s) |
$15,017.00 |
| FederalInterestAndDividends |
|
Federal interest and dividends subject to state taxation |
$9,000.00 |
| HealthCareDepositedFunds |
|
Funds deposited into, and earnings of, a medical savings account for eligible medical exp |
$4,963.00 |
| NonCharterOrPublicSchoolCredit |
|
Nonchartered, nonpublic school tuition credit |
$500.00 |
| TotalInstallmentPayment |
|
OH Estimated Tax, IT 40P Extension Payments, and Overpayments Credited to Current Tax Year |
$2,000.00 |
| |
|
|
|
| SD Return # 1 Information |
|
|
|
| SchoolDistrictNumber |
|
What is the school district number for which you are filing the SD 100? |
0204 |
| TaxType |
|
Tax Type |
Traditional |
| |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| NOLCarryBack |
|
Is the amended return an NOL carryback? |
No |
| |
|
|
|
| Residency Status |
|
School district residency |
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| SD Return # 1 - Additional Information |
|
|
|
| InstallmentPayments |
|
SD 100 ES & SD 40P, Extension Payments and Credit carryforward from previous year return |
$4,000.00 |
| OverpymtCreditedNextYear |
|
Original return only - amount of line 16 to be carried forward to next year's tax liability |
$20.00 |
| |
|
|
|
| Return |
|
|
|
| IT1040 - Pages 1 & 2 |
| FederalAdjustedGrossIncome |
1 |
Federal Adjusted Gross Income |
($56,852.00) |
| TotalIncomeAddition |
2a |
Additions to federal adjusted gross income |
$135,017.00 |
| TotalIncomeDeduction |
2b |
Deductions from federal adjusted gross income |
$5,215.00 |
| OhioAdjustedGrossIncome |
3 |
Ohio Adjusted Gross Income (OAGI) |
$72,950.00 |
| ExemptionDeduction |
4 |
Personal and dependent exemption deduction |
$6,450.00 |
| TaxableIncome |
5 |
Ohio income tax base |
$66,500.00 |
| TaxableBusinessIncome |
6 |
Taxable business income (Ohio IT BUS, line 13) |
$0.00 |
| TaxableIncomeLessBusinessIncome |
7 |
Line 5 minus line 6 (if less than 0, enter 0) |
$66,500.00 |
| |
7a |
Amount from line 7 on page 1 |
$66,500.00 |
| NonBusinessIncomeTaxLiability |
8a |
Nonbusiness income tax liability |
$1,573.00 |
| BusinessIncomeTaxLiability |
8b |
Business income tax liability (Ohio IT BUS, line 14) |
$0.00 |
| IncomeTaxLiabilityBeforeCredits |
8c |
Income tax liability before credits (line 8a plus 8b) |
$1,573.00 |
| OhioNonRefundableCredits |
9 |
Ohio nonrefundable credits |
$550.00 |
| TaxLiabAfterNonrefundableCrdt |
10 |
Tax liability after nonrefundable credits |
$1,023.00 |
| UnderPaymentInterestPenalty |
11 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| UnpaidUseTax |
12 |
Sales and use tax due on Internet, mail order or other out-of-state purchases |
$274.00 |
| TotalTaxLiability |
13 |
Total Ohio tax liability before withholding or estimated payments |
$1,297.00 |
| TaxWithheld |
14 |
Ohio income tax withheld |
$0.00 |
| InstallmentPayment |
15 |
Add the Ohio estimated & extension payments & credit carryforward from previous year return |
$2,000.00 |
| RefundableTaxCredits |
16 |
Refundable credits |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
17 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayment |
18 |
Total Ohio Tax Payments |
$2,000.00 |
| OverpymtRecdOnOrigAmendRtn |
19 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
20 |
Line 18 minus line 19 |
$2,000.00 |
| AmountUnderpaid |
21 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
22 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
23 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
24 |
Overpayment |
$703.00 |
| OverpymtCreditedNextYear |
25 |
Original return only - amount of line 24 to be carried forward to next year's tax liability |
$0.00 |
| CharityOrgName |
26a |
Amount of line 24 to be donated - Wildlife species |
$0.00 |
| CharityOrgName |
26b |
Amount of line 24 to be donated - Military injury relief |
$0.00 |
| CharityOrgName |
26c |
Amount of line 24 to be donated - Ohio History Fund |
$0.00 |
| CharityOrgName |
26d |
Amount of line 24 to be donated - Nature Preserves/Scenic Rivers |
$0.00 |
| CharityOrgName |
26e |
Amount of line 24 to be donated - Breast/cervical cancer |
$0.00 |
| CharityOrgName |
26f |
Amount of line 24 to be donated - Wishes for sick children |
$0.00 |
| TotalDonation |
26g |
Total |
$0.00 |
| Refund |
27 |
Your Refund |
$703.00 |
| |
|
|
|
| Schedule of Adjustments |
| Additions |
|
|
|
| NonOhioAndLocalGovIntAndDiv |
1 |
Non-Ohio state or local government interest and dividends |
$100,000.00 |
| PassThruEntityTaxesPaid |
2 |
Certain Ohio pass-through entity and financial institutions taxes paid |
$11,000.00 |
| TuitionExpenseReimbursement |
3 |
Reimbursement of college tutition expenses and fees deducted in any previous year(s) and noneducation expenditures from a college savings account |
$15,017.00 |
| SaleAndDispstnLossOfOhioOblig |
4 |
Losses from sale or disposition of Ohio public obligations |
$0.00 |
| NonMedicalWithdrawals |
5 |
Nonmedical withdrawals from a medical savings account |
$0.00 |
| ReimExpPrevDeducted |
6 |
Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if the reimbursement is not in federal adjusted gross income |
$0.00 |
| IRC168And179AdjAdd |
7 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| FederalInterestAndDividends |
8 |
Federal interest and dividends subject to state taxation |
$9,000.00 |
| FederalConformityAdditions |
9 |
Federal conformity additions |
$0.00 |
| TotalIncomeAddition |
10 |
Total additions |
$135,017.00 |
| |
|
|
|
| Deductions |
|
|
|
| BusinessIncomeDeduction |
11 |
Business income deduction (attach Ohio Schedule IT BUS, line 11) |
$0.00 |
| OHFullYrEmpCompEarnNeighState |
12 |
Employee compensation earned in Ohio by residents of neighboring states |
$0.00 |
| IRS1040StateMuniIncomeOverpymt |
13 |
State or municipal income tax overpayments shown on the federal 1040, Sch 1, line 1 |
$0.00 |
| SocialSecurityBenefits |
14 |
Taxable Social Security benefits |
$0.00 |
| RailroadRetirementBenefits |
15 |
Certain railroad retirement benefits |
$0.00 |
| ObligIntrstPublicServicePay |
16 |
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 state of Ohio or income from a transfer agreement |
$0.00 |
| IndDevAcct |
17 |
Amounts contributed to an individual development account |
$0.00 |
| STABLEAcct |
18 |
Amounts contributed to STABLE account; Ohio's ABLE plan |
$0.00 |
| OutOfStateDisasterWorkIncome |
19 |
Income earned in Ohio by a qualifying out-of-state business or employee for disaster work conducted during a disaster response period |
$0.00 |
| FederalIntAndDivExempt |
20 |
Federal interest and dividends exempt from state taxation |
$0.00 |
| IRC168And179AdjDed |
21 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| IRS1040RefundOrReimbursements |
22 |
Refund or reimbursements shown on the federal 1040, schedule 1 for itemized deductions claimed on a prior year federal income tax return |
$0.00 |
| RepaymentOfIncomeReported |
23 |
Repayment of income reported in a prior year |
$0.00 |
| NotDeductedWageExpense |
24 |
Wage expense not deducted due to claiming the federal work opportunity credit |
$0.00 |
| FederalConformityDeductions |
25 |
Federal conformity deductions |
$0.00 |
| MilitaryPayForResident |
26 |
Military pay for Ohio residents received while the military member was stationed outside Ohio |
$0.00 |
| IncomeErndMilitCivilianNRSpouse |
27 |
Certain income earned by military nonresidents and civilian nonresident spouses |
$0.00 |
| UniformedServcsRetirmtIncome |
28 |
Uniformed services retirement income |
$0.00 |
| MilitaryInjuryReliefFund |
29 |
Military injury relief fund |
$0.00 |
| NationalGuardReimAndBenft |
30 |
Certain Ohio National Guard reimbursements and benefits |
$0.00 |
| CollegeAdvSavAndTuitPurchCred |
31 |
Ohio 529 contributions, tuition credit purchases |
$0.00 |
| PellOhioCollegeOppTaxableGrant |
32 |
Pell/Ohio College Opportunity taxable grant amounts used to pay room and board |
$0.00 |
| OhioEducatorExpenses |
33 |
Ohio educator expenses in excess of federal deduction |
$0.00 |
| DisabilityBenefits |
34 |
Disability benefits |
$0.00 |
| SurvivorBenefits |
35 |
Survivor benefits |
$0.00 |
| UnsubsidizedMedicalExpense |
36 |
Unreimbursed long-term care insurance premiums, unsubsidized health care insurance premiums and excess health care expenses (see instructions for worksheet) |
$0.00 |
| HealthCareDepositedFunds |
37 |
Funds deposited into, and earnings of, a medical savings account for eligible health care expenses (see instructions for worksheet) |
$5,215.00 |
| QualOrganDonorExp |
38 |
Qualified organ donor expenses |
$0.00 |
| TotalIncomeDeduction |
39 |
Total deductions |
$5,215.00 |
| |
|
|
|
| Schedule IT BUS |
|
|
|
| |
|
Part 1 |
|
| BusScheduleB |
1 |
Sch B - Interest and Ordinary Dividends |
$0.00 |
| BusScheduleC |
2 |
Sch C - Profit or Loss From Business (Sole Proprietership) |
($75,000.00) |
| BusScheduleD |
3 |
Sch D - Capital Gains and Losses |
$0.00 |
| BusScheduleE |
4 |
Sch E - Supplemental Income and Loss |
$0.00 |
| GuaranteedPayments |
5 |
Guranteed payments, compensation and/or wages from each pass-through entity in which you have at least a 20% direct or indirect ownership interest |
$0.00 |
| BusScheduleF |
6 |
Sch F - Profit or Loss From Farming |
$0.00 |
| OtherItemsOfIncome |
7 |
Other items of income and gain separately stated on federal Schedule K-1, federal 4797 gains and/or losses reported on federal 4797 and miscellaneous federal income tax adjustments, if any |
$0.00 |
| TotalOfBusinessIncome |
8 |
Total of business income (add lines 1 through 7) |
($75,000.00) |
| |
|
Part 2 |
|
| AllBusinessIncome |
9 |
All business income (enter the lesser of line 8 above or Ohio IT1040, line 1). If zero or negative, stop here and do not complete Part 3. |
$0.00 |
| FilingStatusBusIncAmt |
10 |
Enter $250,000 if single or MFJ, enter $125,000 if MFS |
$0.00 |
| LessOfFilStatBusIncAmtOrAllBusInc |
11 |
Lesser of line 9 or line 10. Enter here and on Ohio Schedule of Adjustments, line 11 |
$0.00 |
| |
|
Part 3 |
|
| AllBusIncLessBusIncDeduction |
12 |
Line 9 minus line 11 (if less than -0-, enter -0-) |
$0.00 |
| TaxableBusinessIncome |
13 |
Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5) |
$0.00 |
| BusinessIncomeTaxLiability |
14 |
Business income tax liability. Multiply line 13 by 3%. Enter here and on Ohio IT 1040, line 8b. |
$0.00 |
| |
|
Part 4 |
|
| NameOfEntity |
|
Name of Entity |
SEBASTIAN'S BAIT AND TACKLE |
| FEINOrSSN |
|
FEIN/SS# |
246798001-0000000 |
| PercentageOfOwnership |
|
Percentage of Ownership |
0.8500 |
| Income Earned By Primary |
|
Primary |
X |
| |
|
|
|
| Schedule of Credits - Nonrefundable |
| TaxLiabilityBeforeCredits |
1 |
Tax liability before credits (From IT1040, line 8c) |
$1,573.00 |
| RetireIncomeCredit |
2 |
Retirement income credit (limit $200 per return) |
$0.00 |
| LumpSumRetirementCredit |
3 |
Lump sum retirement credit (include Ohio LS WKS, line 6) |
$0.00 |
| SeniorCitizenCredit |
4 |
Senior citizen credit |
$50.00 |
| LumpSumDistributionCredit |
5 |
Lump sum distribution credit (include Ohio LS WKS, line 3) |
$0.00 |
| ChildAndDependCareCredit |
6 |
Child care and dependent care credit (see the worksheet in the instructions) |
$0.00 |
| DisplacedWorkerTrainingCredit |
7 |
Displaced worker training credit (see the worksheet in the instructions) |
$0.00 |
| CampaignContributionCredit |
8 |
Campaign contribution credit |
$0.00 |
| ExemptionCredit |
9 |
Income-based exemption credit |
$0.00 |
| TotCreditsBeforeJointFiling |
10 |
Total (add lines 2 through 9) |
$50.00 |
| TaxLessCredit |
11 |
Tax less credits (line 1 minus line 10; if less than -0-, enter -0-) |
$1,523.00 |
| JointFilingCredit |
12 |
Joint filing credit |
$0.00 |
| EarnedIncomeCredit |
13 |
Earned income credit (multiply Fed EITC by 30%) |
$0.00 |
| HomeSchoolExpensesCredit |
14 |
Home school expenses credit |
$0.00 |
| ScholarshipDonationCredit |
15 |
Scholarship donation credit |
$0.00 |
| NonCharterOrPublicSchoolCredit |
16 |
Nonchartered, nonpublic school tuition credit |
$500.00 |
| VocationalJobCredit |
17 |
Vocational job credit |
$0.00 |
| AdoptionCredit |
18 |
Ohio adoption credit |
$0.00 |
| JobRetentionCredit |
19 |
Nonrefundable job retention credit |
$0.00 |
| NewEmpInEntZoneCredit |
20 |
Credit for eligible new employees in an enterprise zone |
$0.00 |
| GrapeProdPropertyPurchCredit |
21 |
Credit for purchases of grape production property |
$0.00 |
| InvestOhioCredit |
22 |
InvestOhio credit |
$0.00 |
| LeadAbatementCredit |
23 |
Lead abatement credit |
$0.00 |
| OpportunityZoneCredit |
24 |
Opportunity zone investment credit |
$0.00 |
| TechInvestCreditCarryfrwd |
25 |
Technology investment credit carryforward |
$0.00 |
| EntZoneDayCareAndTrngCredit |
26 |
Enterprise zone day care and training credits |
$0.00 |
| ResearchAndDevelopmentCredit |
27 |
Research and development credit |
$0.00 |
| OhioHistoricPreservationCredit |
28 |
Nonrefundable Ohio historic preservation credit |
$0.00 |
| TotAdditionalCredits |
29 |
Total (add lines 12 through 28) |
$500.00 |
| TaxLessCrdtMinusTotAddlCrdts |
30 |
Tax less additional credits (line 11 minus line 29; if less than -0-, enter -0-) |
$1,023.00 |
| |
|
Nonresident Credit |
|
| NonOhioIncome |
31 |
Nonresident Portion of Ohio adjusted gross income |
$0.00 |
| OhioAdjustedGrossIncome |
32 |
Ohio adjusted gross income |
$0.00 |
| NonResIncomeCreditRatio |
33a |
Divide line 31 by line 32 |
0.0000 |
| NonresidentAndPartYearCredit |
33 |
Nonresident credit (line 30 times line 33a) |
$0.00 |
| |
|
Resident Credit |
|
| ResidentTaxCredit |
34 |
Resident Credit - Ohio IT RC, line 7 |
$0.00 |
| TotalNonrefundableCredits |
35 |
Total nonrefundable credits |
$550.00 |
| |
|
|
|
| Schedule of Credits - Refundable |
| HistoricPreservationCredit |
36 |
Refundable Ohio historic preservation credit |
$0.00 |
| JobCreationAndJobRetentionCrd |
37 |
Refundable job creation credit & job retention credit |
$0.00 |
| PassthroughEntityCredit |
38 |
Pass-through entity credit |
$0.00 |
| MotionPictureProductionCredit |
39 |
Motion Picture & Broadway theatrical production credit |
$0.00 |
| VentureCapitalCredit |
40 |
Venture Capital credit |
$0.00 |
| TotalRefundableCredit |
41 |
Total refundable credits |
$0.00 |
| |
|
|
|
| School District Return (#0204) |
|
|
|
| SchoolDistrictTaxableIncome |
1 |
School district taxable income: Traditional or Earned Income tax base |
$66,500.00 |
| TaxAmount |
2 |
School District Tax .____ times line 1. |
$333.00 |
| SeniorCitizenCredit |
3 |
Senior Citizen Credit |
$50.00 |
| TaxLessCredit |
4 |
School District Income Tax liability |
$283.00 |
| UnderPaymentInterestPenalty |
5 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| TotalTax |
6 |
Total school district income tax liability (line 4 plus line 5) |
$283.00 |
| TotalTax |
6a |
Amount from line 6, page 1 |
$283.00 |
| TaxWithheld |
7 |
School district income tax withheld |
$0.00 |
| InstallmentPayments |
8 |
SD 100 ES & SD 40P, Extension Payments and Credit carryforward from previous year return |
$4,000.00 |
| AmtPrevPaidWithOrigAmendRtn |
9 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayments |
10 |
Total school district income tax payments (add lines 7, 8 and 9) |
$4,000.00 |
| OverpymtRecdOnOrigAmendRtn |
11 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
12 |
Line 10 minus line 11. Place a negative sign ("-") in the box if the amount is less than -0- |
$4,000.00 |
| AmountUnderpaid |
13 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
14 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
15 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
16 |
Overpayment |
$3,717.00 |
| OverpymtCreditedNextYear |
17 |
Original return only - amount of line 16 to be carried forward to next year's tax liability |
$20.00 |
| Refund |
18 |
Your Refund |
$3,697.00 |
| Traditional Tax Base School District Amounts |
|
|
|
| TaxableIncome |
19 |
Ohio income tax base (Ohio IT 1040, line 3 minus line 4) |
$66,500.00 |
| BusinessIncomeDeductionAddback |
20 |
Business income deduction add-back |
$0.00 |
| TotalTraditionalSDIncome |
21 |
Total Traditional Tax Base School District Income (Line 19 + Line 20) |
$66,500.00 |
| NonResidentIncome |
22 |
Amount of traditional tax base school district income that you earned while not a resident |
$0.00 |
| SchoolDistrictTaxableIncome |
23 |
School District Taxable Income (Enter here and on line 1) |
$66,500.00 |
| Earned Income Tax Base School District Amounts |
|
|
|
| WagesAndOtherCompensations |
24 |
Wages and other compensation as described in the instructions |
$0.00 |
| SelfEmploymentEarnings |
25 |
Net Earnings from Self Employment |
$0.00 |
| FederalConformityAdjustments |
26 |
Federal Conformity Adjustments |
$0.00 |
| SchoolDistrictTaxableIncome |
27 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| |
|
|
|
| What is Tested? |
|
If you do not support: |
|
| IT1040WithSD100 |
|
|
|
| Paid Preparer |
|
|
|
| Preparer Contact - Authorized |
|
|
|
| MFJ status |
|
|
|
| Foreign address |
|
|
|
| Foreign W-2 |
|
Change the foreign addresses to an Ohio address |
|
| |
|
|
|
| IT1040 |
|
|
|
| Full year resident |
|
|
|
| Negative Federal adjusted gross income |
|
Make FAGI $0 or $1 and adjust Ohio Sch. of Adj amounts so that line 3 matches the test scenario |
|
| [$46,100 - $96,150] tax bracket |
|
|
|
| JFC - Not eligible |
|
|
|
| Sch. of Adj - Non-Ohio state or local int/div |
|
Move amount to a Sch. of Adj addition line you do support |
|
| Sch. of Adj - PTE and financial institutions taxes paid |
|
Move amount to a Sch. of Adj addition line you do support |
|
| Sch. of Adj - Reimbursement of college expenses/non-ed exp |
|
Move amount to a Sch. of Adj addition line you do support |
|
| Sch. of Adj - Fed interest subject to state taxation |
|
Move amount to a Sch. of Adj addition line you do support |
|
| Sch. of Adj - Medical savings account |
|
Move amount to a Sch. of Adj deduction line you do support |
|
| Sch of Credits - Noncharter, nonpublic school tuition credit |
|
Remove the credit amount |
|
| Use tax worksheet |
|
Disregard the worksheet information |
|
| MSA account worksheet |
|
Disregard the worksheet information |
|
| Installment payments |
|
|
|
| |
|
|
|
| SD100 |
|
|
|
| Traditional school district |
|
|
|
| Installment payments |
|
Remove payment amount |
|
| Senior Citizen Credit |
|
Remove credit |
|
| Refund/credit carryforward split |
|
Change to refund the full overpayment |
|
| Ohio Test #7 |
|
|
IT1040WithSD100 |
| Taxpayer Information |
|
Description |
|
| TaxpayerSSN |
|
Primary Social Security Number |
400-XX-7607 |
| FirstName |
|
Primary First Name |
TOM |
| MiddleInitial |
|
Primary Middle Initial |
A |
| LastName |
|
Primary Last Name |
TOE |
| DateOfBirth |
|
Date of Birth - Primary |
1962-05-05 |
| |
|
|
|
| TaxpayerSSN |
|
Spouse's Social Security Number |
400-XX-7657 |
| FirstName |
|
Spouse First Name |
ANGELINA MARIAS |
| MiddleInitial |
|
Spouse Middle Initial |
N |
| LastName |
|
Spouse Last Name |
TOE |
| DateOfBirth |
|
Date of Birth - Spouse |
1962-06-06 |
| |
|
|
|
| USPhone |
|
Taxpayer's Phone Number |
[<=9999999]###-#### |
| EmailAddress |
|
Taxpayer's E-mail Address |
TOE@YAHOO.COM |
| |
|
|
|
| AddressLine1Txt |
|
Address Line 1 |
100 WEST ST |
| CityNm |
|
City |
CAMDEN |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
45311 |
| |
|
|
|
| MailingAddressCounty |
|
Ohio County |
PREBLE |
| SchoolDistrictNumber |
|
Ohio Public School District Number - Resident District |
6804 |
| |
|
|
|
| Preparer Information |
|
|
|
| Self-Prepared |
|
|
|
| SelfPrepared |
|
Return is self-prepared |
X |
| |
|
|
|
| Income Statements |
|
|
|
| W-2 #1 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
643456789-0000000 |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
TOMATOES TO GROW |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
17 E MAIN ST |
| CityNm |
|
City |
REYNOLDSBURG |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43068 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7607 |
| EmployeNm |
|
Employee's Name |
TOM A TOE |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
100 WEST ST |
| CityNm |
|
City |
CAMDEN |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
45311 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$23,200.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$336.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$23,200.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$1,438.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$23,200.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$336.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
51-210654 |
| StateWagesAmt |
|
State Wages |
$23,200.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$200.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$18,700.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$151.00 |
| LocalityNm |
|
Name of Locality |
DAYTON |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$4,500.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$35.00 |
| LocalityNm |
|
Name of Locality |
TROY |
| |
|
|
|
| SchoolDistrictWages |
|
School District Wages |
$23,200.00 |
| SchoolDistrictTaxWithheld |
|
School District Tax Withheld |
$406.00 |
| SchoolDistrictNumber |
|
School District # |
6804 |
| |
|
|
|
| W-2 #2 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
643456789-0000000 |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
TOMATOES TO GROW |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
17 E MAIN ST |
| CityNm |
|
City |
REYNOLDSBURG |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43068 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7657 |
| EmployeeNm |
|
Employee's Name |
ANGELINA MARIAS N TOE |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
100 WEST ST |
| CityNm |
|
City |
CAMDEN |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
45311 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$84,455.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$5,000.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$84,455.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$5,236.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$84,455.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$1,225.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
51-210654 |
| StateWagesAmt |
|
State Wages |
$66,670.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$2,800.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$31,670.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$554.00 |
| LocalityNm |
|
Name of Locality |
TROY |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$35,000.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$788.00 |
| LocalityNm |
|
Name of Locality |
DAYTON |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
IL |
| EmployerStateIdNum |
|
State ID Number |
52687 |
| StateWagesAmt |
|
State Wages |
$17,785.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$250.00 |
| |
|
|
|
| SchoolDistrictWages |
|
School District Wages |
$66,670.00 |
| SchoolDistrictTaxWithheld |
|
School District Tax Withheld |
$1,167.00 |
| SchoolDistrictNumber |
|
School District # |
6804 |
| |
|
|
|
| 1099-B |
|
|
|
| PayerName / BusinessNameLine1Txt |
|
Payer's Name |
MAIN STREET BANK |
| |
|
|
|
| AddressLine1Txt |
|
Payer's US Address |
1 MAIN ST |
| CityNm |
|
Payer's City |
MONTPELIER |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZIPCd |
|
Payer's Zip Code |
43543 |
| PayerEIN |
|
Payer's Federal Identification Number |
303456789-0000000 |
| |
|
|
|
| SSN |
|
Recipient's Identification Number |
400-XX-7657 |
| Name |
|
Recipient's Name |
ANGELINA MARIAS N TOE |
| AddressLine1Txt |
|
Recipient Address Line 1 Text |
100 WEST ST |
| CityNm |
|
Recipient's City |
CAMDEN |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
45311 |
| |
|
|
|
| Proceeds |
|
Box 1d Proceeds |
$10.00 |
| |
|
|
|
| StateTaxWithheldAmt |
|
Box 16 State Tax Withheld |
$1.00 |
| StateAbbreviationCd |
|
Box 14 State |
OH |
| PayerStateIdNumber |
|
Box 15 State identification no |
52-065432 |
| StateDistributionAmt |
|
Proceeds |
$10.00 |
| |
|
|
|
| 1099-DIV |
|
|
|
| PayersName / BusinessNameLine1Txt |
|
Payer's Name |
MAIN STREET BANK |
| AddressLine1Txt |
|
Payer's US Address Line 1 Text |
1 MAIN ST |
| AddressLine2Txt |
|
Payer's US Address Line 2 Text |
|
| CityNm |
|
Payer's City |
MONTPELIER |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZIPCd |
|
Payer's Zip Code |
43543 |
| PayerFederalIdNumber |
|
Payer's Federal Identification Number |
303456789-0000000 |
| |
|
|
|
| RecipientsIdNumber |
|
Recipient's Identification Number |
400-XX-7657 |
| RecipientsName |
|
Recipient's Name |
ANGELINA MARIAS N TOE |
| AddressLine1Txt |
|
Recipient Address Line 1 Text |
100 WEST ST |
| CityNm |
|
Recipient's City |
CAMDEN |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
45311 |
| |
|
|
|
| TotalOrdinaryDividend |
|
Box 1a Total Ordinary Dividends |
$1,240.00 |
| |
|
|
|
| StateTaxWithheldAmt |
|
Box 14 State Tax Withheld |
$74.00 |
| StateAbbreviationCd |
|
Box 12 State |
OH |
| PayersStateIdNumber |
|
Box 13 State identification no |
52-065432 |
| StateDistributionAmt |
|
Total Ordinary Dividends |
$1,240.00 |
| |
|
|
|
| Return Information |
|
|
|
| Federal Return Data |
|
|
|
| |
|
Filing Status |
Married Filing Joint |
| |
|
Exemptions, Self |
4 |
| |
|
Total wages, salaries, tips, etc. |
$107,655.00 |
| |
|
Taxable Ordinary Dividends |
$1,240.00 |
| |
|
Total Capital gain or (loss) |
$10.00 |
| |
|
Adjusted Gross Income |
$108,905.00 |
| |
|
Earned Income Tax Credit |
$0.00 |
| |
|
|
|
| State Return Data |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| FilingStatus |
|
|
|
| MarriedFilingJointly |
|
|
X |
| |
|
|
|
| Did you file federal extension Form 4868? |
|
|
Yes |
| |
|
|
|
| Did you take the Standard deduction or itemize? |
|
|
Standard |
| |
|
|
|
| Can someone else claim you (or your spouse) as a dependent? |
|
|
|
| ClaimedAsDependent |
|
|
No |
| |
|
|
|
| Schedule of Dependents |
|
Total Exemptions |
4 |
| NumberOfDependents |
|
|
2 |
| SSN |
|
|
400-XX-7682 |
| DateOfBirth |
|
|
2000-08-11 |
| Relationship |
|
|
SON |
| FirstName |
|
|
SON |
| LastName |
|
|
TOE |
| |
|
|
|
| SSN |
|
|
400-XX-7683 |
| DateOfBirth |
|
|
2003-02-15 |
| Relationship |
|
|
DAUGHTER |
| FirstName |
|
|
DAUGHTER |
| LastName |
|
|
TOE |
| |
|
|
|
| Residency Status |
|
|
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| PartYearResident |
|
Part-Year Resident |
X |
| ResidentFromDate |
|
First date you were a resident |
2022-03-01 |
| ResidentToDate |
|
Last date you were a resident |
2022-12-31 |
| NonResidentState |
|
State of Residence |
IL |
| |
|
|
|
| JointFilingCredit |
|
Eligible for JFC? |
Yes |
| |
|
|
|
| Unreimbursed Healthcare Expenses Worksheet |
| UnreimbPremNoEmpPaidOrMedicare |
1 |
Enter amounts paid for unreimbursed dental, vision and health insurance |
$5,000.00 |
| UnreimbLTCPrem |
2 |
Enter amounts paid for unreimbursed long-term care insurance premiums |
$200.00 |
| UnreimbPremEligEmpPaidOrMedicare |
3 |
Enter amounts paid for unreimbursed dental, vision and health insurance |
$4,000.00 |
| MedCareAmts |
4 |
Enter amounts paid for medical care during the year |
$300.00 |
| UnreimbPremEligAndMedCareAmts |
5 |
Sum of lines 3 and 4 |
$4,300.00 |
| FederalAdjustedGrossIncome |
6 |
Enter your federal adjusted gross income. If less than zero, enter zero |
$108,905.00 |
| FAGIMul7HalfPer |
7 |
Multiply line 6 by 7.5% (0.075) |
$8,168.00 |
| ElgPremAndCareLessFAGIMul7HalfPer |
8 |
Line 5 minus line 7. If less than zero, enter zero |
$0.00 |
| TotalHealthCareExpDed |
9 |
Add lines 1, 2, and 8. Enter the total here and on Ohio Schedule of Adjustments, line 36 |
$5,200.00 |
| |
|
|
|
| Displaced Worker Training Credit Worksheet |
|
|
|
| |
- |
Did you lose your job because the place you worked either permanently closed or moved, or because your employer abolished your job or shift |
Yes |
| |
- |
During the 12-month period beginning when you lost your job, did you pay for any displaced worker training? |
Yes |
| |
- |
While you were receiving displaced worker training, were you either unemployed or working no more than 20 hours per week? |
Yes |
| |
1a |
Amount of displaced worker training expense paid by primary |
$120.00 |
| |
1b |
Amount of displaced worker training expense paid by spouse |
$80.00 |
| |
|
|
|
| Certificate Information |
| Job Retention Credit - NonRef |
|
|
|
| TaxpayerSSN |
|
SSN listed on Certificate |
400-XX-7607 |
| TaxpayerEIN |
|
FEIN listed on Certificate |
359854123-0000000 |
| CertificateNumber |
|
Identifying Number listed on Certificate |
JC_5255_2019 |
| ApprovedAmount |
|
Total Amount of Credit Issued |
$5,000.00 |
| |
|
|
|
| InvestOhio credit |
|
|
|
| TaxpayerSSN |
|
SSN listed on Certificate |
400-XX-7607 |
| CertificateNumber |
|
Identifying Number listed on Certificate |
8256-2018 |
| ApprovedAmount |
|
Total Amount of Credit Issued |
$10,000.00 |
| |
|
|
|
| Lead Abatement Credit |
|
|
|
| TaxpayerSSN |
|
SSN listed on Certificate |
400-XX-7607 |
| CertificateNumber |
|
Identifying Number listed on Certificate |
8000-2020 |
| ApprovedAmount |
|
Total Amount of Credit Issued |
$20.00 |
| |
|
|
|
| Research and development credit |
|
|
|
| TaxpayerSSN |
|
SSN listed on Certificate |
400-XX-7607 |
| CertificateNumber |
|
Identifying Number listed on Certificate |
RD_4144_2017 |
| ApprovedAmount |
|
Total Amount of Credit Issued |
$75,000.00 |
| |
|
|
|
| Nonrefundable Ohio historic preservation credit |
|
|
|
| TaxpayerSSN |
|
SSN listed on Certificate |
400-XX-7607 |
| ApprovedAmount |
|
Total Amount of Credit Issued |
$50,000.00 |
| |
|
|
|
| Additional Information |
|
|
|
| AdoptionCredit |
|
Ohio Adoption Credit |
$1,500.00 |
| JobRetentionCredit |
|
Nonrefundable job retention credit |
$4.00 |
| NewEmpInEntZoneCredit |
|
Credit for eligible new employees in an enterprise zone |
$5.00 |
| GrapeProdPropertyPurchCredit |
|
Credit for purchases of grape production property |
$7.00 |
| InvestOhioCredit |
|
Credit for investing in an Ohio small business |
$8.00 |
| LeadAbatementCredit |
|
Credit for lead abatement costs incurred |
$20.00 |
| OpportunityZoneCredit |
|
Credit for investing in Ohio Opportunity Zones |
$25.00 |
| TechInvestCreditCarryfrwd |
|
Technology investment credit carryforward |
$6.00 |
| EntZoneDayCareAndTrngCredit |
|
Enterprise zone day care and training credits |
$9.00 |
| ResearchAndDevelopmentCredit |
|
Research and development credit |
$10.00 |
| OhioHistoricPreservationCredit |
|
Nonrefundable Ohio historic preservation credit |
$1.00 |
| NonOhioIncome |
|
Nonresident Portion of Ohio adjusted gross income |
$17,785.00 |
| TotalInstallmentPayment |
|
Ohio Estimated Tax, IT-40P Extension Payments, and Overpayments Credited to Current Tax Year |
$925.00 |
| OverpymtCreditedNextYear |
|
Amount Credited to Next Year's Tax Liability |
$100.00 |
| CharityOrgName |
|
Donation From Taxpayer - Ohio History Fund |
$80.00 |
| CharityOrgName |
|
Donation From Taxpayer - Breast/cervical cancer |
$60.00 |
| |
|
|
|
| SD Return # 1 Information |
|
|
|
| SchoolDistrictNumber |
|
What is the school district number for which you are filing the SD 100? |
6804 |
| TaxType |
|
Tax Type |
Traditional |
| |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| Residency Status |
|
School district residency |
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| PartYearResident |
|
Part-Year Resident |
X |
| ResidentFromDate |
|
First date you were a resident |
2022-03-01 |
| ResidentToDate |
|
Last date you were a resident |
2022-12-31 |
| |
|
|
|
| SD Return # 1 Additional Information |
|
|
|
| NonResidentIncome |
|
Amount of traditional tax base school district income that you earned while not a resident |
$17,785.00 |
| |
|
|
|
| Return |
|
|
|
| IT1040 - Pages 1 & 2 |
| FederalAdjustedGrossIncome |
1 |
Federal Adjusted Gross Income |
$108,905.00 |
| TotalIncomeAddition |
2a |
Additions to federal adjusted gross income |
$0.00 |
| TotalIncomeDeduction |
2b |
Deductions from federal adjusted gross income |
$5,200.00 |
| OhioAdjustedGrossIncome |
3 |
Ohio Adjusted Gross Income (OAGI) |
$103,705.00 |
| ExemptionDeduction |
4 |
Personal and dependent exemption deduction |
$7,600.00 |
| TaxableIncome |
5 |
Ohio income tax base |
$96,105.00 |
| TaxableBusinessIncome |
6 |
Taxable business income (Ohio IT BUS, line 13) |
$0.00 |
| TaxableIncomeLessBusinessIncome |
7 |
Line 5 minus line 6 (if less than 0, enter 0) |
$96,105.00 |
| |
7a |
Amount from line 7 on page 1 |
$96,105.00 |
| NonBusinessIncomeTaxLiability |
8a |
Nonbusiness income tax liability |
$2,547.00 |
| BusinessIncomeTaxLiability |
8b |
Business income tax liability (Ohio IT BUS, line 14) |
$0.00 |
| IncomeTaxLiabilityBeforeCredits |
8c |
Income tax liability before credits (line 8a plus 8b) |
$2,547.00 |
| OhioNonRefundableCredits |
9 |
Ohio nonrefundable credits |
$1,942.00 |
| TaxLiabAfterNonrefundableCrdt |
10 |
Tax liability after nonrefundable credits |
$605.00 |
| UnderPaymentInterestPenalty |
11 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| UnpaidUseTax |
12 |
Sales and use tax due on Internet, mail order or other out-of-state purchases |
$0.00 |
| TotalTaxLiability |
13 |
Total Ohio tax liability before withholding or estimated payments |
$605.00 |
| TaxWithheld |
14 |
Ohio income tax withheld |
$3,075.00 |
| InstallmentPayment |
15 |
Add the Ohio estimated & extension payments & credit carryforward from previous year return |
$925.00 |
| RefundableTaxCredits |
16 |
Refundable credits |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
17 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayment |
18 |
Total Ohio Tax Payments |
$4,000.00 |
| OverpymtRecdOnOrigAmendRtn |
19 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
20 |
Line 18 minus line 19 |
$4,000.00 |
| AmountUnderpaid |
21 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
22 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
23 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
24 |
Overpayment |
$3,395.00 |
| OverpymtCreditedNextYear |
25 |
Original return only - amount of line 24 to be carried forward to next year's tax liability |
$100.00 |
| CharityOrgName |
26a |
Amount of line 24 to be donated - Wildlife species |
$0.00 |
| CharityOrgName |
26b |
Amount of line 24 to be donated - Military injury relief |
$0.00 |
| CharityOrgName |
26c |
Amount of line 24 to be donated - Ohio History Fund |
$80.00 |
| CharityOrgName |
26d |
Amount of line 24 to be donated - Nature Preserves/Scenic Rivers |
$0.00 |
| CharityOrgName |
26e |
Amount of line 24 to be donated - Breast/cervical cancer |
$60.00 |
| CharityOrgName |
26f |
Amount of line 24 to be donated - Wishes for sick children |
$0.00 |
| TotalDonation |
26g |
Total |
$140.00 |
| Refund |
27 |
Your Refund |
$3,155.00 |
| |
|
|
|
| Schedule of Adjustments |
| Additions |
|
|
|
| NonOhioAndLocalGovIntAndDiv |
1 |
Non-Ohio state or local government interest and dividends |
$0.00 |
| PassThruEntityTaxesPaid |
2 |
Certain Ohio pass-through entity and financial institutions taxes paid |
$0.00 |
| TuitionExpenseReimbursement |
3 |
Reimbursement of college tutition expenses and fees deducted in any previous year(s) and noneducation expenditures from a college savings account |
$0.00 |
| SaleAndDispstnLossOfOhioOblig |
4 |
Losses from sale or disposition of Ohio public obligations |
$0.00 |
| NonMedicalWithdrawals |
5 |
Nonmedical withdrawals from a medical savings account |
$0.00 |
| ReimExpPrevDeducted |
6 |
Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if the reimbursement is not in federal adjusted gross income |
$0.00 |
| IRC168And179AdjAdd |
7 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| FederalInterestAndDividends |
8 |
Federal interest and dividends subject to state taxation |
$0.00 |
| FederalConformityAdditions |
9 |
Federal conformity additions |
$0.00 |
| TotalIncomeAddition |
10 |
Total additions |
$0.00 |
| |
|
|
|
| Deductions |
|
|
|
| BusinessIncomeDeduction |
11 |
Business income deduction (attach Ohio Schedule IT BUS, line 11) |
$0.00 |
| OHFullYrEmpCompEarnNeighState |
12 |
Employee compensation earned in Ohio by residents of neighboring states |
$0.00 |
| IRS1040StateMuniIncomeOverpymt |
13 |
State or municipal income tax overpayments shown on the federal 1040, Sch 1, line 1 |
$0.00 |
| SocialSecurityBenefits |
14 |
Taxable Social Security benefits |
$0.00 |
| RailroadRetirementBenefits |
15 |
Certain railroad retirement benefits |
$0.00 |
| ObligIntrstPublicServicePay |
16 |
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 state of Ohio or income from a transfer agreement |
$0.00 |
| IndDevAcct |
17 |
Amounts contributed to an individual development account |
$0.00 |
| STABLEAcct |
18 |
Amounts contributed to STABLE account; Ohio's ABLE plan |
$0.00 |
| OutOfStateDisasterWorkIncome |
19 |
Income earned in Ohio by a qualifying out-of-state business or employee for disaster work conducted during a disaster response period |
$0.00 |
| FederalIntAndDivExempt |
20 |
Federal interest and dividends exempt from state taxation |
$0.00 |
| IRC168And179AdjDed |
21 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| IRS1040RefundOrReimbursements |
22 |
Refund or reimbursements shown on the federal 1040, schedule 1 for itemized deductions claimed on a prior year federal income tax return |
$0.00 |
| RepaymentOfIncomeReported |
23 |
Repayment of income reported in a prior year |
$0.00 |
| NotDeductedWageExpense |
24 |
Wage expense not deducted due to claiming the federal work opportunity credit |
$0.00 |
| FederalConformityDeductions |
25 |
Federal conformity deductions |
$0.00 |
| MilitaryPayForResident |
26 |
Military pay for Ohio residents received while the military member was stationed outside Ohio |
$0.00 |
| IncomeErndMilitCivilianNRSpouse |
27 |
Certain income earned by military nonresidents and civilian nonresident spouses |
$0.00 |
| UniformedServcsRetirmtIncome |
28 |
Uniformed services retirement income |
$0.00 |
| MilitaryInjuryReliefFund |
29 |
Military injury relief fund |
$0.00 |
| NationalGuardReimAndBenft |
30 |
Certain Ohio National Guard reimbursements and benefits |
$0.00 |
| CollegeAdvSavAndTuitPurchCred |
31 |
Ohio 529 contributions, tuition credit purchases |
$0.00 |
| PellOhioCollegeOppTaxableGrant |
32 |
Pell/Ohio College Opportunity taxable grant amounts used to pay room and board |
$0.00 |
| OhioEducatorExpenses |
33 |
Ohio educator expenses in excess of federal deduction |
$0.00 |
| DisabilityBenefits |
34 |
Disability benefits |
$0.00 |
| SurvivorBenefits |
35 |
Survivor benefits |
$0.00 |
| UnsubsidizedMedicalExpense |
36 |
Unreimbursed long-term care insurance premiums, unsubsidized health care insurance premiums and excess health care expenses (see instructions for worksheet) |
$5,200.00 |
| HealthCareDepositedFunds |
37 |
Funds deposited into, and earnings of, a medical savings account for eligible health care expenses (see instructions for worksheet) |
$0.00 |
| QualOrganDonorExp |
38 |
Qualified organ donor expenses |
$0.00 |
| TotalIncomeDeduction |
39 |
Total deductions |
$5,200.00 |
| |
|
|
|
| Schedule IT BUS |
|
|
|
| |
|
Part 1 |
|
| BusScheduleB |
1 |
Sch B - Interest and Ordinary Dividends |
$0.00 |
| BusScheduleC |
2 |
Sch C - Profit or Loss From Business (Sole Proprietership) |
$0.00 |
| BusScheduleD |
3 |
Sch D - Capital Gains and Losses |
$0.00 |
| BusScheduleE |
4 |
Sch E - Supplemental Income and Loss |
$0.00 |
| GuaranteedPayments |
5 |
Guranteed payments, compensation and/or wages from each pass-through entity in which you have at least a 20% direct or indirect ownership interest |
$0.00 |
| BusScheduleF |
6 |
Sch F - Profit or Loss From Farming |
$0.00 |
| OtherItemsOfIncome |
7 |
Other items of income and gain separately stated on federal Schedule K-1, federal 4797 gains and/or losses reported on federal 4797 and miscellaneous federal income tax adjustments, if any |
$0.00 |
| TotalOfBusinessIncome |
8 |
Total of business income (add lines 1 through 7) |
$0.00 |
| |
|
Part 2 |
|
| AllBusinessIncome |
9 |
All business income (enter the lesser of line 8 above or Ohio IT1040, line 1). If zero or negative, stop here and do not complete Part 3. |
$0.00 |
| FilingStatusBusIncAmt |
10 |
Enter $250,000 if single or MFJ, enter $125,000 if MFS |
$0.00 |
| LessOfFilStatBusIncAmtOrAllBusInc |
11 |
Lesser of line 9 or line 10. Enter here and on Ohio Schedule of Adjustments, line 11 |
$0.00 |
| |
|
Part 3 |
|
| AllBusIncLessBusIncDeduction |
12 |
Line 9 minus line 11 (if less than -0-, enter -0-) |
$0.00 |
| TaxableBusinessIncome |
13 |
Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5) |
$0.00 |
| BusinessIncomeTaxLiability |
14 |
Business income tax liability. Multiply line 13 by 3%. Enter here and on Ohio IT 1040, line 8b. |
$0.00 |
| |
|
|
|
| Schedule of Credits - Nonrefundable |
| TaxLiabilityBeforeCredits |
1 |
Tax liability before credits (From IT1040, line 8c) |
$2,547.00 |
| RetireIncomeCredit |
2 |
Retirement income credit (limit $200 per return) |
$0.00 |
| LumpSumRetirementCredit |
3 |
Lump sum retirement credit (include Ohio LS WKS, line 6) |
$0.00 |
| SeniorCitizenCredit |
4 |
Senior citizen credit |
$0.00 |
| LumpSumDistributionCredit |
5 |
Lump sum distribution credit (include Ohio LS WKS, line 3) |
$0.00 |
| ChildAndDependCareCredit |
6 |
Child care and dependent care credit (see the worksheet in the instructions) |
$0.00 |
| DisplacedWorkerTrainingCredit |
7 |
Displaced worker training credit (see the worksheet in the instructions) |
$100.00 |
| CampaignContributionCredit |
8 |
Campaign contribution credit |
$0.00 |
| ExemptionCredit |
9 |
Income-based exemption credit |
$0.00 |
| TotCreditsBeforeJointFiling |
10 |
Total (add lines 2 through 9) |
$100.00 |
| TaxLessCredit |
11 |
Tax less credits (line 1 minus line 10; if less than -0-, enter -0-) |
$2,447.00 |
| JointFilingCredit |
12 |
Joint filing credit |
$122.00 |
| EarnedIncomeCredit |
13 |
Earned income credit (multiply Fed EITC by 30%) |
$0.00 |
| HomeSchoolExpensesCredit |
14 |
Home school expenses credit |
$0.00 |
| ScholarshipDonationCredit |
15 |
Scholarship donation credit |
$0.00 |
| NonCharterOrPublicSchoolCredit |
16 |
Nonchartered, nonpublic school tuition credit |
$0.00 |
| VocationalJobCredit |
17 |
Vocational job credit |
$0.00 |
| AdoptionCredit |
18 |
Ohio adoption credit |
$1,500.00 |
| JobRetentionCredit |
19 |
Nonrefundable job retention credit |
$4.00 |
| NewEmpInEntZoneCredit |
20 |
Credit for eligible new employees in an enterprise zone |
$5.00 |
| GrapeProdPropertyPurchCredit |
21 |
Credit for purchases of grape production property |
$7.00 |
| InvestOhioCredit |
22 |
InvestOhio credit |
$8.00 |
| LeadAbatementCredit |
23 |
Lead abatement credit |
$20.00 |
| OpportunityZoneCredit |
24 |
Opportunity zone investment credit |
$25.00 |
| TechInvestCreditCarryfrwd |
25 |
Technology investment credit carryforward |
$6.00 |
| EntZoneDayCareAndTrngCredit |
26 |
Enterprise zone day care and training credits |
$9.00 |
| ResearchAndDevelopmentCredit |
27 |
Research and development credit |
$10.00 |
| OhioHistoricPreservationCredit |
28 |
Nonrefundable Ohio historic preservation credit |
$1.00 |
| TotAdditionalCredits |
29 |
Total (add lines 12 through 28) |
$1,717.00 |
| TaxLessCrdtMinusTotAddlCrdts |
30 |
Tax less additional credits (line 11 minus line 29; if less than -0-, enter -0-) |
$730.00 |
| |
|
Nonresident Credit |
|
| NonOhioIncome |
31 |
Nonresident Portion of Ohio adjusted gross income |
$17,785.00 |
| OhioAdjustedGrossIncome |
32 |
Ohio adjusted gross income |
$103,705.00 |
| NonResIncomeCreditRatio |
33a |
Divide line 31 by line 32 |
0.1714 |
| NonresidentAndPartYearCredit |
33 |
Nonresident credit (line 30 times line 33a) |
$125.00 |
| |
|
Resident Credit |
|
| ResidentTaxCredit |
34 |
Resident Credit - Ohio IT RC, line 7 |
$0.00 |
| TotalNonrefundableCredits |
35 |
Total nonrefundable credits |
$1,942.00 |
| |
|
|
|
| Schedule of Credits - Refundable |
| HistoricPreservationCredit |
36 |
Refundable Ohio historic preservation credit |
$0.00 |
| JobCreationAndJobRetentionCrd |
37 |
Refundable job creation credit & job retention credit |
$0.00 |
| PassthroughEntityCredit |
38 |
Pass-through entity credit |
$0.00 |
| MotionPictureProductionCredit |
39 |
Motion Picture & Broadway theatrical production credit |
$0.00 |
| VentureCapitalCredit |
40 |
Venture Capital credit |
$0.00 |
| TotalRefundableCredit |
41 |
Total refundable credits |
$0.00 |
| |
|
|
|
| School District Return (#6804) |
|
|
|
| SchoolDistrictTaxableIncome |
1 |
School district taxable income: Traditional or Earned Income tax base |
$78,320.00 |
| TaxAmount |
2 |
School District Tax .____ times line 1. |
$1,371.00 |
| SeniorCitizenCredit |
3 |
Senior Citizen Credit |
$0.00 |
| TaxLessCredit |
4 |
School District Income Tax liability |
$1,371.00 |
| UnderPaymentInterestPenalty |
5 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| TotalTax |
6 |
Total school district income tax liability (line 4 plus line 5) |
$1,371.00 |
| TotalTax |
6a |
Amount from line 6, page 1 |
$1,371.00 |
| TaxWithheld |
7 |
School district income tax withheld |
$1,573.00 |
| InstallmentPayments |
8 |
SD 100 ES & SD 40P, Extension Payments and Credit carryforward from previous year return |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
9 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayments |
10 |
Total school district income tax payments (add lines 7, 8 and 9) |
$1,573.00 |
| OverpymtRecdOnOrigAmendRtn |
11 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
12 |
Line 10 minus line 11. Place a negative sign ("-") in the box if the amount is less than -0- |
$1,573.00 |
| AmountUnderpaid |
13 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
14 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
15 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
16 |
Overpayment |
$202.00 |
| OverpymtCreditedNextYear |
17 |
Original return only - amount of line 16 to be carried forward to next year's tax liability |
$0.00 |
| Refund |
18 |
Your Refund |
$202.00 |
| Traditional Tax Base School District Amounts |
|
|
|
| TaxableIncome |
19 |
Ohio income tax base (Ohio IT 1040, line 3 minus line 4) |
$96,105.00 |
| BusinessIncomeDeductionAddback |
20 |
Business income deduction add-back |
$0.00 |
| TotalTraditionalSDIncome |
21 |
Total Traditional Tax Base School District Income (Line 19 + Line 20) |
$96,105.00 |
| NonResidentIncome |
22 |
Amount of traditional tax base school district income that you earned while not a resident |
$17,785.00 |
| SchoolDistrictTaxableIncome |
23 |
School District Taxable Income (Enter here and on line 1) |
$78,320.00 |
| Earned Income Tax Base School District Amounts |
|
|
|
| WagesAndOtherCompensations |
24 |
Wages and other compensation as described in the instructions |
$0.00 |
| SelfEmploymentEarnings |
25 |
Net Earnings from Self Employment |
$0.00 |
| FederalConformityAdjustments |
26 |
Federal Conformity Adjustments |
$0.00 |
| SchoolDistrictTaxableIncome |
27 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| |
|
|
|
| What is Tested? |
If you do not support: |
| IT1040WithSD100 |
|
|
|
| Self-Prepared |
|
|
|
| MFJ status |
|
|
|
| W-2 |
|
|
|
| 1099-B |
|
Change to 1099R with a distribution code of 1 (early distribution). This will not create a retirement income credit. |
|
| 1099-DIV |
|
Change to 1099R with a distribution code of 1 (early distribution). This will not create a retirement income credit. |
|
| |
|
|
|
| IT1040 |
|
|
|
| Primary - Full year resident |
|
If different residency statuses are not supported, change the primary to a part-year resident |
|
| Spouse - Part-year resident |
|
If part-year residency status is not supported, see Alternate Test #7 |
|
| FiledFedExtForm4868 - Yes |
|
|
|
| Schedule of Dependents |
|
|
|
| [$92,150 - $115,300] tax bracket |
|
|
|
| 5% joint filing credit |
|
|
|
| Sch. of Adj - Health/medical expenses |
|
Move amount to a Sch. of Adj deduction line you do support |
|
| Sch of Credits - DWC |
|
Remove the credit amount |
|
| Sch of Credits - Adoption credit |
|
Remove the credit amount |
|
| Sch of Credits - Job retention credit |
|
Remove the credit amount |
|
| Sch of Credits - Eligible new employees in enterprise zone |
|
Remove the credit amount |
|
| Sch of Credits - Purchase of grape production property |
|
Remove the credit amount |
|
| Sch of Credits - Invest Ohio Credit |
|
Remove the credit amount |
|
| Sch of Credits - Lead Abatement Credit |
|
Remove the credit amount |
|
| Sch of Credits - Opportunity Zone Credit |
|
Remove the credit amount |
|
| Sch of Credits - Technology investment credit carryforward |
|
Remove the credit amount |
|
| Sch of Credits - Enterprise zone day care training |
|
Remove the credit amount |
|
| Sch of Credits - Research and development |
|
Remove the credit amount |
|
| Sch of Credits - Ohio historic preservation |
|
Remove the credit amount |
|
| Sch of Credits - Non-resident credit |
|
See Alternate test #7 |
|
| Installment payments |
|
Remove payment amounts |
|
| Amount of line 24 to be donated - Ohio History Fund |
|
|
|
| Amount of line 24 to be donated - Breast/cervical cancer |
|
|
|
| Credit carryforward/Refund split |
|
Remove the credit carryforward amount |
|
| |
|
|
|
| SD100 |
|
|
|
| Traditional Tax Base School District |
|
|
|
| Primary - Full year resident |
|
If different residency statuses are not supported, change the primary to a part-year resident |
|
| Spouse - Part-year resident |
|
If part-year residency status is not supported, see Alternate Test #7 |
|
| Ohio Alt Test #7 |
|
|
IT1040WithSD100 |
| Taxpayer Information |
|
Description |
|
| TaxpayerSSN |
|
Primary Social Security Number |
400-XX-7607 |
| FirstName |
|
Primary First Name |
TOM |
| MiddleInitial |
|
Primary Middle Initial |
A |
| LastName |
|
Primary Last Name |
TOE |
| DateOfBirth |
|
Date of Birth - Primary |
1962-05-05 |
| |
|
|
|
| TaxpayerSSN |
|
Spouse's Social Security Number |
400-XX-7657 |
| FirstName |
|
Spouse First Name |
ANGELINA MARIAS |
| MiddleInitial |
|
Spouse Middle Initial |
N |
| LastName |
|
Spouse Last Name |
TOE |
| DateOfBirth |
|
Date of Birth - Spouse |
1962-06-06 |
| |
|
|
|
| USPhone |
|
Taxpayer's Phone Number |
[<=9999999]###-#### |
| ForeignPhone |
|
Foreign Phone Number |
|
| EmailAddress |
|
Taxpayer's E-mail Address |
TOE@YAHOO.COM |
| |
|
|
|
| AddressLine1Txt |
|
Address Line 1 |
100 WEST ST |
| CityNm |
|
City |
CAMDEN |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
45311 |
| |
|
|
|
| MailingAddressCounty |
|
Ohio County |
PREBLE |
| SchoolDistrictNumber |
|
Ohio Public School District Number - Resident District |
6804 |
| |
|
|
|
| Preparer Information |
|
|
|
| Self-Prepared |
|
|
|
| SelfPrepared |
|
Return is self-prepared |
X |
| |
|
|
|
| Income Statements |
|
|
|
| W-2 #1 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
643456789-0000000 |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
TOMATOES TO GROW |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
17 E MAIN ST |
| CityNm |
|
City |
REYNOLDSBURG |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43068 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7607 |
| EmployeNm |
|
Employee's Name |
TOM A TOE |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
100 WEST ST |
| CityNm |
|
City |
CAMDEN |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
45311 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$23,200.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$336.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$23,200.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$1,438.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$23,200.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$336.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
51-210654 |
| StateWagesAmt |
|
State Wages |
$23,200.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$200.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$18,700.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$151.00 |
| LocalityNm |
|
Name of Locality |
DAYTON |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$4,500.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$35.00 |
| LocalityNm |
|
Name of Locality |
TROY |
| |
|
|
|
| SchoolDistrictWages |
|
School District Wages |
$23,200.00 |
| SchoolDistrictTaxWithheld |
|
School District Tax Withheld |
$406.00 |
| SchoolDistrictNumber |
|
School District # |
6804 |
| |
|
|
|
| W-2 #2 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
643456789-0000000 |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
TOMATOES TO GROW |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
17 E MAIN ST |
| CityNm |
|
City |
REYNOLDSBURG |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43068 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7657 |
| EmployeeNm |
|
Employee's Name |
ANGELINA MARIAS N TOE |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
100 WEST ST |
| CityNm |
|
City |
CAMDEN |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
45311 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$84,455.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$5,000.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$84,455.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$5,236.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$84,455.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$1,225.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
51-210654 |
| StateWagesAmt |
|
State Wages |
$84,455.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$2,800.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$49,455.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$554.00 |
| LocalityNm |
|
Name of Locality |
TROY |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$35,000.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$788.00 |
| LocalityNm |
|
Name of Locality |
DAYTON |
| |
|
|
|
| SchoolDistrictWages |
|
School District Wages |
$84,455.00 |
| SchoolDistrictTaxWithheld |
|
School District Tax Withheld |
$1,478.00 |
| SchoolDistrictNumber |
|
School District # |
6804 |
| |
|
|
|
| 1099-B |
|
|
|
| PayerName / BusinessNameLine1Txt |
|
Payer's Name |
MAIN STREET BANK |
| |
|
|
|
| AddressLine1Txt |
|
Payer's US Address |
1 MAIN ST |
| CityNm |
|
Payer's City |
MONTPELIER |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZIPCd |
|
Payer's Zip Code |
43543 |
| PayerEIN |
|
Payer's Federal Identification Number |
303456789-0000000 |
| |
|
|
|
| SSN |
|
Recipient's Identification Number |
400-XX-7657 |
| Name |
|
Recipient's Name |
ANGELINA MARIAS N TOE |
| AddressLine1Txt |
|
Recipient Address Line 1 Text |
100 WEST ST |
| CityNm |
|
Recipient's City |
CAMDEN |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
45311 |
| |
|
|
|
| Proceeds |
|
Box 1d Proceeds |
$10.00 |
| |
|
|
|
| StateTaxWithheldAmt |
|
Box 16 State Tax Withheld |
$1.00 |
| StateAbbreviationCd |
|
Box 14 State |
OH |
| PayerStateIdNumber |
|
Box 15 State identification no |
52-065432 |
| StateDistributionAmt |
|
Proceeds |
$10.00 |
| |
|
|
|
| 1099-DIV |
|
|
|
| PayersName / BusinessNameLine1Txt |
|
Payer's Name |
MAIN STREET BANK |
| AddressLine1Txt |
|
Payer's US Address Line 1 Text |
1 MAIN ST |
| AddressLine2Txt |
|
Payer's US Address Line 2 Text |
|
| CityNm |
|
Payer's City |
MONTPELIER |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZIPCd |
|
Payer's Zip Code |
43543 |
| PayerFederalIdNumber |
|
Payer's Federal Identification Number |
303456789-0000000 |
| |
|
|
|
| RecipientsIdNumber |
|
Recipient's Identification Number |
400-XX-7657 |
| RecipientsName |
|
Recipient's Name |
ANGELINA MARIAS N TOE |
| AddressLine1Txt |
|
Recipient Address Line 1 Text |
100 WEST ST |
| CityNm |
|
Recipient's City |
CAMDEN |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
45311 |
| |
|
|
|
| TotalOrdinaryDividend |
|
Box 1a Total Ordinary Dividends |
$1,240.00 |
| |
|
|
|
| StateTaxWithheldAmt |
|
Box 14 State Tax Withheld |
$74.00 |
| StateAbbreviationCd |
|
Box 12 State |
OH |
| PayersStateIdNumber |
|
Box 13 State identification no |
52-065432 |
| StateDistributionAmt |
|
Total Ordinary Dividends |
$1,240.00 |
| |
|
|
|
| Return Information |
|
|
|
| Federal Return Data |
|
|
|
| |
|
Filing Status |
Married Filing Joint |
| |
|
Exemptions, Self |
4 |
| |
|
Total wages, salaries, tips, etc. |
$107,655.00 |
| |
|
Taxable Ordinary Dividends |
$1,240.00 |
| |
|
Total Capital gain or (loss) |
$10.00 |
| |
|
Adjusted Gross Income |
$108,905.00 |
| |
|
Earned Income Tax Credit |
$0.00 |
| State Return Data |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| FilingStatus |
|
|
|
| MarriedFilingJointly |
|
|
X |
| |
|
|
|
| Did you file federal extension Form 4868? |
|
|
Yes |
| |
|
|
|
| Did you take the Standard deduction or itemize? |
|
|
Standard |
| |
|
|
|
| Can someone else claim you (or your spouse) as a dependent? |
|
|
|
| ClaimedAsDependent |
|
|
No |
| |
|
|
|
| Schedule of Dependents |
|
Total Exemptions |
4 |
| NumberOfDependents |
|
|
2 |
| SSN |
|
|
400-XX-7682 |
| DateOfBirth |
|
|
1992-08-11 |
| Relationship |
|
|
SON |
| FirstName |
|
|
SON |
| LastName |
|
|
TOE |
| |
|
|
|
| SSN |
|
|
400-XX-7683 |
| DateOfBirth |
|
|
1999-02-05 |
| Relationship |
|
|
DAUGHTER |
| FirstName |
|
|
DAUGHTER |
| LastName |
|
|
TOE |
| |
|
|
|
| Residency Status |
|
|
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| JointFilingCredit |
|
Eligible for JFC? |
Yes |
| |
|
|
|
| Unreimbursed Healthcare Expenses Worksheet |
| UnreimbPremNoEmpPaidOrMedicare |
1 |
Enter amounts paid for unreimbursed dental, vision and health insurance |
$5,000.00 |
| UnreimbLTCPrem |
2 |
Enter amounts paid for unreimbursed long-term care insurance premiums |
$500.00 |
| UnreimbPremEligEmpPaidOrMedicare |
3 |
Enter amounts paid for unreimbursed dental, vision and health insurance |
$5,000.00 |
| MedCareAmts |
4 |
Enter amounts paid for medical care during the year |
$300.00 |
| UnreimbPremEligAndMedCareAmts |
5 |
Sum of lines 3 and 4 |
$5,300.00 |
| FederalAdjustedGrossIncome |
6 |
Enter your federal adjusted gross income. If less than zero, enter zero |
$108,905.00 |
| FAGIMul7HalfPer |
7 |
Multiply line 6 by 7.5% (0.075) |
$8,168.00 |
| ElgPremAndCareLessFAGIMul7HalfPer |
8 |
Line 5 minus line 7. If less than zero, enter zero |
$0.00 |
| TotalHealthCareExpDed |
9 |
Add lines 1, 2, and 8. Enter the total here and on Ohio Schedule of Adjustments, line 36 |
$5,500.00 |
| |
|
|
|
| Displaced Worker Training Credit Worksheet |
|
|
|
| |
- |
Did you lose your job because the place you worked either permanently closed or moved, or because your employer abolished your job or shift |
Yes |
| |
- |
During the 12-month period beginning when you lost your job, did you pay for any displaced worker training? |
Yes |
| |
- |
While you were receiving displaced worker training, were you either unemployed or working no more than 20 hours per week? |
Yes |
| |
1a |
Amount of displaced worker training expense you paid |
$120.00 |
| |
1b |
Amount of displaced worker training expense your spouse paid |
$80.00 |
| |
|
|
|
| Certificate Information |
| Job Retention Credit - NonRef |
|
|
|
| TaxpayerSSN |
|
SSN listed on Certificate |
400-XX-7607 |
| TaxpayerEIN |
|
FEIN listed on Certificate |
359854123-0000000 |
| CertificateNumber |
|
Identifying Number listed on Certificate |
JC_5255_2019 |
| ApprovedAmount |
|
Total Amount of Credit Issued |
$5,000.00 |
| |
|
|
|
| InvestOhio credit |
|
|
|
| TaxpayerSSN |
|
SSN listed on Certificate |
400-XX-7607 |
| TaxpayerEIN |
|
FEIN listed on Certificate |
|
| CertificateNumber |
|
Identifying Number listed on Certificate |
8256-2018 |
| ApprovedAmount |
|
Total Amount of Credit Issued |
$10,000.00 |
| |
|
|
|
| Lead Abatement Credit |
|
|
|
| TaxpayerSSN |
|
SSN listed on Certificate |
400-XX-7607 |
| TaxpayerEIN |
|
FEIN listed on Certificate |
|
| CertificateNumber |
|
Identifying Number listed on Certificate |
8000-2020 |
| ApprovedAmount |
|
Total Amount of Credit Issued |
$20.00 |
| |
|
|
|
| Research and development credit |
|
|
|
| TaxpayerSSN |
|
SSN listed on Certificate |
400-XX-7607 |
| TaxpayerEIN |
|
FEIN listed on Certificate |
|
| CertificateNumber |
|
Identifying Number listed on Certificate |
RD_4144_2017 |
| ApprovedAmount |
|
Total Amount of Credit Issued |
$75,000.00 |
| |
|
|
|
| Nonrefundable Ohio historic preservation credit |
|
|
|
| TaxpayerSSN |
|
SSN listed on Certificate |
400-XX-7607 |
| TaxpayerEIN |
|
FEIN listed on Certificate |
|
| CertificateNumber |
|
Identifying Number listed on Certificate |
|
| ApprovedAmount |
|
Total Amount of Credit Issued |
$50,000.00 |
| |
|
|
|
| Additional Information |
|
|
|
| AdoptionCredit |
|
Ohio Adoption Credit |
$1,500.00 |
| JobRetentionCredit |
|
Nonrefundable job retention credit |
$4.00 |
| NewEmpInEntZoneCredit |
|
Credit for eligible new employees in an enterprise zone |
$5.00 |
| GrapeProdPropertyPurchCredit |
|
Credit for purchases of grape production property |
$7.00 |
| InvestOhioCredit |
|
Credit for investing in an Ohio small business |
$8.00 |
| LeadAbatementCredit |
|
Credit for lead abatement costs incurred |
$20.00 |
| OpportunityZoneCredit |
|
Opportunity zone investment credit |
$3.00 |
| TechInvestCreditCarryfrwd |
|
Technology investment credit carryforward |
$6.00 |
| EntZoneDayCareAndTrngCredit |
|
Enterprise zone day care and training credits |
$9.00 |
| ResearchAndDevelopmentCredit |
|
Research and development credit |
$10.00 |
| OhioHistoricPreservationCredit |
|
Nonrefundable Ohio historic preservation credit |
$1.00 |
| TotalInstallmentPayment |
|
Ohio Estimated Tax, IT-40P Extension Payments, and Overpayments Credited to Current Tax Year |
$100.00 |
| OverpymtCreditedNextYear |
|
Amount Credited to Next Year's Tax Liability |
$100.00 |
| CharityOrgName |
|
Donation From Taxpayer - Ohio History Fund |
$80.00 |
| CharityOrgName |
|
Donation From Taxpayer - Breast/cervical cancer |
$60.00 |
| |
|
|
|
| SD Return # 1 Information |
|
|
|
| SchoolDistrictNumber |
|
What is the school district number for which you are filing the SD 100? |
6804 |
| TaxType |
|
Tax Type |
Traditional |
| |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| Residency Status |
|
School district residency |
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| Return |
|
|
|
| IT1040 - Pages 1 & 2 |
| FederalAdjustedGrossIncome |
1 |
Federal Adjusted Gross Income |
$108,905.00 |
| TotalIncomeAddition |
2a |
Additions to federal adjusted gross income |
$0.00 |
| TotalIncomeDeduction |
2b |
Deductions from federal adjusted gross income |
$5,500.00 |
| OhioAdjustedGrossIncome |
3 |
Ohio Adjusted Gross Income (OAGI) |
$103,405.00 |
| ExemptionDeduction |
4 |
Personal and dependent exemption deduction |
$7,600.00 |
| TaxableIncome |
5 |
Ohio income tax base |
$95,805.00 |
| TaxableBusinessIncome |
6 |
Taxable business income (Ohio IT BUS, line 13) |
$0.00 |
| TaxableIncomeLessBusinessIncome |
7 |
Line 5 minus line 6 (if less than 0, enter 0) |
$95,805.00 |
| |
7a |
Amount from line 7 on page 1 |
$95,805.00 |
| NonBusinessIncomeTaxLiability |
8a |
Nonbusiness income tax liability |
$2,535.00 |
| BusinessIncomeTaxLiability |
8b |
Business income tax liability (Ohio IT BUS, line 14) |
$0.00 |
| IncomeTaxLiabilityBeforeCredits |
8c |
Income tax liability before credits (line 8a plus 8b) |
$2,535.00 |
| OhioNonRefundableCredits |
9 |
Ohio nonrefundable credits |
$1,795.00 |
| TaxLiabAfterNonrefundableCrdt |
10 |
Tax liability after nonrefundable credits |
$740.00 |
| UnderPaymentInterestPenalty |
11 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| UnpaidUseTax |
12 |
Sales and use tax due on Internet, mail order or other out-of-state purchases |
$0.00 |
| TotalTaxLiability |
13 |
Total Ohio tax liability before withholding or estimated payments |
$740.00 |
| TaxWithheld |
14 |
Ohio income tax withheld |
$3,075.00 |
| InstallmentPayment |
15 |
Add the Ohio estimated & extension payments & credit carryforward from previous year return |
$100.00 |
| RefundableTaxCredits |
16 |
Refundable credits |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
17 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayment |
18 |
Total Ohio Tax Payments |
$3,175.00 |
| OverpymtRecdOnOrigAmendRtn |
19 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
20 |
Line 18 minus line 19 |
$3,175.00 |
| AmountUnderpaid |
21 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
22 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
23 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
24 |
Overpayment |
$2,435.00 |
| OverpymtCreditedNextYear |
25 |
Original return only - amount of line 24 to be carried forward to next year's tax liability |
$100.00 |
| CharityOrgName |
26a |
Amount of line 24 to be donated - Wildlife species |
$0.00 |
| CharityOrgName |
26b |
Amount of line 24 to be donated - Military injury relief |
$0.00 |
| CharityOrgName |
26c |
Amount of line 24 to be donated - Ohio History Fund |
$80.00 |
| CharityOrgName |
26d |
Amount of line 24 to be donated - Nature Preserves/Scenic Rivers |
$0.00 |
| CharityOrgName |
26e |
Amount of line 24 to be donated - Breast/cervical cancer |
$60.00 |
| CharityOrgName |
26f |
Amount of line 24 to be donated - Wishes for sick children |
$0.00 |
| TotalDonation |
26g |
Total |
$140.00 |
| Refund |
27 |
Your Refund |
$2,195.00 |
| |
|
|
|
| Schedule of Adjustments |
| Additions |
|
|
|
| NonOhioAndLocalGovIntAndDiv |
1 |
Non-Ohio state or local government interest and dividends |
$0.00 |
| PassThruEntityTaxesPaid |
2 |
Certain Ohio pass-through entity and financial institutions taxes paid |
$0.00 |
| TuitionExpenseReimbursement |
3 |
Reimbursement of college tutition expenses and fees deducted in any previous year(s) and noneducation expenditures from a college savings account |
$0.00 |
| SaleAndDispstnLossOfOhioOblig |
4 |
Losses from sale or disposition of Ohio public obligations |
$0.00 |
| NonMedicalWithdrawals |
5 |
Nonmedical withdrawals from a medical savings account |
$0.00 |
| ReimExpPrevDeducted |
6 |
Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if the reimbursement is not in federal adjusted gross income |
$0.00 |
| IRC168And179AdjAdd |
7 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| FederalInterestAndDividends |
8 |
Federal interest and dividends subject to state taxation |
$0.00 |
| FederalConformityAdditions |
9 |
Federal conformity additions |
$0.00 |
| TotalIncomeAddition |
10 |
Total additions |
$0.00 |
| |
|
|
|
| Deductions |
|
|
|
| BusinessIncomeDeduction |
11 |
Business income deduction (attach Ohio Schedule IT BUS, line 11) |
$0.00 |
| OHFullYrEmpCompEarnNeighState |
12 |
Employee compensation earned in Ohio by residents of neighboring states |
$0.00 |
| IRS1040StateMuniIncomeOverpymt |
13 |
State or municipal income tax overpayments shown on the federal 1040, Sch 1, line 1 |
$0.00 |
| SocialSecurityBenefits |
14 |
Taxable Social Security benefits |
$0.00 |
| RailroadRetirementBenefits |
15 |
Certain railroad retirement benefits |
$0.00 |
| ObligIntrstPublicServicePay |
16 |
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 state of Ohio or income from a transfer agreement |
$0.00 |
| IndDevAcct |
17 |
Amounts contributed to an individual development account |
$0.00 |
| STABLEAcct |
18 |
Amounts contributed to STABLE account; Ohio's ABLE plan |
$0.00 |
| OutOfStateDisasterWorkIncome |
19 |
Income earned in Ohio by a qualifying out-of-state business or employee for disaster work conducted during a disaster response period |
$0.00 |
| FederalIntAndDivExempt |
20 |
Federal interest and dividends exempt from state taxation |
$0.00 |
| IRC168And179AdjDed |
21 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| IRS1040RefundOrReimbursements |
22 |
Refund or reimbursements shown on the federal 1040, schedule 1 for itemized deductions claimed on a prior year federal income tax return |
$0.00 |
| RepaymentOfIncomeReported |
23 |
Repayment of income reported in a prior year |
$0.00 |
| NotDeductedWageExpense |
24 |
Wage expense not deducted due to claiming the federal work opportunity credit |
$0.00 |
| FederalConformityDeductions |
25 |
Federal conformity deductions |
$0.00 |
| MilitaryPayForResident |
26 |
Military pay for Ohio residents received while the military member was stationed outside Ohio |
$0.00 |
| IncomeErndMilitCivilianNRSpouse |
27 |
Certain income earned by military nonresidents and civilian nonresident spouses |
$0.00 |
| UniformedServcsRetirmtIncome |
28 |
Uniformed services retirement income |
$0.00 |
| MilitaryInjuryReliefFund |
29 |
Military injury relief fund |
$0.00 |
| NationalGuardReimAndBenft |
30 |
Certain Ohio National Guard reimbursements and benefits |
$0.00 |
| CollegeAdvSavAndTuitPurchCred |
31 |
Ohio 529 contributions, tuition credit purchases |
$0.00 |
| PellOhioCollegeOppTaxableGrant |
32 |
Pell/Ohio College Opportunity taxable grant amounts used to pay room and board |
$0.00 |
| OhioEducatorExpenses |
33 |
Ohio educator expenses in excess of federal deduction |
$0.00 |
| DisabilityBenefits |
34 |
Disability benefits |
$0.00 |
| SurvivorBenefits |
35 |
Survivor benefits |
$0.00 |
| UnsubsidizedMedicalExpense |
36 |
Unreimbursed long-term care insurance premiums, unsubsidized health care insurance premiums and excess health care expenses (see instructions for worksheet) |
$5,500.00 |
| HealthCareDepositedFunds |
37 |
Funds deposited into, and earnings of, a medical savings account for eligible health care expenses (see instructions for worksheet) |
$0.00 |
| QualOrganDonorExp |
38 |
Qualified organ donor expenses |
$0.00 |
| TotalIncomeDeduction |
39 |
Total deductions |
$5,500.00 |
| |
|
|
|
| Schedule IT BUS |
|
|
|
| |
|
Part 1 |
|
| BusScheduleB |
1 |
Sch B - Interest and Ordinary Dividends |
$0.00 |
| BusScheduleC |
2 |
Sch C - Profit or Loss From Business (Sole Proprietership) |
$0.00 |
| BusScheduleD |
3 |
Sch D - Capital Gains and Losses |
$0.00 |
| BusScheduleE |
4 |
Sch E - Supplemental Income and Loss |
$0.00 |
| GuaranteedPayments |
5 |
Guranteed payments, compensation and/or wages from each pass-through entity in which you have at least a 20% direct or indirect ownership interest |
$0.00 |
| BusScheduleF |
6 |
Sch F - Profit or Loss From Farming |
$0.00 |
| OtherItemsOfIncome |
7 |
Other items of income and gain separately stated on federal Schedule K-1, federal 4797 gains and/or losses reported on federal 4797 and miscellaneous federal income tax adjustments, if any |
$0.00 |
| TotalOfBusinessIncome |
8 |
Total of business income (add lines 1 through 7) |
$0.00 |
| |
|
Part 2 |
|
| AllBusinessIncome |
9 |
All business income (enter the lesser of line 8 above or Ohio IT1040, line 1). If zero or negative, stop here and do not complete Part 3. |
$0.00 |
| FilingStatusBusIncAmt |
10 |
Enter $250,000 if single or MFJ, enter $125,000 if MFS |
$0.00 |
| LessOfFilStatBusIncAmtOrAllBusInc |
11 |
Lesser of line 9 or line 10. Enter here and on Ohio Schedule of Adjustments, line 11 |
$0.00 |
| |
|
Part 3 |
|
| AllBusIncLessBusIncDeduction |
12 |
Line 9 minus line 11 (if less than -0-, enter -0-) |
$0.00 |
| TaxableBusinessIncome |
13 |
Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5) |
$0.00 |
| BusinessIncomeTaxLiability |
14 |
Business income tax liability. Multiply line 13 by 3%. Enter here and on Ohio IT 1040, line 8b. |
$0.00 |
| |
|
Part 4 |
|
| NameOfEntity |
1 |
Name of Entity |
|
| FEINOrSSN |
|
FEIN/SS# |
|
| PercentageOfOwnership |
|
Percentage of Ownership |
|
| Income Earned By Primary |
|
Primary |
|
| Income Earned By Spouse |
|
Spouse |
|
| |
|
|
|
| Schedule of Credits - Nonrefundable |
| TaxLiabilityBeforeCredits |
1 |
Tax liability before credits (From IT1040, line 8c) |
$2,535.00 |
| RetireIncomeCredit |
2 |
Retirement income credit (limit $200 per return) |
$0.00 |
| LumpSumRetirementCredit |
3 |
Lump sum retirement credit (include Ohio LS WKS, line 6) |
$0.00 |
| SeniorCitizenCredit |
4 |
Senior citizen credit |
$0.00 |
| LumpSumDistributionCredit |
5 |
Lump sum distribution credit (include Ohio LS WKS, line 3) |
$0.00 |
| ChildAndDependCareCredit |
6 |
Child care and dependent care credit (see the worksheet in the instructions) |
$0.00 |
| DisplacedWorkerTrainingCredit |
7 |
Displaced worker training credit (see the worksheet in the instructions) |
$100.00 |
| CampaignContributionCredit |
8 |
Campaign contribution credit |
$0.00 |
| ExemptionCredit |
9 |
Income-based exemption credit |
$0.00 |
| TotCreditsBeforeJointFiling |
10 |
Total (add lines 2 through 9) |
$100.00 |
| TaxLessCredit |
11 |
Tax less credits (line 1 minus line 10; if less than -0-, enter -0-) |
$2,435.00 |
| JointFilingCredit |
12 |
Joint filing credit |
$122.00 |
| EarnedIncomeCredit |
13 |
Earned income credit (multiply Fed EITC by 30%) |
$0.00 |
| HomeSchoolExpensesCredit |
14 |
Home school expenses credit |
$0.00 |
| ScholarshipDonationCredit |
15 |
Scholarship donation credit |
$0.00 |
| NonCharterOrPublicSchoolCredit |
16 |
Nonchartered, nonpublic school tuition credit |
$0.00 |
| VocationalJobCredit |
17 |
Vocational job credit |
$0.00 |
| AdoptionCredit |
18 |
Ohio adoption credit |
$1,500.00 |
| JobRetentionCredit |
19 |
Nonrefundable job retention credit |
$4.00 |
| NewEmpInEntZoneCredit |
20 |
Credit for eligible new employees in an enterprise zone |
$5.00 |
| GrapeProdPropertyPurchCredit |
21 |
Credit for purchases of grape production property |
$7.00 |
| InvestOhioCredit |
22 |
InvestOhio credit |
$8.00 |
| LeadAbatementCredit |
23 |
Lead abatement credit |
$20.00 |
| OpportunityZoneCredit |
24 |
Opportunity zone investment credit |
$3.00 |
| TechInvestCreditCarryfrwd |
25 |
Technology investment credit carryforward |
$6.00 |
| EntZoneDayCareAndTrngCredit |
26 |
Enterprise zone day care and training credits |
$9.00 |
| ResearchAndDevelopmentCredit |
27 |
Research and development credit |
$10.00 |
| OhioHistoricPreservationCredit |
28 |
Nonrefundable Ohio historic preservation credit |
$1.00 |
| TotAdditionalCredits |
29 |
Total (add lines 12 through 28) |
$1,695.00 |
| TaxLessCrdtMinusTotAddlCrdts |
30 |
Tax less additional credits (line 11 minus line 29; if less than -0-, enter -0-) |
$740.00 |
| |
|
Nonresident Credit |
|
| NonOhioIncome |
31 |
Nonresident Portion of Ohio adjusted gross income |
$0.00 |
| OhioAdjustedGrossIncome |
32 |
Ohio adjusted gross income |
$0.00 |
| NonResIncomeCreditRatio |
33a |
Divide line 31 by line 32 |
0.0000 |
| NonresidentAndPartYearCredit |
33 |
Nonresident credit (line 30 times line 33a) |
$0.00 |
| |
|
Resident Credit |
|
| ResidentTaxCredit |
34 |
Resident Credit - Ohio IT RC, line 7 |
$0.00 |
| TotalNonrefundableCredits |
35 |
Total nonrefundable credits |
$1,795.00 |
| |
|
|
|
| Schedule of Credits - Refundable |
| HistoricPreservationCredit |
36 |
Refundable Ohio historic preservation credit |
$0.00 |
| JobCreationAndJobRetentionCrd |
37 |
Refundable job creation credit & job retention credit |
$0.00 |
| PassthroughEntityCredit |
38 |
Pass-through entity credit |
$0.00 |
| MotionPictureProductionCredit |
39 |
Motion Picture & Broadway theatrical production credit |
$0.00 |
| VentureCapitalCredit |
40 |
Venture Capital credit |
$0.00 |
| TotalRefundableCredit |
41 |
Total refundable credits |
$0.00 |
| |
|
|
|
| School District Return (#6804) |
|
|
|
| SchoolDistrictTaxableIncome |
1 |
School district taxable income: Traditional or Earned Income tax base |
$95,805.00 |
| TaxAmount |
2 |
School District Tax .____ times line 1. |
$1,677.00 |
| SeniorCitizenCredit |
3 |
Senior Citizen Credit |
$0.00 |
| TaxLessCredit |
4 |
School District Income Tax liability |
$1,677.00 |
| UnderPaymentInterestPenalty |
5 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| TotalTax |
6 |
Total school district income tax liability (line 4 plus line 5) |
$1,677.00 |
| TotalTax |
6a |
Amount from line 6, page 1 |
$1,677.00 |
| TaxWithheld |
7 |
School district income tax withheld |
$1,884.00 |
| InstallmentPayments |
8 |
SD 100 ES & SD 40P, Extension Payments and Credit carryforward from previous year return |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
9 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayments |
10 |
Total school district income tax payments (add lines 7, 8 and 9) |
$1,884.00 |
| OverpymtRecdOnOrigAmendRtn |
11 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
12 |
Line 10 minus line 11. Place a negative sign ("-") in the box if the amount is less than -0- |
$1,884.00 |
| AmountUnderpaid |
13 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
14 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
15 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
16 |
Overpayment |
$207.00 |
| OverpymtCreditedNextYear |
17 |
Original return only - amount of line 16 to be carried forward to next year's tax liability |
$0.00 |
| Refund |
18 |
Your Refund |
$207.00 |
| Traditional Tax Base School District Amounts |
|
|
|
| TaxableIncome |
19 |
Ohio income tax base (Ohio IT 1040, line 3 minus line 4) |
$95,805.00 |
| BusinessIncomeDeductionAddback |
20 |
Business income deduction add-back |
$0.00 |
| TotalTraditionalSDIncome |
21 |
Total Traditional Tax Base School District Income (Line 19 + Line 20) |
$95,805.00 |
| NonResidentIncome |
22 |
Amount of traditional tax base school district income that you earned while not a resident |
$0.00 |
| SchoolDistrictTaxableIncome |
23 |
School District Taxable Income (Enter here and on line 1) |
$95,805.00 |
| Earned Income Tax Base School District Amounts |
|
|
|
| WagesAndOtherCompensations |
24 |
Wages and other compensation as described in the instructions |
$0.00 |
| SelfEmploymentEarnings |
25 |
Net Earnings from Self Employment |
$0.00 |
| FederalConformityAdjustments |
26 |
Federal Conformity Adjustments |
$0.00 |
| SchoolDistrictTaxableIncome |
27 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| |
|
|
|
| What is Tested? |
If you do not support: |
| IT1040WithSD100 |
|
|
|
| Self-Prepared |
|
|
|
| MFJ status |
|
|
|
| Ohio W2 |
|
|
|
| 1099-B |
|
Change to 1099R with a distribution code of 1 (early distribution). This will not create a retirement income credit. |
|
| 1099-DIV |
|
Change to 1099R with a distribution code of 1 (early distribution). This will not create a retirement income credit. |
|
| |
|
|
|
| IT1040 |
|
|
|
| Full Year Resident |
|
|
|
| FiledFedExtForm4868 - Yes |
|
|
|
| Schedule of Dependents |
|
|
|
| [$92,150 - $115,300] tax bracket |
|
|
|
| 5% joint filing credit |
|
|
|
| Sch. of Adj - Health/medical expenses |
|
Move amount to a Sch. of Adj deduction line you do support |
|
| Sch of Credits - DWC |
|
Remove the credit amount |
|
| Sch of Credits - Adoption credit |
|
Remove the credit amount |
|
| Sch of Credits - Job retention credit |
|
Remove the credit amount |
|
| Sch of Credits - Eligible new employees in enterprise zone |
|
Remove the credit amount |
|
| Sch of Credits - Purchase of grape production property |
|
Remove the credit amount |
|
| Sch of Credits - Invest Ohio Credit |
|
Remove the credit amount |
|
| Sch of Credits - Lead Abatement Credit |
|
Remove the credit amount |
|
| Sch of Credits - Opportunity Zone Credit |
|
Remove the credit amount |
|
| Sch of Credits - Technology investment credit carryforward |
|
Remove the credit amount |
|
| Sch of Credits - Enterprise zone day care training |
|
Remove the credit amount |
|
| Sch of Credits - Research and development |
|
Remove the credit amount |
|
| Sch of Credits - Ohio historic preservation |
|
Remove the credit amount |
|
| Installment payments |
|
Remove payment amounts |
|
| Amount of line 24 to be donated - Ohio History Fund |
|
|
|
| Amount of line 24 to be donated - Breast/cervical cancer |
|
|
|
| Credit carryforward/Refund split |
|
Remove the credit carryforward amount |
|
| |
|
|
|
| SD100 |
|
|
|
| Traditional tax base school district |
|
|
|
| Full Year Resident |
|
|
|
| Ohio Test #8 |
|
|
IT1040 |
| Taxpayer Information |
|
Description |
|
| TaxpayerSSN |
|
Primary Social Security Number |
400-XX-7608 |
| FirstName |
|
Primary First Name |
BRUTUS |
| MiddleInitial |
|
Primary Middle Initial |
|
| LastName |
|
Primary Last Name |
BUCKEYE |
| NameSuffix |
|
Name Suffix |
|
| DateOfBirth |
|
Date of Birth - Primary |
2001-02-01 |
| |
|
|
|
| USPhone |
|
Taxpayer's Phone Number |
[<=9999999]###-#### |
| ForeignPhone |
|
Foreign Phone Number |
|
| EmailAddress |
|
Taxpayer's E-mail Address |
BRUTUS@MSN.COM |
| |
|
|
|
| AddressLine1Txt |
|
Address Line 1 |
123 S MAIN ST |
| CityNm |
|
City |
COLUMBUS |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43229 |
| |
|
|
|
| MailingAddressCounty |
|
Ohio County |
FRANKLIN |
| SchoolDistrictNumber |
|
Ohio Public School District Number - Resident District |
2503 |
| |
|
|
|
| Preparer Information |
|
|
|
| Non-Paid Preparer |
|
|
|
| PreparerName |
|
NonPaid Preparer's name |
AVA WHITE |
| PhoneNumber |
|
NonPaid Preparer's phone number |
[<=9999999]###-#### |
| EmailAddress |
|
NonPaid Preparer's Email Address |
AVA@AVA.COM |
| PTIN |
|
NonPaid Preparer's PTIN |
P23568921 |
| AddressLine1Txt |
|
NonPaid Preparer's US Address |
200 SOUTH ST |
| CityNm |
|
City |
COLUMBUS |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
ZIPCode |
43229 |
| |
|
|
|
| ContactPreparerAuthorization |
|
Preparer Authorization Check Box |
Yes |
| |
|
|
|
| Return Information |
|
|
|
| Federal Return Data |
|
|
|
| |
|
Filing Status |
Single |
| |
|
Exemptions, Self |
0 |
| |
|
Total Wages, salaries, tips,etc. |
$0.00 |
| |
|
Taxable Refunds, credits or offsets of state and local income taxes |
$0.00 |
| |
|
Total Business loss |
$0.00 |
| |
|
Net profit or (loss) from Schedule C, Schedule C-EZ, and Schedule K1 |
$0.00 |
| |
|
Adjusted Gross Income |
$0.00 |
| |
|
Earned Income Tax Credit |
$0.00 |
| State Return Data |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| FilingStatus |
|
|
|
| Single |
|
|
X |
| |
|
|
|
| Did you file federal extension Form 4868? |
|
|
No |
| |
|
|
|
| Did you take the Standard deduction or itemize? |
|
|
Unknown |
| |
|
|
|
| Can someone else claim you (or your spouse) as a dependent? |
|
|
|
| ClaimedAsDependent |
|
|
Yes |
| |
|
|
|
| Residency Status |
|
|
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| Unpaid Use Tax Worksheets |
|
|
|
| a. |
|
Did you make any out of state purchases |
Yes |
| b. |
|
Did the retailer charge you any sales tax |
No |
| c. |
|
Amount of Purchases that you did not pay sales tax |
$72,507.00 |
| d. |
|
County sales tax rate |
7.50% |
| |
|
|
|
| Certificate Information |
| Refundable historic preservation credit |
|
|
|
| TaxpayerSSN |
|
SSN listed on Certificate |
400-XX-7608 |
| TaxpayerEIN |
|
FEIN listed on Certificate |
|
| CertificateNumber |
|
Identifying Number listed on Certificate |
|
| ApprovedAmount |
|
Total Amount of Credit Issued |
$250,000.00 |
| |
|
|
|
| Job creation credit and job retention credit, refundable portion |
|
|
|
| TaxpayerSSN |
|
SSN listed on Certificate |
400-XX-7608 |
| TaxpayerEIN |
|
FEIN listed on Certificate |
862456851-0000000 |
| CertificateNumber |
|
Identifying Number listed on Certificate |
JC_8562_2016 |
| ApprovedAmount |
|
Total Amount of Credit Issued |
$150,000.00 |
| |
|
|
|
| Motion Picture & Broadway theatrical production credit |
|
|
|
| TaxpayerSSN |
|
SSN listed on Certificate |
400-XX-7608 |
| TaxpayerEIN |
|
FEIN listed on Certificate |
862456851-0000000 |
| CertificateNumber |
|
Identifying Number listed on Certificate |
845 |
| ApprovedAmount |
|
Total Amount of Credit Issued |
$35,000.00 |
| |
|
|
|
| Additional Information |
|
|
|
| HistoricPreservationCredit |
|
Refundable Ohio historic preservation credit |
$145,000.00 |
| JobCreationAndJobRetentionCrd |
|
Refundable job creation credit & job retention credit |
$25,000.00 |
| MotionPictureProductionCredit |
|
Motion Picture & Broadway theatrical production credit |
$10,000.00 |
| VentureCapitalCredit |
|
Venture Capital Credit |
$2,000.00 |
| |
|
|
|
| Return |
|
|
|
| IT1040 - Pages 1 & 2 |
| FederalAdjustedGrossIncome |
1 |
Federal Adjusted Gross Income |
$0.00 |
| TotalIncomeAddition |
2a |
Additions to federal adjusted gross income |
$0.00 |
| TotalIncomeDeduction |
2b |
Deductions from federal adjusted gross income |
$0.00 |
| OhioAdjustedGrossIncome |
3 |
Ohio Adjusted Gross Income (OAGI) |
$0.00 |
| ExemptionDeduction |
4 |
Personal and dependent exemption deduction |
$0.00 |
| TaxableIncome |
5 |
Ohio income tax base |
$0.00 |
| TaxableBusinessIncome |
6 |
Taxable business income (Ohio IT BUS, line 13) |
$0.00 |
| TaxableIncomeLessBusinessIncome |
7 |
Line 5 minus line 6 (if less than 0, enter 0) |
$0.00 |
| |
7a |
Amount from line 7 on page 1 |
$0.00 |
| NonBusinessIncomeTaxLiability |
8a |
Nonbusiness income tax liability |
$0.00 |
| BusinessIncomeTaxLiability |
8b |
Business income tax liability (Ohio IT BUS, line 14) |
$0.00 |
| IncomeTaxLiabilityBeforeCredits |
8c |
Income tax liability before credits (line 8a plus 8b) |
$0.00 |
| OhioNonRefundableCredits |
9 |
Ohio nonrefundable credits |
$0.00 |
| TaxLiabAfterNonrefundableCrdt |
10 |
Tax liability after nonrefundable credits |
$0.00 |
| UnderPaymentInterestPenalty |
11 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| UnpaidUseTax |
12 |
Sales and use tax due on Internet, mail order or other out-of-state purchases |
$5,438.00 |
| TotalTaxLiability |
13 |
Total Ohio tax liability before withholding or estimated payments |
$5,438.00 |
| TaxWithheld |
14 |
Ohio income tax withheld |
$0.00 |
| InstallmentPayment |
15 |
Add the Ohio estimated & extension payments & credit carryforward from previous year return |
$0.00 |
| RefundableTaxCredits |
16 |
Refundable credits |
$182,000.00 |
| AmtPrevPaidWithOrigAmendRtn |
17 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayment |
18 |
Total Ohio Tax Payments |
$182,000.00 |
| OverpymtRecdOnOrigAmendRtn |
19 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
20 |
Line 18 minus line 19 |
$182,000.00 |
| AmountUnderpaid |
21 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
22 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
23 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
24 |
Overpayment |
$176,562.00 |
| OverpymtCreditedNextYear |
25 |
Original return only - amount of line 24 to be carried forward to next year's tax liability |
$0.00 |
| CharityOrgName |
26f |
Amount of line 24 to be donated - Wildlife species |
$0.00 |
| CharityOrgName |
26a |
Amount of line 24 to be donated - Military injury relief |
$0.00 |
| CharityOrgName |
26b |
Amount of line 24 to be donated - Ohio History Fund |
$0.00 |
| CharityOrgName |
26c |
Amount of line 24 to be donated - Nature Preserves/Scenic Rivers |
$0.00 |
| CharityOrgName |
26d |
Amount of line 24 to be donated - Breast/cervical cancer |
$0.00 |
| CharityOrgName |
26e |
Amount of line 24 to be donated - Wishes for sick children |
$0.00 |
| TotalDonation |
26g |
Total |
$0.00 |
| Refund |
27 |
Your Refund |
$176,562.00 |
| |
|
|
|
| Schedule of Adjustments |
| Additions |
|
|
|
| NonOhioAndLocalGovIntAndDiv |
1 |
Non-Ohio state or local government interest and dividends |
$0.00 |
| PassThruEntityTaxesPaid |
2 |
Certain Ohio pass-through entity and financial institutions taxes paid |
$0.00 |
| TuitionExpenseReimbursement |
3 |
Reimbursement of college tutition expenses and fees deducted in any previous year(s) and noneducation expenditures from a college savings account |
$0.00 |
| SaleAndDispstnLossOfOhioOblig |
4 |
Losses from sale or disposition of Ohio public obligations |
$0.00 |
| NonMedicalWithdrawals |
5 |
Nonmedical withdrawals from a medical savings account |
$0.00 |
| ReimExpPrevDeducted |
6 |
Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if the reimbursement is not in federal adjusted gross income |
$0.00 |
| IRC168And179AdjAdd |
7 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| FederalInterestAndDividends |
8 |
Federal interest and dividends subject to state taxation |
$0.00 |
| FederalConformityAdditions |
9 |
Federal conformity additions |
$0.00 |
| TotalIncomeAddition |
10 |
Total additions |
$0.00 |
| |
|
|
|
| Deductions |
|
|
|
| BusinessIncomeDeduction |
11 |
Business income deduction (attach Ohio Schedule IT BUS, line 11) |
$0.00 |
| OHFullYrEmpCompEarnNeighState |
12 |
Employee compensation earned in Ohio by residents of neighboring states |
$0.00 |
| IRS1040StateMuniIncomeOverpymt |
13 |
State or municipal income tax overpayments shown on the federal 1040, Sch 1, line 1 |
$0.00 |
| SocialSecurityBenefits |
14 |
Taxable Social Security benefits |
$0.00 |
| RailroadRetirementBenefits |
15 |
Certain railroad retirement benefits |
$0.00 |
| ObligIntrstPublicServicePay |
16 |
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 state of Ohio or income from a transfer agreement |
$0.00 |
| IndDevAcct |
17 |
Amounts contributed to an individual development account |
$0.00 |
| STABLEAcct |
18 |
Amounts contributed to STABLE account; Ohio's ABLE plan |
$0.00 |
| OutOfStateDisasterWorkIncome |
19 |
Income earned in Ohio by a qualifying out-of-state business or employee for disaster work conducted during a disaster response period |
$0.00 |
| FederalIntAndDivExempt |
20 |
Federal interest and dividends exempt from state taxation |
$0.00 |
| IRC168And179AdjDed |
21 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| IRS1040RefundOrReimbursements |
22 |
Refund or reimbursements shown on the federal 1040, schedule 1 for itemized deductions claimed on a prior year federal income tax return |
$0.00 |
| RepaymentOfIncomeReported |
23 |
Repayment of income reported in a prior year |
$0.00 |
| NotDeductedWageExpense |
24 |
Wage expense not deducted due to claiming the federal work opportunity credit |
$0.00 |
| FederalConformityDeductions |
25 |
Federal conformity deductions |
$0.00 |
| MilitaryPayForResident |
26 |
Military pay for Ohio residents received while the military member was stationed outside Ohio |
$0.00 |
| IncomeErndMilitCivilianNRSpouse |
27 |
Certain income earned by military nonresidents and civilian nonresident spouses |
$0.00 |
| UniformedServcsRetirmtIncome |
28 |
Uniformed services retirement income |
$0.00 |
| MilitaryInjuryReliefFund |
29 |
Military injury relief fund |
$0.00 |
| NationalGuardReimAndBenft |
30 |
Certain Ohio National Guard reimbursements and benefits |
$0.00 |
| CollegeAdvSavAndTuitPurchCred |
31 |
Ohio 529 contributions, tuition credit purchases |
$0.00 |
| PellOhioCollegeOppTaxableGrant |
32 |
Pell/Ohio College Opportunity taxable grant amounts used to pay room and board |
$0.00 |
| OhioEducatorExpenses |
33 |
Ohio educator expenses in excess of federal deduction |
$0.00 |
| DisabilityBenefits |
34 |
Disability benefits |
$0.00 |
| SurvivorBenefits |
35 |
Survivor benefits |
$0.00 |
| UnsubsidizedMedicalExpense |
36 |
Unreimbursed long-term care insurance premiums, unsubsidized health care insurance premiums and excess health care expenses (see instructions for worksheet) |
$0.00 |
| HealthCareDepositedFunds |
37 |
Funds deposited into, and earnings of, a medical savings account for eligible health care expenses (see instructions for worksheet) |
$0.00 |
| QualOrganDonorExp |
38 |
Qualified organ donor expenses |
$0.00 |
| TotalIncomeDeduction |
39 |
Total deductions |
$0.00 |
| |
|
|
|
| Schedule IT BUS |
|
|
|
| |
|
Part 1 |
|
| BusScheduleB |
1 |
Sch B - Interest and Ordinary Dividends |
$0.00 |
| BusScheduleC |
2 |
Sch C - Profit or Loss From Business (Sole Proprietership) |
$0.00 |
| BusScheduleD |
3 |
Sch D - Capital Gains and Losses |
$0.00 |
| BusScheduleE |
4 |
Sch E - Supplemental Income and Loss |
$0.00 |
| GuaranteedPayments |
5 |
Guranteed payments, compensation and/or wages from each pass-through entity in which you have at least a 20% direct or indirect ownership interest |
$0.00 |
| BusScheduleF |
6 |
Sch F - Profit or Loss From Farming |
$0.00 |
| OtherItemsOfIncome |
7 |
Other items of income and gain separately stated on federal Schedule K-1, federal 4797 gains and/or losses reported on federal 4797 and miscellaneous federal income tax adjustments, if any |
$0.00 |
| TotalOfBusinessIncome |
8 |
Total of business income (add lines 1 through 7) |
$0.00 |
| |
|
Part 2 |
|
| AllBusinessIncome |
9 |
All business income (enter the lesser of line 8 above or Ohio IT1040, line 1). If zero or negative, stop here and do not complete Part 3. |
$0.00 |
| FilingStatusBusIncAmt |
10 |
Enter $250,000 if single or MFJ, enter $125,000 if MFS |
$0.00 |
| LessOfFilStatBusIncAmtOrAllBusInc |
11 |
Lesser of line 9 or line 10. Enter here and on Ohio Schedule of Adjustments, line 11 |
$0.00 |
| |
|
Part 3 |
|
| AllBusIncLessBusIncDeduction |
12 |
Line 9 minus line 11 (if less than -0-, enter -0-) |
$0.00 |
| TaxableBusinessIncome |
13 |
Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5) |
$0.00 |
| BusinessIncomeTaxLiability |
14 |
Business income tax liability. Multiply line 13 by 3%. Enter here and on Ohio IT 1040, line 8b. |
$0.00 |
| |
|
|
|
| Schedule of Credits - Nonrefundable |
| TaxLiabilityBeforeCredits |
1 |
Tax liability before credits (From IT1040, line 8c) |
$0.00 |
| RetireIncomeCredit |
2 |
Retirement income credit (limit $200 per return) |
$0.00 |
| LumpSumRetirementCredit |
3 |
Lump sum retirement credit (include Ohio LS WKS, line 6) |
$0.00 |
| SeniorCitizenCredit |
4 |
Senior citizen credit |
$0.00 |
| LumpSumDistributionCredit |
5 |
Lump sum distribution credit (include Ohio LS WKS, line 3) |
$0.00 |
| ChildAndDependCareCredit |
6 |
Child care and dependent care credit (see the worksheet in the instructions) |
$0.00 |
| DisplacedWorkerTrainingCredit |
7 |
Displaced worker training credit (see the worksheet in the instructions) |
$0.00 |
| CampaignContributionCredit |
8 |
Campaign contribution credit |
$0.00 |
| ExemptionCredit |
9 |
Income-based exemption credit |
$0.00 |
| TotCreditsBeforeJointFiling |
10 |
Total (add lines 2 through 9) |
$0.00 |
| TaxLessCredit |
11 |
Tax less credits (line 1 minus line 10; if less than -0-, enter -0-) |
$0.00 |
| JointFilingCredit |
12 |
Joint filing credit |
$0.00 |
| EarnedIncomeCredit |
13 |
Earned income credit (multiply Fed EITC by 30%) |
$0.00 |
| HomeSchoolExpensesCredit |
14 |
Home school expenses credit |
$0.00 |
| ScholarshipDonationCredit |
15 |
Scholarship donation credit |
$0.00 |
| NonCharterOrPublicSchoolCredit |
16 |
Nonchartered, nonpublic school tuition credit |
$0.00 |
| VocationalJobCredit |
17 |
Vocational job credit |
$0.00 |
| AdoptionCredit |
18 |
Ohio adoption credit |
$0.00 |
| JobRetentionCredit |
19 |
Nonrefundable job retention credit |
$0.00 |
| NewEmpInEntZoneCredit |
20 |
Credit for eligible new employees in an enterprise zone |
$0.00 |
| GrapeProdPropertyPurchCredit |
21 |
Credit for purchases of grape production property |
$0.00 |
| InvestOhioCredit |
22 |
InvestOhio credit |
$0.00 |
| LeadAbatementCredit |
23 |
Lead abatement credit |
$0.00 |
| OpportunityZoneCredit |
24 |
Opportunity zone investment credit |
$0.00 |
| TechInvestCreditCarryfrwd |
25 |
Technology investment credit carryforward |
$0.00 |
| EntZoneDayCareAndTrngCredit |
26 |
Enterprise zone day care and training credits |
$0.00 |
| ResearchAndDevelopmentCredit |
27 |
Research and development credit |
$0.00 |
| OhioHistoricPreservationCredit |
28 |
Nonrefundable Ohio historic preservation credit |
$0.00 |
| TotAdditionalCredits |
29 |
Total (add lines 12 through 28) |
$0.00 |
| TaxLessCrdtMinusTotAddlCrdts |
30 |
Tax less additional credits (line 11 minus line 29; if less than -0-, enter -0-) |
$0.00 |
| |
|
Nonresident Credit |
|
| NonOhioIncome |
31 |
Nonresident Portion of Ohio adjusted gross income |
$0.00 |
| OhioAdjustedGrossIncome |
32 |
Ohio adjusted gross income |
$0.00 |
| NonResIncomeCreditRatio |
33a |
Divide line 31 by line 32 |
0.0000 |
| NonresidentAndPartYearCredit |
33 |
Nonresident credit (line 30 times line 33a) |
$0.00 |
| |
|
Resident Credit |
|
| ResidentTaxCredit |
34 |
Resident Credit - Ohio IT RC, line 7 |
$0.00 |
| TotalNonrefundableCredits |
35 |
Total nonrefundable credits |
$0.00 |
| |
|
|
|
| Schedule of Credits - Refundable |
| HistoricPreservationCredit |
36 |
Refundable Ohio historic preservation credit |
$145,000.00 |
| JobCreationAndJobRetentionCrd |
37 |
Refundable job creation credit & job retention credit |
$25,000.00 |
| PassthroughEntityCredit |
38 |
Pass-through entity credit |
$0.00 |
| MotionPictureProductionCredit |
39 |
Motion Picture & Broadway theatrical production credit |
$10,000.00 |
| VentureCapitalCredit |
40 |
Venture Capital credit |
$2,000.00 |
| TotalRefundableCredit |
41 |
Total refundable credits |
$182,000.00 |
| |
|
|
|
| What is Tested? |
If you do not support: |
| IT1040 |
|
|
|
| Non-paid preparer |
|
|
|
| Preparer Contact - Authorized |
|
|
|
| Single status |
|
|
|
| No W-2/1099 information |
|
|
|
| |
|
|
|
| IT1040 |
|
|
|
| Full year resident |
|
|
|
| Claimed as a dependent - Yes |
|
|
|
| $0 FAGI |
|
Change FAGI to $1 |
|
| Use tax |
|
|
|
| Sch of Credits - Historic preservation credit |
|
Remove credit amount |
|
| Sch of Credits - Job creation credit & job retention credit |
|
Remove credit amount |
|
| Sch of Credits - Motion picture credit |
|
Remove credit amount |
|
| Sch of Credits - Venture capital credit |
|
Remove credit amount |
|
| |
|
|
|
| No school district return |
|
|
|
| Ohio Test #9 |
|
|
IT1040WithSD100 |
| Taxpayer Information |
|
Description |
|
| TaxpayerSSN |
|
Primary Social Security Number |
400-XX-7609 |
| FirstName |
|
Primary First Name |
PAQUITA SUNITA |
| LastName |
|
Primary Last Name |
JEFFERSON-WILLOUGHBY |
| DateOfBirth |
|
Date of Birth - Primary |
1966-06-30 |
| |
|
|
|
| TaxpayerSSN |
|
Spouse's Social Security Number |
400-XX-7659 |
| FirstName |
|
Spouse First Name |
JEFFREY |
| LastName |
|
Spouse Last Name |
JEFFERSON |
| DateOfBirth |
|
Date of Birth - Spouse |
1969-10-10 |
| |
|
|
|
| USPhone |
|
Taxpayer's Phone Number |
[<=9999999]###-#### |
| EmailAddress |
|
Taxpayer's E-mail Address |
JEFFERSON@TAX.GOV |
| |
|
|
|
| AddressLine1Txt |
|
Address Line 1 |
12345 REFUGEE-JERSEY RD |
| CityNm |
|
City |
WEEHAWKEN |
| StateAbbreviationCd |
|
State |
NJ |
| ZIPCd |
|
Zip Code |
07086 |
| |
|
|
|
| MailingAddressCounty |
|
Ohio County |
FRANKLIN |
| SchoolDistrictNumber |
|
Ohio Public School District Number - Resident District |
9999 |
| |
|
|
|
| Preparer Information |
|
|
|
| Self-Prepared |
|
|
|
| SelfPrepared |
|
Return is self-prepared |
X |
| |
|
|
|
| Income Statements |
|
|
|
| W-2 #1 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
319876543-0000000 |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
WEARABLE GARMENTS MFG |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
2 WASHINGTON CIR |
| CityNm |
|
City |
WEST LIBERTY |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43357 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7609 |
| EmployeNm |
|
Employee's Name |
PAQUITA SUNITA JEFFERSON-WILLOUGHBY |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
12345 REFUGEE-JERSEY RD |
| CityNm |
|
City |
WEEHAWKEN |
| StateAbbreviationCd |
|
State |
NJ |
| ZIPCd |
|
Zip Code |
07086 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$106,963.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$38,000.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$106,963.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$6,632.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$106,963.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$1,551.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
NJ |
| EmployerStateIdNum |
|
State ID Number |
123-456-789/123 |
| StateWagesAmt |
|
State Wages |
$106,963.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$6,700.00 |
| |
|
|
|
| W-2 #2 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
319876543-0000000 |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
WEARABLE GARMENTS MFG |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
2 WASHINGTON CIR |
| CityNm |
|
City |
WEST LIBERTY |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43357 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7659 |
| EmployeeNm |
|
Employee's Name |
JEFFREY JEFFERSON |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
12345 REFUGEE-JERSEY RD |
| CityNm |
|
City |
WEEHAWKEN |
| StateAbbreviationCd |
|
State |
NJ |
| ZIPCd |
|
Zip Code |
07086 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$47,000.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$5,000.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$47,000.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$2,914.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$47,000.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$682.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
54-656565 |
| StateWagesAmt |
|
State Wages |
$47,000.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$1,400.00 |
| |
|
|
|
| SchoolDistrictWages |
|
School District Wages |
$47,000.00 |
| SchoolDistrictTaxWithheld |
|
School District Tax Withheld |
$875.00 |
| SchoolDistrictNumber |
|
School District # |
1105 |
| |
|
|
|
| W-2 #3 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
310987888-####### |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
UNITED STATES AIR FORCE |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
123 PENTAGON LANE |
| CityNm |
|
City |
WASHINGTON |
| StateAbbreviationCd |
|
State |
DC |
| ZIPCd |
|
Zip Code |
20001 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7659 |
| EmployeNm |
|
Employee's Name |
JEFFREY JEFFERSON |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
12345 REFUGEE-JERSEY RD |
| CityNm |
|
City |
WEEHAWKEN |
| StateAbbreviationCd |
|
State |
NJ |
| ZIPCd |
|
Zip Code |
07086 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$123,000.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$12,300.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$123,000.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$7,626.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$123,000.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$1,784.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
NJ |
| EmployerStateIdNum |
|
State ID Number |
79-1235491 |
| StateWagesAmt |
|
State Wages |
$123,000.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$8,610.00 |
| |
|
|
|
| W-2 #4 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
310987654-####### |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
AMERICAN ELECTRIC POWER INC |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
123 POWER STREET |
| CityNm |
|
City |
WEEHAWKEN |
| StateAbbreviationCd |
|
State |
NJ |
| ZIPCd |
|
Zip Code |
07086 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7659 |
| EmployeNm |
|
Employee's Name |
JEFFREY JEFFERSON |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
12345 REFUGEE-JERSEY RD |
| CityNm |
|
City |
WEEHAWKEN |
| StateAbbreviationCd |
|
State |
NJ |
| ZIPCd |
|
Zip Code |
07086 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$3,000.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$300.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$3,000.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$186.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$3,000.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$44.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
51-654321 |
| StateWagesAmt |
|
State Wages |
$3,000.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$50.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$3,000.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$30.00 |
| LocalityNm |
|
Name of Locality |
CLEVELAND |
| |
|
|
|
| Return Information |
|
|
|
| Federal Return Data |
|
|
|
| |
|
Filing Status |
Married Filing Joint |
| |
|
Exemptions, Self |
2 |
| |
|
Total Wages, Salaries, Tips, etc. |
$279,963.00 |
| |
|
Federal Sch. B: Interest income HH Bond |
$400.00 |
| |
|
Federal Sch. B: Total Taxable Interest and Ordinary Dividends - Business Income |
$500.00 |
| |
|
Federal Sch. C: Total Profit or (Loss) From Business (Sole Proprietership) |
($5,000.00) |
| |
|
Federal Sch. D: Total Taxable Capital Gains and Losses - Business Income |
$4,000.00 |
| |
|
Federal Sch. E: Total Supplemental Income and Loss - Business Income |
($6,000.00) |
| |
|
Federal Sch. F: Total Profit or Loss From Farming |
$15,275.00 |
| |
|
Other Business Income (Loss) |
($6,000.00) |
| |
|
Self Employment Tax Deduction |
($726.00) |
| |
|
Adjusted Gross Income |
$282,412.00 |
| |
|
Earned Income Tax Credit |
$0.00 |
| State Return Data |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| FilingStatus |
|
|
|
| MarriedFilingJointly |
|
|
X |
| |
|
|
|
| Did you file federal extension Form 4868? |
|
|
No |
| |
|
|
|
| Did you take the Standard deduction or itemize? |
|
|
Standard |
| |
|
|
|
| Can someone else claim you (or your spouse) as a dependent? |
|
|
|
| ClaimedAsDependent |
|
|
No |
| |
|
|
|
| Residency Status |
|
|
|
| PrimaryResidencyStatus |
|
|
|
| FullYearNonResident |
|
Full-Year NonResident |
X |
| NonResidentState |
|
State of Residence |
NJ |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| FullYearNonResident |
|
Full-Year NonResident |
X |
| NonResidentState |
|
State of Residence |
NJ |
| |
|
Irrebutable Presumption of Nonohio Domicile (IT-NRS) |
X |
| |
|
|
|
| JointFilingCredit |
|
Eligible for JFC? |
Yes |
| |
|
|
|
| Additional Information |
|
|
|
| TuitionExpenseReimbursement |
|
Non-Education Expenditures from College Savings Account |
$9,150.00 |
| OutOfStateDisasterWorkIncome |
|
Income earned in Ohio by a qualifying out-of-state business or employee for disaster work conducted during a disaster response period |
$3,000.00 |
| FederalIntAndDivExempt |
|
Federal interest and dividends exempt from state taxation |
$400.00 |
| NonOhioIncome |
|
Nonresident Portion of Ohio adjusted gross income |
$115,387.00 |
| |
|
|
|
| SD Return # 1 Information |
|
|
|
| SchoolDistrictNumber |
|
What is the school district number for which you are filing the SD 100? |
1105 |
| TaxType |
|
Tax Type |
Traditional |
| |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| Residency Status |
|
School district residency |
|
| PrimaryResidencyStatus |
|
|
|
| FullYearNonResident |
|
Full-Year NonResident |
X |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| FullYearNonResident |
|
Full-Year NonResident |
X |
| |
|
|
|
| Return |
|
|
|
| IT1040 - Pages 1 & 2 |
| FederalAdjustedGrossIncome |
1 |
Federal Adjusted Gross Income |
$282,412.00 |
| TotalIncomeAddition |
2a |
Additions to federal adjusted gross income |
$9,150.00 |
| TotalIncomeDeduction |
2b |
Deductions from federal adjusted gross income |
$129,175.00 |
| OhioAdjustedGrossIncome |
3 |
Ohio Adjusted Gross Income (OAGI) |
$162,387.00 |
| ExemptionDeduction |
4 |
Personal and dependent exemption deduction |
$3,800.00 |
| TaxableIncome |
5 |
Ohio income tax base |
$158,587.00 |
| TaxableBusinessIncome |
6 |
Taxable business income (Ohio IT BUS, line 13) |
$0.00 |
| TaxableIncomeLessBusinessIncome |
7 |
Line 5 minus line 6 (if less than 0, enter 0) |
$158,587.00 |
| |
7a |
Amount from line 7 on page 1 |
$158,587.00 |
| NonBusinessIncomeTaxLiability |
8a |
Nonbusiness income tax liability |
$4,982.00 |
| BusinessIncomeTaxLiability |
8b |
Business income tax liability (Ohio IT BUS, line 14) |
$0.00 |
| IncomeTaxLiabilityBeforeCredits |
8c |
Income tax liability before credits (line 8a plus 8b) |
$4,982.00 |
| OhioNonRefundableCredits |
9 |
Ohio nonrefundable credits |
$3,612.00 |
| TaxLiabAfterNonrefundableCrdt |
10 |
Tax liability after nonrefundable credits |
$1,370.00 |
| UnderPaymentInterestPenalty |
11 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| UnpaidUseTax |
12 |
Sales and use tax due on Internet, mail order or other out-of-state purchases |
$0.00 |
| TotalTaxLiability |
13 |
Total Ohio tax liability before withholding or estimated payments |
$1,370.00 |
| TaxWithheld |
14 |
Ohio income tax withheld |
$1,450.00 |
| InstallmentPayment |
15 |
Add the Ohio estimated & extension payments & credit carryforward from previous year return |
$0.00 |
| RefundableTaxCredits |
16 |
Refundable credits |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
17 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayment |
18 |
Total Ohio Tax Payments |
$1,450.00 |
| OverpymtRecdOnOrigAmendRtn |
19 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
20 |
Line 18 minus line 19 |
$1,450.00 |
| AmountUnderpaid |
21 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
22 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
23 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
24 |
Overpayment |
$80.00 |
| OverpymtCreditedNextYear |
25 |
Original return only - amount of line 24 to be carried forward to next year's tax liability |
$0.00 |
| CharityOrgName |
26a |
Amount of line 24 to be donated - Wildlife species |
$0.00 |
| CharityOrgName |
26b |
Amount of line 24 to be donated - Military injury relief |
$0.00 |
| CharityOrgName |
26c |
Amount of line 24 to be donated - Ohio History Fund |
$0.00 |
| CharityOrgName |
26d |
Amount of line 24 to be donated - Nature Preserves/Scenic Rivers |
$0.00 |
| CharityOrgName |
26e |
Amount of line 24 to be donated - Breast/cervical cancer |
$0.00 |
| CharityOrgName |
26f |
Amount of line 24 to be donated - Wishes for sick children |
$0.00 |
| TotalDonation |
26g |
Total |
$0.00 |
| Refund |
27 |
Your Refund |
$80.00 |
| |
|
|
|
| Schedule of Adjustments |
| Additions |
|
|
|
| NonOhioAndLocalGovIntAndDiv |
1 |
Non-Ohio state or local government interest and dividends |
$0.00 |
| PassThruEntityTaxesPaid |
2 |
Certain Ohio pass-through entity and financial institutions taxes paid |
$0.00 |
| TuitionExpenseReimbursement |
3 |
Reimbursement of college tutition expenses and fees deducted in any previous year(s) and noneducation expenditures from a college savings account |
$9,150.00 |
| SaleAndDispstnLossOfOhioOblig |
4 |
Losses from sale or disposition of Ohio public obligations |
$0.00 |
| NonMedicalWithdrawals |
5 |
Nonmedical withdrawals from a medical savings account |
$0.00 |
| ReimExpPrevDeducted |
6 |
Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if the reimbursement is not in federal adjusted gross income |
$0.00 |
| IRC168And179AdjAdd |
7 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| FederalInterestAndDividends |
8 |
Federal interest and dividends subject to state taxation |
$0.00 |
| FederalConformityAdditions |
9 |
Federal conformity additions |
$0.00 |
| TotalIncomeAddition |
10 |
Total additions |
$9,150.00 |
| |
|
|
|
| Deductions |
|
|
|
| BusinessIncomeDeduction |
11 |
Business income deduction (attach Ohio Schedule IT BUS, line 11) |
$2,775.00 |
| OHFullYrEmpCompEarnNeighState |
12 |
Employee compensation earned in Ohio by residents of neighboring states |
$0.00 |
| IRS1040StateMuniIncomeOverpymt |
13 |
State or municipal income tax overpayments shown on the federal 1040, Sch 1, line 1 |
$0.00 |
| SocialSecurityBenefits |
14 |
Taxable Social Security benefits |
$0.00 |
| RailroadRetirementBenefits |
15 |
Certain railroad retirement benefits |
$0.00 |
| ObligIntrstPublicServicePay |
16 |
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 state of Ohio or income from a transfer agreement |
$0.00 |
| IndDevAcct |
17 |
Amounts contributed to an individual development account |
$0.00 |
| STABLEAcct |
18 |
Amounts contributed to STABLE account; Ohio's ABLE plan |
$0.00 |
| OutOfStateDisasterWorkIncome |
19 |
Income earned in Ohio by a qualifying out-of-state business or employee for disaster work conducted during a disaster response period |
$3,000.00 |
| FederalIntAndDivExempt |
20 |
Federal interest and dividends exempt from state taxation |
$400.00 |
| IRC168And179AdjDed |
21 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| IRS1040RefundOrReimbursements |
22 |
Refund or reimbursements shown on the federal 1040, schedule 1 for itemized deductions claimed on a prior year federal income tax return |
$0.00 |
| RepaymentOfIncomeReported |
23 |
Repayment of income reported in a prior year |
$0.00 |
| NotDeductedWageExpense |
24 |
Wage expense not deducted due to claiming the federal work opportunity credit |
$0.00 |
| FederalConformityDeductions |
25 |
Federal conformity deductions |
$0.00 |
| MilitaryPayForResident |
26 |
Military pay for Ohio residents received while the military member was stationed outside Ohio |
$0.00 |
| IncomeErndMilitCivilianNRSpouse |
27 |
Certain income earned by military nonresidents and civilian nonresident spouses |
$123,000.00 |
| UniformedServcsRetirmtIncome |
28 |
Uniformed services retirement income |
$0.00 |
| MilitaryInjuryReliefFund |
29 |
Military injury relief fund |
$0.00 |
| NationalGuardReimAndBenft |
30 |
Certain Ohio National Guard reimbursements and benefits |
$0.00 |
| CollegeAdvSavAndTuitPurchCred |
31 |
Ohio 529 contributions, tuition credit purchases |
$0.00 |
| PellOhioCollegeOppTaxableGrant |
32 |
Pell/Ohio College Opportunity taxable grant amounts used to pay room and board |
$0.00 |
| OhioEducatorExpenses |
33 |
Ohio educator expenses in excess of federal deduction |
$0.00 |
| DisabilityBenefits |
34 |
Disability benefits |
$0.00 |
| SurvivorBenefits |
35 |
Survivor benefits |
$0.00 |
| UnsubsidizedMedicalExpense |
36 |
Unreimbursed long-term care insurance premiums, unsubsidized health care insurance premiums and excess health care expenses (see instructions for worksheet) |
$0.00 |
| HealthCareDepositedFunds |
37 |
Funds deposited into, and earnings of, a medical savings account for eligible health care expenses (see instructions for worksheet) |
$0.00 |
| QualOrganDonorExp |
38 |
Qualified organ donor expenses |
$0.00 |
| TotalIncomeDeduction |
39 |
Total deductions |
$129,175.00 |
| |
|
|
|
| Schedule IT BUS |
|
|
|
| |
|
Part 1 |
|
| BusScheduleB |
1 |
Sch B - Interest and Ordinary Dividends |
$500.00 |
| BusScheduleC |
2 |
Sch C - Profit or Loss From Business (Sole Proprietership) |
($5,000.00) |
| BusScheduleD |
3 |
Sch D - Capital Gains and Losses |
$4,000.00 |
| BusScheduleE |
4 |
Sch E - Supplemental Income and Loss |
($6,000.00) |
| GuaranteedPayments |
5 |
Guranteed payments, compensation and/or wages from each pass-through entity in which you have at least a 20% direct or indirect ownership interest |
$0.00 |
| BusScheduleF |
6 |
Sch F - Profit or Loss From Farming |
$15,275.00 |
| OtherItemsOfIncome |
7 |
Other items of income and gain separately stated on federal Schedule K-1, federal 4797 gains and/or losses reported on federal 4797 and miscellaneous federal income tax adjustments, if any |
($6,000.00) |
| TotalOfBusinessIncome |
8 |
Total of business income (add lines 1 through 7) |
$2,775.00 |
| |
|
Part 2 |
|
| AllBusinessIncome |
9 |
All business income (enter the lesser of line 8 above or Ohio IT1040, line 1). If zero or negative, stop here and do not complete Part 3. |
$2,775.00 |
| FilingStatusBusIncAmt |
10 |
Enter $250,000 if single or MFJ, enter $125,000 if MFS |
$250,000.00 |
| LessOfFilStatBusIncAmtOrAllBusInc |
11 |
Lesser of line 9 or line 10. Enter here and on Ohio Schedule of Adjustments, line 11 |
$2,775.00 |
| |
|
Part 3 |
|
| AllBusIncLessBusIncDeduction |
12 |
Line 9 minus line 11 (if less than -0-, enter -0-) |
$0.00 |
| TaxableBusinessIncome |
13 |
Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5) |
$0.00 |
| BusinessIncomeTaxLiability |
14 |
Business income tax liability. Multiply line 13 by 3%. Enter here and on Ohio IT 1040, line 8b. |
$0.00 |
| |
|
Part 4 |
|
| NameOfEntity |
|
Name of Entity |
JOE'S FARM |
| FEINOrSSN |
|
FEIN/SS# |
621987654-####### |
| PercentageOfOwnership |
|
Percentage of Ownership |
0.0500 |
| Income Earned By Primary |
|
Primary |
X |
| |
|
|
|
| Schedule of Credits - Nonrefundable |
| TaxLiabilityBeforeCredits |
1 |
Tax liability before credits (From IT1040, line 8c) |
$4,982.00 |
| RetireIncomeCredit |
2 |
Retirement income credit (limit $200 per return) |
$0.00 |
| LumpSumRetirementCredit |
3 |
Lump sum retirement credit (include Ohio LS WKS, line 6) |
$0.00 |
| SeniorCitizenCredit |
4 |
Senior citizen credit |
$0.00 |
| LumpSumDistributionCredit |
5 |
Lump sum distribution credit (include Ohio LS WKS, line 3) |
$0.00 |
| ChildAndDependCareCredit |
6 |
Child care and dependent care credit (see the worksheet in the instructions) |
$0.00 |
| DisplacedWorkerTrainingCredit |
7 |
Displaced worker training credit (see the worksheet in the instructions) |
$0.00 |
| CampaignContributionCredit |
8 |
Campaign contribution credit |
$0.00 |
| ExemptionCredit |
9 |
Income-based exemption credit |
$0.00 |
| TotCreditsBeforeJointFiling |
10 |
Total (add lines 2 through 9) |
$0.00 |
| TaxLessCredit |
11 |
Tax less credits (line 1 minus line 10; if less than -0-, enter -0-) |
$4,982.00 |
| JointFilingCredit |
12 |
Joint filing credit |
$249.00 |
| EarnedIncomeCredit |
13 |
Earned income credit (multiply Fed EITC by 30%) |
$0.00 |
| HomeSchoolExpensesCredit |
14 |
Home school expenses credit |
$0.00 |
| ScholarshipDonationCredit |
15 |
Scholarship donation credit |
$0.00 |
| NonCharterOrPublicSchoolCredit |
16 |
Nonchartered, nonpublic school tuition credit |
$0.00 |
| VocationalJobCredit |
17 |
Vocational job credit |
$0.00 |
| AdoptionCredit |
18 |
Ohio adoption credit |
$0.00 |
| JobRetentionCredit |
19 |
Nonrefundable job retention credit |
$0.00 |
| NewEmpInEntZoneCredit |
20 |
Credit for eligible new employees in an enterprise zone |
$0.00 |
| GrapeProdPropertyPurchCredit |
21 |
Credit for purchases of grape production property |
$0.00 |
| InvestOhioCredit |
22 |
InvestOhio credit |
$0.00 |
| LeadAbatementCredit |
23 |
Lead abatement credit |
$0.00 |
| OpportunityZoneCredit |
24 |
Opportunity zone investment credit |
$0.00 |
| TechInvestCreditCarryfrwd |
25 |
Technology investment credit carryforward |
$0.00 |
| EntZoneDayCareAndTrngCredit |
26 |
Enterprise zone day care and training credits |
$0.00 |
| ResearchAndDevelopmentCredit |
27 |
Research and development credit |
$0.00 |
| OhioHistoricPreservationCredit |
28 |
Nonrefundable Ohio historic preservation credit |
$0.00 |
| TotAdditionalCredits |
29 |
Total (add lines 12 through 28) |
$249.00 |
| TaxLessCrdtMinusTotAddlCrdts |
30 |
Tax less additional credits (line 11 minus line 29; if less than -0-, enter -0-) |
$4,733.00 |
| |
|
Nonresident Credit |
|
| NonOhioIncome |
31 |
Nonresident Portion of Ohio adjusted gross income |
$115,387.00 |
| OhioAdjustedGrossIncome |
32 |
Ohio adjusted gross income |
$162,387.00 |
| NonResIncomeCreditRatio |
33a |
Divide line 31 by line 32 |
0.7105 |
| NonresidentAndPartYearCredit |
33 |
Nonresident credit (line 30 times line 33a) |
$3,363.00 |
| |
|
Resident Credit |
|
| ResidentTaxCredit |
34 |
Resident Credit - Ohio IT RC, line 7 |
$0.00 |
| TotalNonrefundableCredits |
35 |
Total nonrefundable credits |
$3,612.00 |
| |
|
|
|
| Schedule of Credits - Refundable |
| HistoricPreservationCredit |
36 |
Refundable Ohio historic preservation credit |
$0.00 |
| JobCreationAndJobRetentionCrd |
37 |
Refundable job creation credit & job retention credit |
$0.00 |
| PassthroughEntityCredit |
38 |
Pass-through entity credit |
$0.00 |
| MotionPictureProductionCredit |
39 |
Motion Picture & Broadway theatrical production credit |
$0.00 |
| VentureCapitalCredit |
40 |
Venture Capital credit |
$0.00 |
| TotalRefundableCredit |
41 |
Total refundable credits |
$0.00 |
| |
|
|
|
| School District Return (#1105) |
|
|
|
| SchoolDistrictTaxableIncome |
1 |
School district taxable income: Traditional or Earned Income tax base |
$0.00 |
| TaxAmount |
2 |
School District Tax .____ times line 1. |
$0.00 |
| SeniorCitizenCredit |
3 |
Senior Citizen Credit |
$0.00 |
| TaxLessCredit |
4 |
School District Income Tax liability |
$0.00 |
| UnderPaymentInterestPenalty |
5 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| TotalTax |
6 |
Total school district income tax liability (line 4 plus line 5) |
$0.00 |
| TotalTax |
6a |
Amount from line 6, page 1 |
$0.00 |
| TaxWithheld |
7 |
School district income tax withheld |
$875.00 |
| InstallmentPayments |
8 |
SD 100 ES & SD 40P, Extension Payments and Credit carryforward from previous year return |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
9 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayments |
10 |
Total school district income tax payments (add lines 7, 8 and 9) |
$875.00 |
| OverpymtRecdOnOrigAmendRtn |
11 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
12 |
Line 10 minus line 11. Place a negative sign ("-") in the box if the amount is less than -0- |
$875.00 |
| AmountUnderpaid |
13 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
14 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
15 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
16 |
Overpayment |
$875.00 |
| OverpymtCreditedNextYear |
17 |
Original return only - amount of line 16 to be carried forward to next year's tax liability |
$0.00 |
| Refund |
18 |
Your Refund |
$875.00 |
| Traditional Tax Base School District Amounts |
|
|
|
| TaxableIncome |
19 |
Ohio income tax base (Ohio IT 1040, line 3 minus line 4) |
$158,587.00 |
| BusinessIncomeDeductionAddback |
20 |
Business income deduction add-back |
$2,775.00 |
| TotalTraditionalSDIncome |
21 |
Total Traditional Tax Base School District Income (Line 19 + Line 20) |
$161,362.00 |
| NonResidentIncome |
22 |
Amount of traditional tax base school district income that you earned while not a resident |
$161,362.00 |
| SchoolDistrictTaxableIncome |
23 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| Earned Income Tax Base School District Amounts |
|
|
|
| WagesAndOtherCompensations |
24 |
Wages and other compensation as described in the instructions |
$0.00 |
| SelfEmploymentEarnings |
25 |
Net Earnings from Self Employment |
$0.00 |
| FederalConformityAdjustments |
26 |
Federal Conformity Adjustments |
$0.00 |
| SchoolDistrictTaxableIncome |
27 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| |
|
|
|
| What is Tested? |
|
If you do not support: |
| IT1040WithSD100 |
|
|
|
| Self-Prepared |
|
|
|
| MFJ status |
|
|
|
| W-2 |
|
|
|
| |
|
|
|
| IT1040 |
|
|
|
| Nonresident |
|
Change to part-year resident (if supported) or see Alternate Test #9 |
|
| Nonresident statement (IT NRS) - Spouse |
|
|
|
| More than $115,300 tax bracket |
|
|
|
| 5% joint filing credit |
|
|
|
| Sch. of Adj - Reimbursement tuition/non-ed expenses |
|
Move amount to a Sch. of Adj addition line you do support |
|
| Sch. of Adj - Disaster Relief |
|
Move amount to a Sch. of Adj deduction line you do support |
|
| Sch. of Adj - Federal interest/dividends exempt |
Move amount to a Sch. of Adj deduction line you do support |
|
| IT BUS - Additional Business Income |
|
Remove if do not support IT BUS |
|
| IT BUS - Entity ownership |
|
Remove if do not support IT BUS |
|
| Sch of Credits - Nonresident credit |
|
See Alternate test #9 |
|
| |
|
|
|
| SD100 |
|
|
|
| Traditional school district |
|
|
|
| Nonresident |
|
Change to part-year resident (if supported) or see Alternate Test #9 |
|
| Ohio Alt Test #9 |
|
|
IT1040WithSD100 |
| Taxpayer Information |
|
Description |
|
| TaxpayerSSN |
|
Primary Social Security Number |
400-XX-7609 |
| FirstName |
|
Primary First Name |
PAQUITA SUNITA |
| LastName |
|
Primary Last Name |
JEFFERSON-WILLOUGHBY |
| DateOfBirth |
|
Date of Birth - Primary |
1966-06-30 |
| |
|
|
|
| TaxpayerSSN |
|
Spouse's Social Security Number |
400-XX-7659 |
| FirstName |
|
Spouse First Name |
JEFFREY |
| LastName |
|
Spouse Last Name |
JEFFERSON |
| DateOfBirth |
|
Date of Birth - Spouse |
1969-10-10 |
| |
|
|
|
| USPhone |
|
Taxpayer's Phone Number |
[<=9999999]###-#### |
| EmailAddress |
|
Taxpayer's E-mail Address |
JEFFERSON@TAX.GOV |
| |
|
|
|
| AddressLine1Txt |
|
Address Line 1 |
12345 REFUGEE RD |
| CityNm |
|
City |
WEEHAWKEN |
| StateAbbreviationCd |
|
State |
NJ |
| ZIPCd |
|
Zip Code |
07086 |
| |
|
|
|
| MailingAddressCounty |
|
Ohio County |
LOGAN |
| SchoolDistrictNumber |
|
Ohio Public School District Number - Resident District |
1105 |
| |
|
|
|
| Preparer Information |
|
|
|
| Self-Prepared |
|
|
|
| SelfPrepared |
|
Return is self-prepared |
X |
| |
|
|
|
| Income Statements |
|
|
|
| W-2 #1 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
319876543-0000000 |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
WEARABLE GARMENTS MFG |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
2 WASHINGTON CIR |
| CityNm |
|
City |
WEST LIBERTY |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43357 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7609 |
| EmployeNm |
|
Employee's Name |
PAQUITA SUNITA JEFFERSON-WILLOUGHBY |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
12345 REFUGEE RD |
| CityNm |
|
City |
WEEHAWKEN |
| StateAbbreviationCd |
|
State |
NJ |
| ZIPCd |
|
Zip Code |
07086 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$106,963.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$38,000.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$106,963.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$6,632.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$106,963.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$1,551.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
54656565 |
| StateWagesAmt |
|
State Wages |
$106,963.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$6,700.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$106,963.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$554.00 |
| LocalityNm |
|
Name of Locality |
WEST LIBERTY |
| |
|
|
|
| W-2 #2 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
319876543-0000000 |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
WEARABLE GARMENTS MFG |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
2 WASHINGTON CIR |
| CityNm |
|
City |
WEST LIBERTY |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43357 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7659 |
| EmployeeNm |
|
Employee's Name |
JEFFREY JEFFERSON |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
12345 REFUGEE RD |
| CityNm |
|
City |
WEEHAWKEN |
| StateAbbreviationCd |
|
State |
NJ |
| ZIPCd |
|
Zip Code |
07086 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$47,000.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$5,000.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$47,000.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$2,914.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$47,000.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$682.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
54-656565 |
| StateWagesAmt |
|
State Wages |
$47,000.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$1,450.00 |
| |
|
|
|
| SchoolDistrictWages |
|
School District Wages |
$47,000.00 |
| SchoolDistrictTaxWithheld |
|
School District Tax Withheld |
$875.00 |
| SchoolDistrictNumber |
|
School District # |
1105 |
| |
|
|
|
| W-2 #3 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
310987654-####### |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
AMERICAN ELECTRIC POWER INC |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
123 POWER STREET |
| CityNm |
|
City |
WEEHAWKEN |
| StateAbbreviationCd |
|
State |
NJ |
| ZIPCd |
|
Zip Code |
07086 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7659 |
| EmployeNm |
|
Employee's Name |
JEFFREY JEFFERSON |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
12345 REFUGEE RD |
| CityNm |
|
City |
WEEHAWKEN |
| StateAbbreviationCd |
|
State |
NJ |
| ZIPCd |
|
Zip Code |
07086 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$3,000.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$300.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$3,000.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$186.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$3,000.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$44.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
51-654321 |
| StateWagesAmt |
|
State Wages |
$3,000.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$50.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$3,000.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$30.00 |
| LocalityNm |
|
Name of Locality |
CLEVELAND |
| |
|
|
|
| Return Information |
|
|
|
| Federal Return Data |
|
|
|
| |
|
Filing Status |
Married Filing Joint |
| |
|
Exemptions, Self |
2 |
| |
|
Total Wages, Salaries, Tips, etc. |
$156,963.00 |
| |
|
Federal Sch. B: Total Taxable Interest and Ordinary Dividends - Business Income |
$500.00 |
| |
|
Federal Sch. C: Total Profit or (Loss) From Business (Sole Proprietership) |
($5,000.00) |
| |
|
Federal Sch. D: Total Taxable Capital Gains and Losses - Business Income |
$4,000.00 |
| |
|
Federal Sch. E: Total Supplemental Income and Loss - Business Income |
($6,000.00) |
| |
|
Federal Sch. F: Total Profit or Loss From Farming |
$15,275.00 |
| |
|
Other Business Income (Loss) |
($6,000.00) |
| |
|
Self Employment Tax Deduction |
($726.00) |
| |
|
Adjusted Gross Income |
$159,012.00 |
| |
|
Earned Income Tax Credit |
$0.00 |
| State Return Data |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| FilingStatus |
|
|
|
| MarriedFilingJointly |
|
|
X |
| |
|
|
|
| Did you file federal extension Form 4868? |
|
|
No |
| |
|
|
|
| Did you take the Standard deduction or itemize? |
|
|
Standard |
| |
|
|
|
| Can someone else claim you (or your spouse) as a dependent? |
|
|
|
| ClaimedAsDependent |
|
|
No |
| |
|
|
|
| Residency Status |
|
|
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| SpouseResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| JointFilingCredit |
|
Eligible for JFC? |
Yes |
| |
|
|
|
| Additional Information |
|
|
|
| TuitionExpenseReimbursement |
|
Non-Education Expenditures from College Savings Account |
$9,150.00 |
| |
|
|
|
| SD Return # 1 Information |
|
|
|
| SchoolDistrictNumber |
|
What is the school district number for which you are filing the SD 100? |
1105 |
| TaxType |
|
Tax Type |
Traditional |
| |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| Residency Status |
|
School district residency |
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| SD Return # 1 - Additional Information |
|
|
|
| |
|
Estimated Payments |
$1,600.00 |
| |
|
|
|
| Return |
|
|
|
| IT1040 - Pages 1 & 2 |
| FederalAdjustedGrossIncome |
1 |
Federal Adjusted Gross Income |
$159,012.00 |
| TotalIncomeAddition |
2a |
Additions to federal adjusted gross income |
$9,150.00 |
| TotalIncomeDeduction |
2b |
Deductions from federal adjusted gross income |
$2,775.00 |
| OhioAdjustedGrossIncome |
3 |
Ohio Adjusted Gross Income (OAGI) |
$165,387.00 |
| ExemptionDeduction |
4 |
Personal and dependent exemption deduction |
$3,800.00 |
| TaxableIncome |
5 |
Ohio income tax base |
$161,587.00 |
| TaxableBusinessIncome |
6 |
Taxable business income (Ohio IT BUS, line 13) |
$0.00 |
| TaxableIncomeLessBusinessIncome |
7 |
Line 5 minus line 6 (if less than 0, enter 0) |
$161,587.00 |
| |
7a |
Amount from line 7 on page 1 |
$161,587.00 |
| NonBusinessIncomeTaxLiability |
8a |
Nonbusiness income tax liability |
$5,101.00 |
| BusinessIncomeTaxLiability |
8b |
Business income tax liability (Ohio IT BUS, line 14) |
$0.00 |
| IncomeTaxLiabilityBeforeCredits |
8c |
Income tax liability before credits (line 8a plus 8b) |
$5,101.00 |
| OhioNonRefundableCredits |
9 |
Ohio nonrefundable credits |
$255.00 |
| TaxLiabAfterNonrefundableCrdt |
10 |
Tax liability after nonrefundable credits |
$4,846.00 |
| UnderPaymentInterestPenalty |
11 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| UnpaidUseTax |
12 |
Sales and use tax due on Internet, mail order or other out-of-state purchases |
$0.00 |
| TotalTaxLiability |
13 |
Total Ohio tax liability before withholding or estimated payments |
$4,846.00 |
| TaxWithheld |
14 |
Ohio income tax withheld |
$8,200.00 |
| InstallmentPayment |
15 |
Add the Ohio estimated & extension payments & credit carryforward from previous year return |
$0.00 |
| RefundableTaxCredits |
16 |
Refundable credits |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
17 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayment |
18 |
Total Ohio Tax Payments |
$8,200.00 |
| OverpymtRecdOnOrigAmendRtn |
19 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
20 |
Line 18 minus line 19 |
$8,200.00 |
| AmountUnderpaid |
21 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
22 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
23 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
24 |
Overpayment |
$3,354.00 |
| OverpymtCreditedNextYear |
25 |
Original return only - amount of line 24 to be carried forward to next year's tax liability |
$0.00 |
| CharityOrgName |
26a |
Amount of line 24 to be donated - Military injury relief |
$0.00 |
| CharityOrgName |
26b |
Amount of line 24 to be donated - Ohio History Fund |
$0.00 |
| CharityOrgName |
26c |
Amount of line 24 to be donated - Nature Preserves/Scenic Rivers |
$0.00 |
| CharityOrgName |
26d |
Amount of line 24 to be donated - Breast/cervical cancer |
$0.00 |
| CharityOrgName |
26e |
Amount of line 24 to be donated - Wishes for sick children |
$0.00 |
| CharityOrgName |
26f |
Amount of line 24 to be donated - Wildlife species |
$0.00 |
| TotalDonation |
26g |
Total |
$0.00 |
| Refund |
27 |
Your Refund |
$3,354.00 |
| |
|
|
|
| Schedule of Adjustments |
| Additions |
|
|
|
| NonOhioAndLocalGovIntAndDiv |
1 |
Non-Ohio state or local government interest and dividends |
$0.00 |
| PassThruEntityTaxesPaid |
2 |
Certain Ohio pass-through entity and financial institutions taxes paid |
$0.00 |
| TuitionExpenseReimbursement |
3 |
Reimbursement of college tutition expenses and fees deducted in any previous year(s) and noneducation expenditures from a college savings account |
$9,150.00 |
| SaleAndDispstnLossOfOhioOblig |
4 |
Losses from sale or disposition of Ohio public obligations |
$0.00 |
| NonMedicalWithdrawals |
5 |
Nonmedical withdrawals from a medical savings account |
$0.00 |
| ReimExpPrevDeducted |
6 |
Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if the reimbursement is not in federal adjusted gross income |
$0.00 |
| IRC168And179AdjAdd |
7 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| FederalInterestAndDividends |
8 |
Federal interest and dividends subject to state taxation |
$0.00 |
| FederalConformityAdditions |
9 |
Federal conformity additions |
$0.00 |
| TotalIncomeAddition |
10 |
Total additions |
$9,150.00 |
| |
|
|
|
| Deductions |
|
|
|
| BusinessIncomeDeduction |
11 |
Business income deduction (attach Ohio Schedule IT BUS, line 11) |
$2,775.00 |
| OHFullYrEmpCompEarnNeighState |
12 |
Employee compensation earned in Ohio by residents of neighboring states |
$0.00 |
| IRS1040StateMuniIncomeOverpymt |
13 |
State or municipal income tax overpayments shown on the federal 1040, Sch 1, line 1 |
$0.00 |
| SocialSecurityBenefits |
14 |
Taxable Social Security benefits |
$0.00 |
| RailroadRetirementBenefits |
15 |
Certain railroad retirement benefits |
$0.00 |
| ObligIntrstPublicServicePay |
16 |
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 state of Ohio or income from a transfer agreement |
$0.00 |
| IndDevAcct |
17 |
Amounts contributed to an individual development account |
$0.00 |
| STABLEAcct |
18 |
Amounts contributed to STABLE account; Ohio's ABLE plan |
$0.00 |
| OutOfStateDisasterWorkIncome |
19 |
Income earned in Ohio by a qualifying out-of-state business or employee for disaster work conducted during a disaster response period |
$0.00 |
| FederalIntAndDivExempt |
20 |
Federal interest and dividends exempt from state taxation |
$0.00 |
| IRC168And179AdjDed |
21 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| IRS1040RefundOrReimbursements |
22 |
Refund or reimbursements shown on the federal 1040, schedule 1 for itemized deductions claimed on a prior year federal income tax return |
$0.00 |
| RepaymentOfIncomeReported |
23 |
Repayment of income reported in a prior year |
$0.00 |
| NotDeductedWageExpense |
24 |
Wage expense not deducted due to claiming the federal work opportunity credit |
$0.00 |
| FederalConformityDeductions |
25 |
Federal conformity deductions |
$0.00 |
| MilitaryPayForResident |
26 |
Military pay for Ohio residents received while the military member was stationed outside Ohio |
$0.00 |
| IncomeErndMilitCivilianNRSpouse |
27 |
Certain income earned by military nonresidents and civilian nonresident spouses |
$0.00 |
| UniformedServcsRetirmtIncome |
28 |
Uniformed services retirement income |
$0.00 |
| MilitaryInjuryReliefFund |
29 |
Military injury relief fund |
$0.00 |
| NationalGuardReimAndBenft |
30 |
Certain Ohio National Guard reimbursements and benefits |
$0.00 |
| CollegeAdvSavAndTuitPurchCred |
31 |
Ohio 529 contributions, tuition credit purchases |
$0.00 |
| PellOhioCollegeOppTaxableGrant |
32 |
Pell/Ohio College Opportunity taxable grant amounts used to pay room and board |
$0.00 |
| OhioEducatorExpenses |
33 |
Ohio educator expenses in excess of federal deduction |
$0.00 |
| DisabilityBenefits |
34 |
Disability benefits |
$0.00 |
| SurvivorBenefits |
35 |
Survivor benefits |
$0.00 |
| UnsubsidizedMedicalExpense |
36 |
Unreimbursed long-term care insurance premiums, unsubsidized health care insurance premiums and excess health care expenses (see instructions for worksheet) |
$0.00 |
| HealthCareDepositedFunds |
37 |
Funds deposited into, and earnings of, a medical savings account for eligible health care expenses (see instructions for worksheet) |
$0.00 |
| QualOrganDonorExp |
38 |
Qualified organ donor expenses |
$0.00 |
| TotalIncomeDeduction |
39 |
Total deductions |
$2,775.00 |
| |
|
|
|
| Schedule IT BUS |
|
|
|
| |
|
Part 1 |
|
| BusScheduleB |
1 |
Sch B - Interest and Ordinary Dividends |
$500.00 |
| BusScheduleC |
2 |
Sch C - Profit or Loss From Business (Sole Proprietership) |
($5,000.00) |
| BusScheduleD |
3 |
Sch D - Capital Gains and Losses |
$4,000.00 |
| BusScheduleE |
4 |
Sch E - Supplemental Income and Loss |
($6,000.00) |
| GuaranteedPayments |
5 |
Guranteed payments, compensation and/or wages from each pass-through entity in which you have at least a 20% direct or indirect ownership interest |
$0.00 |
| BusScheduleF |
6 |
Sch F - Profit or Loss From Farming |
$15,275.00 |
| OtherItemsOfIncome |
7 |
Other items of income and gain separately stated on federal Schedule K-1, federal 4797 gains and/or losses reported on federal 4797 and miscellaneous federal income tax adjustments, if any |
($6,000.00) |
| TotalOfBusinessIncome |
8 |
Total of business income (add lines 1 through 7) |
$2,775.00 |
| |
|
Part 2 |
|
| AllBusinessIncome |
9 |
All business income (enter the lesser of line 8 above or Ohio IT1040, line 1). If zero or negative, stop here and do not complete Part 3. |
$2,775.00 |
| FilingStatusBusIncAmt |
10 |
Enter $250,000 if single or MFJ, enter $125,000 if MFS |
$250,000.00 |
| LessOfFilStatBusIncAmtOrAllBusInc |
11 |
Lesser of line 9 or line 10. Enter here and on Ohio Schedule of Adjustments, line 11 |
$2,775.00 |
| |
|
Part 3 |
|
| AllBusIncLessBusIncDeduction |
12 |
Line 9 minus line 11 (if less than -0-, enter -0-) |
$0.00 |
| TaxableBusinessIncome |
13 |
Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5) |
$0.00 |
| BusinessIncomeTaxLiability |
14 |
Business income tax liability. Multiply line 13 by 3%. Enter here and on Ohio IT 1040, line 8b. |
$0.00 |
| |
|
Part 4 |
|
| NameOfEntity |
|
Name of Entity |
JOE'S FARM |
| FEINOrSSN |
|
FEIN/SS# |
621987654-####### |
| PercentageOfOwnership |
|
Percentage of Ownership |
.0500 |
| Income Earned By Primary |
|
Primary |
X |
| |
|
|
|
| Schedule of Credits - Nonrefundable |
| TaxLiabilityBeforeCredits |
1 |
Tax liability before credits (From IT1040, line 8c) |
$5,101.00 |
| RetireIncomeCredit |
2 |
Retirement income credit (limit $200 per return) |
$0.00 |
| LumpSumRetirementCredit |
3 |
Lump sum retirement credit (include Ohio LS WKS, line 6) |
$0.00 |
| SeniorCitizenCredit |
4 |
Senior citizen credit |
$0.00 |
| LumpSumDistributionCredit |
5 |
Lump sum distribution credit (include Ohio LS WKS, line 3) |
$0.00 |
| ChildAndDependCareCredit |
6 |
Child care and dependent care credit (see the worksheet in the instructions) |
$0.00 |
| DisplacedWorkerTrainingCredit |
7 |
Displaced worker training credit (see the worksheet in the instructions) |
$0.00 |
| CampaignContributionCredit |
8 |
Campaign contribution credit |
$0.00 |
| ExemptionCredit |
9 |
Income-based exemption credit |
$0.00 |
| TotCreditsBeforeJointFiling |
10 |
Total (add lines 2 through 9) |
$0.00 |
| TaxLessCredit |
11 |
Tax less credits (line 1 minus line 10; if less than -0-, enter -0-) |
$5,101.00 |
| JointFilingCredit |
12 |
Joint filing credit |
$255.00 |
| EarnedIncomeCredit |
13 |
Earned income credit (multiply Fed EITC by 30%) |
$0.00 |
| HomeSchoolExpensesCredit |
14 |
Home school expenses credit |
$0.00 |
| ScholarshipDonationCredit |
15 |
Scholarship donation credit |
$0.00 |
| NonCharterOrPublicSchoolCredit |
16 |
Nonchartered, nonpublic school tuition credit |
$0.00 |
| VocationalJobCredit |
17 |
Vocational job credit |
$0.00 |
| AdoptionCredit |
18 |
Ohio adoption credit |
$0.00 |
| JobRetentionCredit |
19 |
Nonrefundable job retention credit |
$0.00 |
| NewEmpInEntZoneCredit |
20 |
Credit for eligible new employees in an enterprise zone |
$0.00 |
| GrapeProdPropertyPurchCredit |
21 |
Credit for purchases of grape production property |
$0.00 |
| InvestOhioCredit |
22 |
InvestOhio credit |
$0.00 |
| LeadAbatementCredit |
23 |
Lead abatement credit |
$0.00 |
| OpportunityZoneCredit |
24 |
Opportunity zone investment credit |
$0.00 |
| TechInvestCreditCarryfrwd |
25 |
Technology investment credit carryforward |
$0.00 |
| EntZoneDayCareAndTrngCredit |
26 |
Enterprise zone day care and training credits |
$0.00 |
| ResearchAndDevelopmentCredit |
27 |
Research and development credit |
$0.00 |
| OhioHistoricPreservationCredit |
28 |
Nonrefundable Ohio historic preservation credit |
$0.00 |
| TotAdditionalCredits |
29 |
Total (add lines 12 through 28) |
$255.00 |
| TaxLessCrdtMinusTotAddlCrdts |
30 |
Tax less additional credits (line 11 minus line 29; if less than -0-, enter -0-) |
$4,846.00 |
| |
|
Nonresident Credit |
|
| NonOhioIncome |
31 |
Nonresident Portion of Ohio adjusted gross income |
$0.00 |
| OhioAdjustedGrossIncome |
32 |
Ohio adjusted gross income |
$0.00 |
| NonResIncomeCreditRatio |
33a |
Divide line 31 by line 32 |
0.0000 |
| NonresidentAndPartYearCredit |
33 |
Nonresident credit (line 30 times line 33a) |
$0.00 |
| |
|
Resident Credit |
|
| ResidentTaxCredit |
34 |
Resident Credit - Ohio IT RC, line 7 |
$0.00 |
| TotalNonrefundableCredits |
35 |
Total nonrefundable credits |
$255.00 |
| |
|
|
|
| Schedule of Credits - Refundable |
| HistoricPreservationCredit |
36 |
Refundable Ohio historic preservation credit |
$0.00 |
| JobCreationAndJobRetentionCrd |
37 |
Refundable job creation credit & job retention credit |
$0.00 |
| PassthroughEntityCredit |
38 |
Pass-through entity credit |
$0.00 |
| MotionPictureProductionCredit |
39 |
Motion Picture & Broadway theatrical production credit |
$0.00 |
| VentureCapitalCredit |
40 |
Venture Capital credit |
$0.00 |
| TotalRefundableCredit |
41 |
Total refundable credits |
$0.00 |
| |
|
|
|
| School District Return (#1105) |
|
|
|
| SchoolDistrictTaxableIncome |
1 |
School district taxable income: Traditional or Earned Income tax base |
$164,362.00 |
| TaxAmount |
2 |
School District Tax .____ times line 1. |
$2,876.00 |
| SeniorCitizenCredit |
3 |
Senior Citizen Credit |
$0.00 |
| TaxLessCredit |
4 |
School District Income Tax liability |
$2,876.00 |
| UnderPaymentInterestPenalty |
5 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| TotalTax |
6 |
Total school district income tax liability (line 4 plus line 5) |
$2,876.00 |
| TotalTax |
6a |
Amount from line 6, page 1 |
$2,876.00 |
| TaxWithheld |
7 |
School district income tax withheld |
$875.00 |
| InstallmentPayments |
8 |
SD 100 ES & SD 40P, Extension Payments and Credit carryforward from previous year return |
$1,600.00 |
| AmtPrevPaidWithOrigAmendRtn |
9 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayments |
10 |
Total school district income tax payments (add lines 7, 8 and 9) |
$2,475.00 |
| OverpymtRecdOnOrigAmendRtn |
11 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
12 |
Line 10 minus line 11. Place a negative sign ("-") in the box if the amount is less than -0- |
$2,475.00 |
| AmountUnderpaid |
13 |
Tax due |
$401.00 |
| InterestDueOnLatePayment |
14 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
15 |
Total Amount Due |
$401.00 |
| AmountOverpaid |
16 |
Overpayment |
$0.00 |
| OverpymtCreditedNextYear |
17 |
Original return only - amount of line 16 to be carried forward to next year's tax liability |
$0.00 |
| Refund |
18 |
Your Refund |
$0.00 |
| Traditional Tax Base School District Amounts |
|
|
|
| TaxableIncome |
19 |
Ohio income tax base (Ohio IT 1040, line 3 minus line 4) |
$161,587.00 |
| BusinessIncomeDeductionAddback |
20 |
Business income deduction add-back |
$2,775.00 |
| TotalTraditionalSDIncome |
21 |
Total Traditional Tax Base School District Income (Line 19 + Line 20) |
$164,362.00 |
| NonResidentIncome |
22 |
Amount of traditional tax base school district income that you earned while not a resident |
$0.00 |
| SchoolDistrictTaxableIncome |
23 |
School District Taxable Income (Enter here and on line 1) |
$164,362.00 |
| Earned Income Tax Base School District Amounts |
|
|
|
| WagesAndOtherCompensations |
24 |
Wages and other compensation as described in the instructions |
$0.00 |
| SelfEmploymentEarnings |
25 |
Net Earnings from Self Employment |
$0.00 |
| FederalConformityAdjustments |
26 |
Federal Conformity Adjustments |
$0.00 |
| SchoolDistrictTaxableIncome |
27 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| |
|
|
|
| What is Tested? |
If you do not support: |
|
| IT1040WithSD100 |
|
|
|
| Self-Prepared |
|
|
|
| MFJ status |
|
|
| Ohio W-2 |
|
|
| |
|
|
|
| IT1040 |
|
|
|
| Full year resident |
|
|
| More than $115,300 tax bracket |
|
|
| 5% joint filing credit |
|
|
| Sch of Adj - Reimbursement of college tuition expenses |
Move amount to a Sch. of Adj addition line you do support |
|
| IT BUS - Additional Business Income |
|
Remove if do not support IT BUS |
|
| IT BUS - Entity ownership |
|
|
|
| |
|
|
|
| SD100 |
|
|
|
| Traditional school district |
|
|
|
| Full year resident |
|
|
|
| Tax due |
|
|
|
| |
|
|
|
| Ohio Test #10 |
|
|
IT1040WithSD100 |
| Taxpayer Information |
|
Description |
|
| TaxpayerSSN |
|
Primary Social Security Number |
400-XX-7610 |
| FirstName |
|
Primary First Name |
CALEB |
| LastName |
|
Primary Last Name |
O'CONNER |
| DateOfBirth |
|
Date of Birth - Primary |
1946-04-15 |
| DateOfDeath |
|
Date of Death - Primary |
2022-12-15 |
| |
|
|
|
| TaxpayerSSN |
|
Spouse's Social Security Number |
400-XX-7660 |
| FirstName |
|
Spouse First Name |
CAITLYN |
| LastName |
|
Spouse Last Name |
O'CONNER |
| DateOfBirth |
|
Date of Birth - Spouse |
1958-11-25 |
| |
|
|
|
| USPhone |
|
Taxpayer's Phone Number |
[<=9999999]###-#### |
| EmailAddress |
|
Taxpayer's E-mail Address |
OCONNER@MSN.COM |
| |
|
|
|
| InCareOfNm |
|
In Care Of Name |
% CAITLYN O'CONNER |
| |
|
|
|
| AddressLine1Txt |
|
Address Line 1 |
30 WOODLAWN AVE |
| CityNm |
|
City |
DELTA |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43515 |
| |
|
|
|
| MailingAddressCounty |
|
Ohio County |
FULTON |
| SchoolDistrictNumber |
|
Ohio Public School District Number - Resident District |
2605 |
| |
|
|
|
| Preparer Information |
|
|
|
| Self-Prepared |
|
|
|
| SelfPrepared |
|
Return is self-prepared |
X |
| |
|
|
|
| Income Statements |
|
|
|
| W-2 #1 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
339876543-0000000 |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
BIRDS UNLMTD |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
25 E 5TH ST |
| AddressLine2Txt |
|
Employer Address Line 2 |
APT 2 |
| CityNm |
|
City |
CANARY |
| StateAbbreviationCd |
|
State |
NE |
| ZIPCd |
|
Zip Code |
68792 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7610 |
| EmployeNm |
|
Employee's Name |
CALEB O'CONNER |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
30 WOODLAWN AVE |
| AddressLine2Txt |
|
Employee Address Line 2 |
|
| CityNm |
|
City |
DELTA |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43515 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$24,500.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$2,125.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$24,500.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$1,519.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$24,500.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$355.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
NE |
| EmployerStateIdNum |
|
State ID Number |
479623 |
| StateWagesAmt |
|
State Wages |
$24,500.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$750.00 |
| |
|
|
|
| W-2 #2 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
343456789-0000000 |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
AAA CORP |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
500 OTTAWA ST |
| AddressLine2Txt |
|
Employer Address Line 2 |
|
| CityNm |
|
City |
DAYTON |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
45402 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7660 |
| EmployeeNm |
|
Employee's Name |
CAITLYN O'CONNER |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
30 WOODLAWN AVE |
| AddressLine2Txt |
|
Employee Address Line 2 |
|
| CityNm |
|
City |
DELTA |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43515 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$105,000.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$1,050.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$105,000.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$6,510.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$105,000.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$1,523.00 |
| |
|
|
|
| StatutoryEmployeeInd |
|
Box 13 |
X |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
51-065432 |
| StateWagesAmt |
|
State Wages |
$105,000.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$372.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$105,000.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$1,411.00 |
| LocalityNm |
|
Name of Locality |
WILLARD |
| |
|
|
|
| 1099R #1 |
|
|
|
| PayerEIN |
|
Payer's Identification Number |
219876543-0000000 |
| PayerName / BusinessNameLine1Txt |
|
Payer's Name |
SUNSET INC |
| |
|
|
|
| AddressLine1Txt |
|
Payer's Address |
98 N OBERLIN DR |
| CityNm |
|
Payer's City |
OBERLIN |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZIPCd |
|
Payer's Zip Code |
44074 |
| |
|
|
|
| RecipientSSN |
|
Recipient's Social Security Number |
400-XX-7610 |
| RecipientNm |
|
Recipient's Name |
CALEB O'CONNER |
| AddressLine1Txt |
|
Recipient's Address Line 1 |
30 WOODLAWN AVE |
| AddressLine2Txt |
|
Recipient's Address Line 2 |
|
| CityNm |
|
Recipient's City |
DELTA |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
43515 |
| |
|
|
|
| GrossDistributionAmt |
|
Gross Distribution Amount |
$5,900.00 |
| TaxableAmt |
|
Taxable Amount |
$5,900.00 |
| TotalDistributionInd |
|
Total Distribution Indicator |
|
| F1099RDistributionCd |
|
Distribution Code |
7 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| PayerStateIdNum |
|
State Payer ID |
52-234567 |
| StateDistributionAmt |
|
State Distribution |
$5,900.00 |
| StateTaxWithheldAmt |
|
State Income Tax Withheld |
$10.00 |
| |
|
|
|
| 1099R #2 |
|
|
|
| PayerEIN |
|
Payer's Identification Number |
361234567-0000000 |
| PayerName / BusinessNameLine1Txt |
|
Payer's Name |
UNITED STATES RAILROAD RETIREMENT BOARD |
| |
|
|
|
| AddressLine1Txt |
|
Payer's Address |
844 N RUSH ST |
| CityNm |
|
Payer's City |
CHICAGO |
| StateAbbreviationCd |
|
Payer's State |
IL |
| ZIPCd |
|
Payer's Zip Code |
60611 |
| |
|
|
|
| RecipientSSN |
|
Recipient's Social Security Number |
400-XX-7610 |
| RecipientNm |
|
Recipient's Name |
CALEB O'CONNER |
| AddressLine1Txt |
|
Recipient's Address Line 1 |
30 WOODLAWN AVE |
| AddressLine2Txt |
|
Recipient's Address Line 2 |
|
| CityNm |
|
Recipient's City |
DELTA |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
43515 |
| |
|
|
|
| GrossDistributionAmt |
|
Gross Distribution Amount |
$200.00 |
| TaxableAmt |
|
Taxable Amount |
$200.00 |
| TotalDistributionInd |
|
Total Distribution Indicator |
|
| F1099RDistributionCd |
|
Distribution Code |
7 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| PayerStateIdNum |
|
State Payer ID |
51-234567 |
| StateDistributionAmt |
|
State Distribution |
$200.00 |
| StateTaxWithheldAmt |
|
State Income Tax Withheld |
$0.00 |
| |
|
|
|
| W-2G #1 |
|
|
|
| BusinessNameLine1Txt |
|
Payer's Name |
STATE OF OHIO |
| AddressLine1Txt |
|
Payer's Address Line 1 |
1030 E BROAD ST |
| CityNm |
|
Payer's City |
COLUMBUS |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZIPCd |
|
Payer's Zip Code |
43205 |
| |
|
|
|
| PayerEIN |
|
Payer's Identification Number |
359876543-0000000 |
| |
|
|
|
| GamblingReportableWinningAmt |
|
Box 1 Reportable Winnings |
$25,376,355.00 |
| GamblingWinningDt |
|
Box 2 Date Won |
2022-05-30 |
| GambilingWinWagerTypeCd |
|
Box 3 Type of Wager |
LOTTERY |
| FederalIncomeTaxWithheldAmt |
|
Box 4 Federal Income Tax Withheld |
$6,344,089.00 |
| |
|
|
|
| RecipientNm |
|
Recipient's Name |
CAITLYN O'CONNER |
| AddressLine1Txt |
|
Recipient's Address Line 1 |
30 WOODLAWN AVE |
| AddressLine2Txt |
|
Recipient's Address Line 2 |
|
| CityNm |
|
Recipient's City |
DELTA |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
43515 |
| |
|
|
|
| RecipientSSN |
|
Recipient ID Number |
400-XX-7660 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 13 State |
OH |
| PayerStateIdNum |
|
Box 13 State ID Number |
52-345678 |
| GamblingWinningAmt |
|
Box 14 State Winnings |
$25,376,355.00 |
| StateTaxWithheldAmt |
|
Box 15 State Income Tax Withheld |
$761,291.00 |
| |
|
|
|
| Return Information |
|
|
|
| Federal Return Data |
|
|
|
| |
|
Filing Status |
Married Filing Jointly |
| |
|
Exemptions, Self |
2 |
| |
|
Total Wages, Salaries, Tips, etc. |
$24,500.00 |
| |
|
Total Taxable Pensions and Annuities, Includes RR Retirement Benefits |
$6,100.00 |
| |
|
Social Security Benefits, Taxable amount |
$300.00 |
| |
|
Schedule C - Statutory Employee Income |
$105,000.00 |
| |
|
Other Income |
$25,376,355.00 |
| |
|
Adjusted Gross Income |
$25,512,255.00 |
| |
|
|
|
| State Return Data |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| FilingStatus |
|
|
|
| MarriedFilingJointly |
|
|
X |
| |
|
|
|
| Did you file federal extension Form 4868? |
|
|
No |
| |
|
|
|
| Did you take the Standard deduction or itemize? |
|
|
Itemized |
| |
|
|
|
| Can someone else claim you (or your spouse) as a dependent? |
|
|
|
| ClaimedAsDependent |
|
|
No |
| |
|
|
|
| Residency Status |
|
|
|
| PrimaryResidencyStatus |
|
|
|
| PartYearResident |
|
Part-Year Resident |
X |
| ResidentFromDate |
|
First date you were a resident |
2022-05-01 |
| ResidentToDate |
|
Last date you were a resident |
2022-12-31 |
| NonResidentState |
|
State of Residence |
NE |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| JointFilingCredit |
|
Eligible for JFC? |
Yes |
| |
|
|
|
| IT 2210 Interest Penalty Calculation |
|
|
|
| Part I - Calculating the required Annual Payment |
2022 Ohio income tax withheld |
$761,673.00 |
| |
|
2022 Ohio timely estimated payments |
$2,000.00 |
| |
|
2022 Ohio income tax liability |
$1,013,384.00 |
| |
|
2021 Ohio income tax liability |
$800,000.00 |
| |
|
|
|
| Part II - Calculating the Interest Penalty Due |
IT1040-ES made 2022-04-18 |
$500.00 |
| |
|
IT1040-ES made 2022-06-15 |
$500.00 |
| |
|
IT1040-ES made 2022-09-15 |
$500.00 |
| |
|
IT1040-ES made 2023-01-17 |
$500.00 |
| |
|
|
|
| IT Interest Due on Late Payment of Tax Calculation |
|
|
| |
|
Date return was filed |
2023-06-17 |
| AmountUnderpaid |
|
Tax due |
$250,647.00 |
| |
|
|
|
| Additional Information |
|
|
|
| ReimExpPrevDeducted |
|
Reimbursements Previously Deducted but not Included In FAGI |
$650.00 |
| SocSecAndRailroadBenefits |
|
Taxable Social Security benefits |
$300.00 |
| RailroadBenefits |
|
Qualifying Railroad Benefits |
$200.00 |
| ScholarshipDonationCredit |
|
Amounts donated to a designated scholarship granting organization
(credit limited to the lesser of the amount donated or $1500) |
$1,700.00 |
| NonOhioIncome |
|
Nonresident Portion of Ohio adjusted gross income |
$24,500.00 |
| NonResidentState |
|
Non-Ohio Part Year Residency State |
NE |
| |
|
|
|
| SD Return # 1 Information |
|
|
|
| SchoolDistrictNumber |
|
What is the school district number for which you are filing the SD 100? |
2605 |
| TaxType |
|
Tax Type |
Traditional |
| |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| NOLCarryBack |
|
Is the amended return an NOL carryback? |
No |
| |
|
|
|
| Residency Status |
|
School district residency |
|
| PrimaryResidencyStatus |
|
|
|
| PartYearResident |
|
Part-Year Resident |
X |
| ResidentFromDate |
|
First date you were a resident |
2022-05-01 |
| ResidentToDate |
|
Last date you were a resident |
2022-12-31 |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| Additional Information - SD |
|
|
|
| NonResidentIncome |
|
Amount of traditional tax base school district income that you earned while not a resident |
$24,500.00 |
| |
|
|
|
| SD 2210 Interest Penalty Calculation |
|
|
|
| Part I - Calculating the required Annual Payment |
2022 Ohio SD income tax withheld |
$0.00 |
| |
|
2022 Ohio SD timely estimated payments |
$2,000.00 |
| |
|
2022 Ohio SD income tax liability |
$254,791.00 |
| |
|
2021 Ohio SD income tax liability |
$300,000.00 |
| |
|
|
|
| Part II - Calculating the Interest Penalty Due |
SD100-ES made 2022-04-18 |
$500.00 |
| |
|
SD100-ES made 2022-06-15 |
$500.00 |
| |
|
SD100-ES made 2022-09-15 |
$500.00 |
| |
|
SD100-ES made 2023-01-17 |
$500.00 |
| |
|
|
|
| SD Interest Due on Late Payment of Tax Calculation |
|
|
| |
|
Date return was filed |
2023-06-17 |
| AmountUnderpaid |
|
Tax due |
$258,647.00 |
| |
|
|
|
| Voucher Info |
|
|
|
| EstimatedPayment #1 |
|
|
|
| PaymentAmount |
|
Amount |
$2,500.00 |
| AccountHolderName |
|
Account Name |
CALEB O'CONNER |
| RequestedPaymentDate |
|
Payment Date |
2023-04-18 |
| |
|
|
|
| EstimatedPayment#2 |
|
|
|
| PaymentAmount |
|
Amount |
$5,000.00 |
| AccountHolderName |
|
Account Name |
CALEB O'CONNER |
| RequestedPaymentDate |
|
Payment Date |
2023-06-15 |
| |
|
|
|
| EstimatedPayment#3 |
|
|
|
| PaymentAmount |
|
Amount |
$6,000.00 |
| AccountHolderName |
|
Account Name |
CALEB O'CONNER |
| RequestedPaymentDate |
|
Payment Date |
2023-09-15 |
| |
|
|
|
| EstimatedPayment#4 |
|
|
|
| PaymentAmount |
|
Amount |
$7,500.00 |
| AccountHolderName |
|
Account Name |
CALEB O'CONNER |
| RequestedPaymentDate |
|
Payment Date |
2024-01-17 |
| |
|
|
|
| EstimatedPayment #1 - SD |
|
|
|
| PaymentAmount |
|
Amount |
$500.00 |
| AccountHolderName |
|
Account Name |
CALEB O'CONNER |
| RequestedPaymentDate |
|
Payment Date |
2023-04-18 |
| |
|
|
|
| EstimatedPayment#2 - SD |
|
|
|
| PaymentAmount |
|
Amount |
$600.00 |
| AccountHolderName |
|
Account Name |
CALEB O'CONNER |
| RequestedPaymentDate |
|
Payment Date |
2023-06-15 |
| |
|
|
|
| EstimatedPayment#3 - SD |
|
|
|
| PaymentAmount |
|
Amount |
$750.00 |
| AccountHolderName |
|
Account Name |
CALEB O'CONNER |
| RequestedPaymentDate |
|
Payment Date |
2023-09-15 |
| |
|
|
|
| EstimatedPayment#4 - SD |
|
|
|
| PaymentAmount |
|
Amount |
$925.00 |
| AccountHolderName |
|
Account Name |
CALEB O'CONNER |
| RequestedPaymentDate |
|
Payment Date |
2024-01-17 |
| |
|
|
|
| Return |
|
|
|
| IT1040 - Pages 1 & 2 |
| FederalAdjustedGrossIncome |
1 |
Federal Adjusted Gross Income |
$25,512,255.00 |
| TotalIncomeAddition |
2a |
Additions to federal adjusted gross income |
$650.00 |
| TotalIncomeDeduction |
2b |
Deductions from federal adjusted gross income |
$500.00 |
| OhioAdjustedGrossIncome |
3 |
Ohio Adjusted Gross Income (OAGI) |
$25,512,405.00 |
| ExemptionDeduction |
4 |
Personal and dependent exemption deduction |
$3,800.00 |
| TaxableIncome |
5 |
Ohio income tax base |
$25,508,605.00 |
| TaxableBusinessIncome |
6 |
Taxable business income (Ohio IT BUS, line 13) |
$0.00 |
| TaxableIncomeLessBusinessIncome |
7 |
Line 5 minus line 6 (if less than 0, enter 0) |
$25,508,605.00 |
| |
7a |
Amount from line 7 on page 1 |
$25,508,605.00 |
| NonBusinessIncomeTaxLiability |
8a |
Nonbusiness income tax liability |
$1,016,447.00 |
| BusinessIncomeTaxLiability |
8b |
Business income tax liability (Ohio IT BUS, line 14) |
$0.00 |
| IncomeTaxLiabilityBeforeCredits |
8c |
Income tax liability before credits (line 8a plus 8b) |
$1,016,447.00 |
| OhioNonRefundableCredits |
9 |
Ohio nonrefundable credits |
$3,063.00 |
| TaxLiabAfterNonrefundableCrdt |
10 |
Tax liability after nonrefundable credits |
$1,013,384.00 |
| UnderPaymentInterestPenalty |
11 |
Interest penalty on underpayment of estimated tax |
$936.00 |
| UnpaidUseTax |
12 |
Sales and use tax due on Internet, mail order or other out-of-state purchases |
$0.00 |
| TotalTaxLiability |
13 |
Total Ohio tax liability before withholding or estimated payments |
$1,014,320.00 |
| TaxWithheld |
14 |
Ohio income tax withheld |
$761,673.00 |
| InstallmentPayment |
15 |
Add the Ohio estimated & extension payments & credit carryforward from previous year return |
$2,000.00 |
| RefundableTaxCredits |
16 |
Refundable credits |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
17 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayment |
18 |
Total Ohio Tax Payments |
$763,673.00 |
| OverpymtRecdOnOrigAmendRtn |
19 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
20 |
Line 18 minus line 19 |
$763,673.00 |
| AmountUnderpaid |
21 |
Tax due |
$250,647.00 |
| InterestDueOnLatePayment |
22 |
Interest due on late payment of tax |
$2,094.00 |
| BalanceDue |
23 |
Total Amount Due |
$252,741.00 |
| AmountOverpaid |
24 |
Overpayment |
$0.00 |
| OverpymtCreditedNextYear |
25 |
Original return only - amount of line 24 to be carried forward to next year's tax liability |
$0.00 |
| CharityOrgName |
26a |
Amount of line 24 to be donated - Wildlife species |
$0.00 |
| CharityOrgName |
26b |
Amount of line 24 to be donated - Military injury relief |
$0.00 |
| CharityOrgName |
26c |
Amount of line 24 to be donated - Ohio History Fund |
$0.00 |
| CharityOrgName |
26d |
Amount of line 24 to be donated - Nature Preserves/Scenic Rivers |
$0.00 |
| CharityOrgName |
26e |
Amount of line 24 to be donated - Breast/cervical cancer |
$0.00 |
| CharityOrgName |
26f |
Amount of line 24 to be donated - Wishes for sick children |
$0.00 |
| TotalDonation |
26g |
Total |
$0.00 |
| Refund |
27 |
Your Refund |
$0.00 |
| |
|
|
|
| Schedule of Adjustments |
| Additions |
|
|
|
| NonOhioAndLocalGovIntAndDiv |
1 |
Non-Ohio state or local government interest and dividends |
$0.00 |
| PassThruEntityTaxesPaid |
2 |
Certain Ohio pass-through entity and financial institutions taxes paid |
$0.00 |
| TuitionExpenseReimbursement |
3 |
Reimbursement of college tutition expenses and fees deducted in any previous year(s) and noneducation expenditures from a college savings account |
$0.00 |
| SaleAndDispstnLossOfOhioOblig |
4 |
Losses from sale or disposition of Ohio public obligations |
$0.00 |
| NonMedicalWithdrawals |
5 |
Nonmedical withdrawals from a medical savings account |
$0.00 |
| ReimExpPrevDeducted |
6 |
Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if the reimbursement is not in federal adjusted gross income |
$650.00 |
| IRC168And179AdjAdd |
7 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| FederalInterestAndDividends |
8 |
Federal interest and dividends subject to state taxation |
$0.00 |
| FederalConformityAdditions |
9 |
Federal conformity additions |
$0.00 |
| TotalIncomeAddition |
10 |
Total additions |
$650.00 |
| |
|
|
|
| Deductions |
|
|
|
| BusinessIncomeDeduction |
11 |
Business income deduction (attach Ohio Schedule IT BUS, line 11) |
$0.00 |
| OHFullYrEmpCompEarnNeighState |
12 |
Employee compensation earned in Ohio by residents of neighboring states |
$0.00 |
| IRS1040StateMuniIncomeOverpymt |
13 |
State or municipal income tax overpayments shown on the federal 1040, Sch 1, line 1 |
$0.00 |
| SocialSecurityBenefits |
14 |
Taxable Social Security benefits |
$300.00 |
| RailroadRetirementBenefits |
15 |
Certain railroad retirement benefits |
$200.00 |
| ObligIntrstPublicServicePay |
16 |
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 state of Ohio or income from a transfer agreement |
$0.00 |
| IndDevAcct |
17 |
Amounts contributed to an individual development account |
$0.00 |
| STABLEAcct |
18 |
Amounts contributed to STABLE account; Ohio's ABLE plan |
$0.00 |
| OutOfStateDisasterWorkIncome |
19 |
Income earned in Ohio by a qualifying out-of-state business or employee for disaster work conducted during a disaster response period |
$0.00 |
| FederalIntAndDivExempt |
20 |
Federal interest and dividends exempt from state taxation |
$0.00 |
| IRC168And179AdjDed |
21 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| IRS1040RefundOrReimbursements |
22 |
Refund or reimbursements shown on the federal 1040, schedule 1 for itemized deductions claimed on a prior year federal income tax return |
$0.00 |
| RepaymentOfIncomeReported |
23 |
Repayment of income reported in a prior year |
$0.00 |
| NotDeductedWageExpense |
24 |
Wage expense not deducted due to claiming the federal work opportunity credit |
$0.00 |
| FederalConformityDeductions |
25 |
Federal conformity deductions |
$0.00 |
| MilitaryPayForResident |
26 |
Military pay for Ohio residents received while the military member was stationed outside Ohio |
$0.00 |
| IncomeErndMilitCivilianNRSpouse |
27 |
Certain income earned by military nonresidents and civilian nonresident spouses |
$0.00 |
| UniformedServcsRetirmtIncome |
28 |
Uniformed services retirement income |
$0.00 |
| MilitaryInjuryReliefFund |
29 |
Military injury relief fund |
$0.00 |
| NationalGuardReimAndBenft |
30 |
Certain Ohio National Guard reimbursements and benefits |
$0.00 |
| CollegeAdvSavAndTuitPurchCred |
31 |
Ohio 529 contributions, tuition credit purchases |
$0.00 |
| PellOhioCollegeOppTaxableGrant |
32 |
Pell/Ohio College Opportunity taxable grant amounts used to pay room and board |
$0.00 |
| OhioEducatorExpenses |
33 |
Ohio educator expenses in excess of federal deduction |
$0.00 |
| DisabilityBenefits |
34 |
Disability benefits |
$0.00 |
| SurvivorBenefits |
35 |
Survivor benefits |
$0.00 |
| UnsubsidizedMedicalExpense |
36 |
Unreimbursed long-term care insurance premiums, unsubsidized health care insurance premiums and excess health care expenses (see instructions for worksheet) |
$0.00 |
| HealthCareDepositedFunds |
37 |
Funds deposited into, and earnings of, a medical savings account for eligible health care expenses (see instructions for worksheet) |
$0.00 |
| QualOrganDonorExp |
38 |
Qualified organ donor expenses |
$0.00 |
| TotalIncomeDeduction |
39 |
Total deductions |
$500.00 |
| |
|
|
|
| Schedule IT BUS |
|
|
|
| |
|
Part 1 |
|
| BusScheduleB |
1 |
Sch B - Interest and Ordinary Dividends |
$0.00 |
| BusScheduleC |
2 |
Sch C - Profit or Loss From Business (Sole Proprietership) |
$0.00 |
| BusScheduleD |
3 |
Sch D - Capital Gains and Losses |
$0.00 |
| BusScheduleE |
4 |
Sch E - Supplemental Income and Loss |
$0.00 |
| GuaranteedPayments |
5 |
Guranteed payments, compensation and/or wages from each pass-through entity in which you have at least a 20% direct or indirect ownership interest |
$0.00 |
| BusScheduleF |
6 |
Sch F - Profit or Loss From Farming |
$0.00 |
| OtherItemsOfIncome |
7 |
Other items of income and gain separately stated on federal Schedule K-1, federal 4797 gains and/or losses reported on federal 4797 and miscellaneous federal income tax adjustments, if any |
$0.00 |
| TotalOfBusinessIncome |
8 |
Total of business income (add lines 1 through 7) |
$0.00 |
| |
|
Part 2 |
|
| AllBusinessIncome |
9 |
All business income (enter the lesser of line 8 above or Ohio IT1040, line 1). If zero or negative, stop here and do not complete Part 3. |
$0.00 |
| FilingStatusBusIncAmt |
10 |
Enter $250,000 if single or MFJ, enter $125,000 if MFS |
$0.00 |
| LessOfFilStatBusIncAmtOrAllBusInc |
11 |
Lesser of line 9 or line 10. Enter here and on Ohio Schedule of Adjustments, line 11 |
$0.00 |
| |
|
Part 3 |
|
| AllBusIncLessBusIncDeduction |
12 |
Line 9 minus line 11 (if less than -0-, enter -0-) |
$0.00 |
| TaxableBusinessIncome |
13 |
Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5) |
$0.00 |
| BusinessIncomeTaxLiability |
14 |
Business income tax liability. Multiply line 13 by 3%. Enter here and on Ohio IT 1040, line 8b. |
$0.00 |
| |
|
Part 4 |
|
| NameOfEntity |
1 |
Name of Entity |
|
| FEINOrSSN |
|
FEIN/SS# |
|
| PercentageOfOwnership |
|
Percentage of Ownership |
|
| Income Earned By Primary |
|
Primary |
|
| Income Earned By Spouse |
|
Spouse |
|
| |
|
|
|
| Schedule of Credits - Nonrefundable |
| TaxLiabilityBeforeCredits |
1 |
Tax liability before credits (From IT1040, line 8c) |
$1,016,447.00 |
| RetireIncomeCredit |
2 |
Retirement income credit (limit $200 per return) |
$0.00 |
| LumpSumRetirementCredit |
3 |
Lump sum retirement credit (include Ohio LS WKS, line 6) |
$0.00 |
| SeniorCitizenCredit |
4 |
Senior citizen credit |
$0.00 |
| LumpSumDistributionCredit |
5 |
Lump sum distribution credit (include Ohio LS WKS, line 3) |
$0.00 |
| ChildAndDependCareCredit |
6 |
Child care and dependent care credit (see the worksheet in the instructions) |
$0.00 |
| DisplacedWorkerTrainingCredit |
7 |
Displaced worker training credit (see the worksheet in the instructions) |
$0.00 |
| CampaignContributionCredit |
8 |
Campaign contribution credit |
$0.00 |
| ExemptionCredit |
9 |
Income-based exemption credit |
$0.00 |
| TotCreditsBeforeJointFiling |
10 |
Total (add lines 2 through 9) |
$0.00 |
| TaxLessCredit |
11 |
Tax less credits (line 1 minus line 10; if less than -0-, enter -0-) |
$1,016,447.00 |
| JointFilingCredit |
12 |
Joint filing credit |
$650.00 |
| EarnedIncomeCredit |
13 |
Earned income credit (multiply Fed EITC by 30%) |
$0.00 |
| HomeSchoolExpensesCredit |
14 |
Home school expenses credit |
$0.00 |
| ScholarshipDonationCredit |
15 |
Scholarship donation credit |
$1,500.00 |
| NonCharterOrPublicSchoolCredit |
16 |
Nonchartered, nonpublic school tuition credit |
$0.00 |
| VocationalJobCredit |
17 |
Vocational job credit |
$0.00 |
| AdoptionCredit |
18 |
Ohio adoption credit |
$0.00 |
| JobRetentionCredit |
19 |
Nonrefundable job retention credit |
$0.00 |
| NewEmpInEntZoneCredit |
20 |
Credit for eligible new employees in an enterprise zone |
$0.00 |
| GrapeProdPropertyPurchCredit |
21 |
Credit for purchases of grape production property |
$0.00 |
| InvestOhioCredit |
22 |
InvestOhio credit |
$0.00 |
| LeadAbatementCredit |
23 |
Lead abatement credit |
$0.00 |
| OpportunityZoneCredit |
24 |
Opportunity zone investment credit |
$0.00 |
| TechInvestCreditCarryfrwd |
25 |
Technology investment credit carryforward |
$0.00 |
| EntZoneDayCareAndTrngCredit |
26 |
Enterprise zone day care and training credits |
$0.00 |
| ResearchAndDevelopmentCredit |
27 |
Research and development credit |
$0.00 |
| OhioHistoricPreservationCredit |
28 |
Nonrefundable Ohio historic preservation credit |
$0.00 |
| TotAdditionalCredits |
29 |
Total (add lines 12 through 28) |
$2,150.00 |
| TaxLessCrdtMinusTotAddlCrdts |
30 |
Tax less additional credits (line 11 minus line 29; if less than -0-, enter -0-) |
$1,014,297.00 |
| |
|
Nonresident Credit |
|
| NonOhioIncome |
31 |
Nonresident Portion of Ohio adjusted gross income |
$24,500.00 |
| OhioAdjustedGrossIncome |
32 |
Ohio adjusted gross income |
$25,512,405.00 |
| NonResIncomeCreditRatio |
33a |
Divide line 31 by line 32 |
0.0009 |
| NonresidentAndPartYearCredit |
33 |
Nonresident credit (line 30 times line 33a) |
$913.00 |
| |
|
Resident Credit |
|
| ResidentTaxCredit |
34 |
Resident Credit - Ohio IT RC, line 7 |
$0.00 |
| TotalNonrefundableCredits |
35 |
Total nonrefundable credits |
$3,063.00 |
| |
|
|
|
| Schedule of Credits - Refundable |
| HistoricPreservationCredit |
36 |
Refundable Ohio historic preservation credit |
$0.00 |
| JobCreationAndJobRetentionCrd |
37 |
Refundable job creation credit & job retention credit |
$0.00 |
| PassthroughEntityCredit |
38 |
Pass-through entity credit |
$0.00 |
| MotionPictureProductionCredit |
39 |
Motion Picture & Broadway theatrical production credit |
$0.00 |
| VentureCapitalCredit |
40 |
Venture Capital credit |
$0.00 |
| TotalRefundableCredit |
41 |
Total refundable credits |
$0.00 |
| |
|
|
|
| School District Return (#2605) |
|
|
|
| SchoolDistrictTaxableIncome |
1 |
School district taxable income: Traditional or Earned Income tax base |
$25,484,105.00 |
| TaxAmount |
2 |
School District Tax .____ times line 1. |
$254,841.00 |
| SeniorCitizenCredit |
3 |
Senior Citizen Credit |
$50.00 |
| TaxLessCredit |
4 |
School District Income Tax liability |
$254,791.00 |
| UnderPaymentInterestPenalty |
5 |
Interest penalty on underpayment of estimated tax |
$5,856.00 |
| TotalTax |
6 |
Total school district income tax liability (line 4 plus line 5) |
$260,647.00 |
| TotalTax |
6a |
Amount from line 6, page 1 |
$260,647.00 |
| TaxWithheld |
7 |
School district income tax withheld |
$0.00 |
| InstallmentPayments |
8 |
SD 100 ES & SD 40P, Extension Payments and Credit carryforward from previous year return |
$2,000.00 |
| AmtPrevPaidWithOrigAmendRtn |
9 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayments |
10 |
Total school district income tax payments (add lines 7, 8 and 9) |
$2,000.00 |
| OverpymtRecdOnOrigAmendRtn |
11 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
12 |
Line 10 minus line 11. Place a negative sign ("-") in the box if the amount is less than -0- |
$2,000.00 |
| AmountUnderpaid |
13 |
Tax due |
$258,647.00 |
| InterestDueOnLatePayment |
14 |
Interest due on late payment of tax |
$2,161.00 |
| BalanceDue |
15 |
Total Amount Due |
$260,808.00 |
| AmountOverpaid |
16 |
Overpayment |
$0.00 |
| OverpymtCreditedNextYear |
17 |
Original return only - amount of line 16 to be carried forward to next year's tax liability |
$0.00 |
| Refund |
18 |
Your Refund |
$0.00 |
| Traditional Tax Base School District Amounts |
|
|
|
| TaxableIncome |
19 |
Ohio income tax base (Ohio IT 1040, line 3 minus line 4) |
$25,508,605.00 |
| BusinessIncomeDeductionAddback |
20 |
Business income deduction add-back |
$0.00 |
| TotalTraditionalSDIncome |
21 |
Total Traditional Tax Base School District Income (Line 19 + Line 20) |
$25,508,605.00 |
| NonResidentIncome |
22 |
Amount of traditional tax base school district income that you earned while not a resident |
$24,500.00 |
| SchoolDistrictTaxableIncome |
23 |
School District Taxable Income (Enter here and on line 1) |
$25,484,105.00 |
| Earned Income Tax Base School District Amounts |
|
|
|
| WagesAndOtherCompensations |
24 |
Wages and other compensation as described in the instructions |
$0.00 |
| SelfEmploymentEarnings |
25 |
Net Earnings from Self Employment |
$0.00 |
| FederalConformityAdjustments |
26 |
Federal Conformity Adjustments |
$0.00 |
| SchoolDistrictTaxableIncome |
27 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| |
|
|
|
| What is Tested? |
|
If you do not support: |
|
| IT1040WithSD100 |
|
|
|
| Self Prepared |
|
|
|
| MFJ status |
|
|
|
| W-2 |
|
|
|
| W-2G |
|
If you do not support the large amount, split into multiple W-2Gs. |
|
| 1099-R |
|
|
|
| 2022 Estimated Payments - IT |
|
Do not provide |
|
| 2022 Estimated Payments - SD |
|
Do not provide |
|
| |
|
|
|
| IT1040 |
|
|
|
| Primary - Part-year resident |
|
If part-year residency status is not supported, see Alternate Test #10 |
|
| Spouse - Full year resident |
|
If different residency statuses are not supported, change the spouse to a part-year resident |
|
| [more than $115,300] tax bracket |
|
|
|
| Maximum joint filing credit ($650) |
|
|
|
| Sch. of Adj - Reimbursement of expenses |
|
Move amount to a Sch. of Adj addition line you do support |
|
| Sch. of Adj - Taxable Social Security benefits |
|
Move amount to a Sch. of Adj deduction line you do support |
|
| Sch. of Adj - Certain railroad retirement benefits |
|
Move amount to a Sch. of Adj deduction line you do support |
|
| Means Testing on Retirement Income and Senior Citizen Credits |
|
|
|
| Sch of Credits - Scholarship donation credit |
|
Remove if not able to support in testing |
|
| Sch of Credits - Nonresident credit |
|
See Alternate Test #10 |
|
| 2210 Underpayment Interest penalty |
|
|
|
| Interest on late payment of tax due |
|
Remove if not able to support in testing |
|
| Tax due |
|
|
|
| |
|
|
|
| SD100 |
|
|
|
| Primary - Part-year resident |
|
See Alternate Test #10 |
|
| Spouse - Full year resident |
|
|
|
| 2210 Underpayment Interest penalty |
|
|
|
| Interest on late payment of tax due |
|
Remove if not able to support in testing |
|
| Tax due |
|
|
|
| Ohio Alt Test #10 |
|
|
IT1040WithSD100 |
| Taxpayer Information |
|
Description |
|
| TaxpayerSSN |
|
Primary Social Security Number |
400-XX-7610 |
| FirstName |
|
Primary First Name |
CALEB |
| LastName |
|
Primary Last Name |
O'CONNER |
| DateOfBirth |
|
Date of Birth - Primary |
1946-04-15 |
| DateOfDeath |
|
Date of Death - Primary |
2022-12-15 |
| |
|
|
|
| TaxpayerSSN |
|
Spouse's Social Security Number |
400-XX-7660 |
| FirstName |
|
Spouse First Name |
CAITLYN |
| LastName |
|
Spouse Last Name |
O'CONNER |
| DateOfBirth |
|
Date of Birth - Spouse |
1957-11-25 |
| |
|
|
|
| USPhone |
|
Taxpayer's Phone Number |
[<=9999999]###-#### |
| EmailAddress |
|
Taxpayer's E-mail Address |
OCONNER@MSN.COM |
| |
|
|
|
| InCareOfNm |
|
In Care Of Name |
% CAITLYN O'CONNER |
| |
|
|
|
| AddressLine1Txt |
|
Address Line 1 |
30 WOODLAWN AVE |
| CityNm |
|
City |
DELTA |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43515 |
| |
|
|
|
| MailingAddressCounty |
|
Ohio County |
FULTON |
| SchoolDistrictNumber |
|
Ohio Public School District Number - Resident District |
2605 |
| |
|
|
|
| Preparer Information |
|
|
|
| Self-Prepared |
|
|
|
| SelfPrepared |
|
Return is self-prepared |
X |
| |
|
|
|
| Income Statements |
|
|
|
| W-2 #1 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
339876543-0000000 |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
BIRDS UNLMTD |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
25 E 5TH ST |
| AddressLine2Txt |
|
Employer Address Line 2 |
APT 2 |
| CityNm |
|
City |
CANARY |
| StateAbbreviationCd |
|
State |
NE |
| ZIPCd |
|
Zip Code |
68792 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7610 |
| EmployeNm |
|
Employee's Name |
CALEB O'CONNER |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
30 WOODLAWN AVE |
| CityNm |
|
City |
DELTA |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43515 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$24,500.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$2,125.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$24,500.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$1,519.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$24,500.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$355 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
51479623 |
| StateWagesAmt |
|
State Wages |
$24,500.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$750.00 |
| |
|
|
|
| W-2 #2 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
343456789-0000000 |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
AAA CORP |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
500 OTTAWA ST |
| AddressLine2Txt |
|
Employer Address Line 2 |
|
| CityNm |
|
City |
DAYTON |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
45402 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7660 |
| EmployeeNm |
|
Employee's Name |
CAITLYN O'CONNER |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
30 WOODLAWN AVE |
| CityNm |
|
City |
DELTA |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43515 |
| |
|
|
|
| StatutoryEmployeeInd |
|
Box 13 |
X |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$105,000.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$1,050.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$105,000.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$6,510.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$105,000.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$1,523.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
51-065432 |
| StateWagesAmt |
|
State Wages |
$105,000.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$372.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$105,000.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$1,411.00 |
| LocalityNm |
|
Name of Locality |
WILLARD |
| |
|
|
|
| 1099R #1 |
|
|
|
| PayerEIN |
|
Payer's Identification Number |
219876543-0000000 |
| PayerName / BusinessNameLine1Txt |
|
Payer's Name |
SUNSET INC |
| |
|
|
|
| AddressLine1Txt |
|
Payer's Address |
98 N OBERLIN DR |
| CityNm |
|
Payer's City |
OBERLIN |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZIPCd |
|
Payer's Zip Code |
44074 |
| |
|
|
|
| RecipientSSN |
|
Recipient's Social Security Number |
400-XX-7610 |
| RecipientNm |
|
Recipient's Name |
CALEB O'CONNER |
| AddressLine1Txt |
|
Recipient's Address Line 1 |
30 WOODLAWN AVE |
| CityNm |
|
Recipient's City |
DELTA |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
43515 |
| |
|
|
|
| GrossDistributionAmt |
|
Gross Distribution Amount |
$5,900.00 |
| TaxableAmt |
|
Taxable Amount |
$5,900.00 |
| F1099RDistributionCd |
|
Distribution Code |
7 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| PayerStateIdNum |
|
State Payer ID |
52-234567 |
| StateDistributionAmt |
|
State Distribution |
$5,900.00 |
| StateTaxWithheldAmt |
|
State Income Tax Withheld |
$10.00 |
| |
|
|
|
| 1099R #2 |
|
|
|
| PayerEIN |
|
Payer's Identification Number |
361234567-0000000 |
| PayerName / BusinessNameLine1Txt |
|
Payer's Name |
UNITED STATES RAILROAD RETIREMENT BOARD |
| |
|
|
|
| AddressLine1Txt |
|
Payer's Address |
844 N RUSH ST |
| CityNm |
|
Payer's City |
CHICAGO |
| StateAbbreviationCd |
|
Payer's State |
IL |
| ZIPCd |
|
Payer's Zip Code |
60611 |
| |
|
|
|
| RecipientSSN |
|
Recipient's Social Security Number |
400-XX-7610 |
| RecipientNm |
|
Recipient's Name |
CALEB O'CONNER |
| AddressLine1Txt |
|
Recipient's Address Line 1 |
30 WOODLAWN AVE |
| CityNm |
|
Recipient's City |
DELTA |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
43515 |
| |
|
|
|
| GrossDistributionAmt |
|
Gross Distribution Amount |
$200.00 |
| TaxableAmt |
|
Taxable Amount |
$200.00 |
| F1099RDistributionCd |
|
Distribution Code |
7 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| PayerStateIdNum |
|
State Payer ID |
51-234567 |
| StateDistributionAmt |
|
State Distribution |
$200.00 |
| StateTaxWithheldAmt |
|
State Income Tax Withheld |
$0.00 |
| |
|
|
|
| W-2G #1 |
|
|
|
| BusinessNameLine1Txt |
|
Payer's Name |
STATE OF OHIO |
| AddressLine1Txt |
|
Payer's Address Line 1 |
1030 E BROAD ST |
| CityNm |
|
Payer's City |
COLUMBUS |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZIPCd |
|
Payer's Zip Code |
43205 |
| |
|
|
|
| PayerEIN |
|
Payer's Identification Number |
359876543-0000000 |
| |
|
|
|
| GamblingReportableWinningAmt |
|
Box 1 Reportable Winnings |
$25,376,355.00 |
| GamblingWinningDt |
|
Box 2 Date Won |
2022-05-30 |
| GambilingWinWagerTypeCd |
|
Box 3 Type of Wager |
LOTTERY |
| FederalIncomeTaxWithheldAmt |
|
Box 4 Federal Income Tax Withheld |
$6,344,089 |
| |
|
|
|
| RecipientNm |
|
Recipient's Name |
CAITLYN O'CONNER |
| AddressLine1Txt |
|
Recipient's Address Line 1 |
30 WOODLAWN AVE |
| CityNm |
|
Recipient's City |
DELTA |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
43515 |
| |
|
|
|
| RecipientSSN |
|
Recipient ID Number |
400-XX-7660 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 13 State |
OH |
| PayerStateIdNum |
|
Box 13 State ID Number |
52-345678 |
| GamblingWinningAmt |
|
Box 14 State Winnings |
$25,376,355.00 |
| StateTaxWithheldAmt |
|
Box 15 State Income Tax Withheld |
$761,291.00 |
| |
|
|
|
| Return Information |
|
|
|
| Federal Return Data |
|
|
|
| |
|
Filing Status |
Married Filing Joint |
| |
|
Exemptions, Self |
2 |
| |
|
Total Wages, Salaries, Tips, etc. |
$24,500.00 |
| |
|
Total Taxable Pensions and Annuities, Includes RR Retirement Benefits |
$6,100.00 |
| |
|
Social Security Benefits, Taxable amount |
$300.00 |
| |
|
Schedule C - Statutory Employee Income |
$105,000.00 |
| |
|
Other Income |
$25,376,355.00 |
| |
|
Adjusted Gross Income |
$25,512,255.00 |
| |
|
Earned Income Tax Credit |
$0.00 |
| State Return Data |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| FilingStatus |
|
|
|
| MarriedFilingJointly |
|
|
X |
| |
|
|
|
| Did you file federal extension Form 4868? |
|
|
No |
| |
|
|
|
| Did you take the Standard deduction or itemize? |
|
|
Itemized |
| |
|
|
|
| Can someone else claim you (or your spouse) as a dependent? |
|
|
|
| ClaimedAsDependent |
|
|
No |
| |
|
|
|
| Residency Status |
|
|
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| JointFilingCredit |
|
Eligible for JFC? |
Yes |
| |
|
|
|
| IT 2210 Interest Penalty Calculation |
|
|
|
| Part I - Calculating the required Annual Payment |
2022 Ohio income tax withheld |
$762,423.00 |
| |
|
2022 Ohio timely estimated payments |
$2,000.00 |
| |
|
2022 Ohio income tax liability |
$1,014,297.00 |
| |
|
2021 Ohio income tax liability |
$800,000.00 |
| |
|
|
|
| Part II - Calculating the Interest Penalty Due |
IT1040-ES made 2022-04-18 |
$500.00 |
| |
|
IT1040-ES made 2022-06-15 |
$500.00 |
| |
|
IT1040-ES made 2022-09-15 |
$500.00 |
| |
|
IT1040-ES made 2023-01-17 |
$500.00 |
| |
|
|
|
| IT Interest Due on Late Payment of Tax Calculation |
|
|
| |
|
Date return was filed |
2023-06-17 |
| AmountUnderpaid |
|
Tax due |
$250,644.00 |
| |
|
|
|
| Additional Information |
|
|
|
| |
|
|
|
| ReimExpPrevDeducted |
|
Reimbursements Previously Deducted but not Included In FAGI |
$650.00 |
| SocSecAndRailroadBenefits |
|
Taxable Social Security benefits |
$300.00 |
| RailroadBenefits |
|
Qualifying Railroad Benefits |
$200.00 |
| ScholarshipDonationCredit |
|
Amounts donated to a designated scholarship granting organization
(credit limited to the lesser of the amount donated or $1500) |
$1,700.00 |
| |
|
|
|
| SD Return # 1 Information |
|
|
|
| SchoolDistrictNumber |
|
What is the school district number for which you are filing the SD 100? |
2605 |
| TaxType |
|
Tax Type |
Traditional |
| |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| Residency Status |
|
School district residency |
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| SD 2210 Interest Penalty Calculation |
|
|
|
| |
|
|
|
| Part I - Calculating the required Annual Payment |
2022 Ohio SD income tax withheld |
$0.00 |
| |
|
2022 Ohio SD timely estimated payments |
$2,000.00 |
| |
|
2022 Ohio SD income tax liability |
$255,036.00 |
| |
|
2021 Ohio SD income tax liability |
$300,000.00 |
| |
|
|
|
| Part II - Calculating the Interest Penalty Due |
SD100-ES made 2022-04-18 |
$500.00 |
| |
|
SD100-ES made 2022-06-15 |
$500.00 |
| |
|
SD100-ES made 2022-09-15 |
$500.00 |
| |
|
SD100-ES made 2023-01-17 |
$500.00 |
| |
|
|
|
| SD Interest Due on Late Payment of Tax Calculation |
|
|
| |
|
Date return was filed |
2023-06-17 |
| AmountUnderpaid |
|
Tax due |
$257,615.00 |
| |
|
|
|
| Voucher Info |
|
|
|
| EstimatedPayment #1 |
|
|
|
| PaymentAmount |
|
Amount |
$2,500.00 |
| AccountHolderName |
|
Account Name |
CALEB O'CONNER |
| RequestedPaymentDate |
|
Payment Date |
2023-04-18 |
| |
|
|
|
| EstimatedPayment#2 |
|
|
|
| PaymentAmount |
|
Amount |
$5,000.00 |
| AccountHolderName |
|
Account Name |
CALEB O'CONNER |
| RequestedPaymentDate |
|
Payment Date |
2023-06-15 |
| |
|
|
|
| EstimatedPayment#3 |
|
|
|
| PaymentAmount |
|
Amount |
$6,000.00 |
| AccountHolderName |
|
Account Name |
CALEB O'CONNER |
| RequestedPaymentDate |
|
Payment Date |
2023-09-15 |
| |
|
|
|
| EstimatedPayment#4 |
|
|
|
| PaymentAmount |
|
Amount |
$7,500.00 |
| AccountHolderName |
|
Account Name |
CALEB O'CONNER |
| RequestedPaymentDate |
|
Payment Date |
2024-01-17 |
| |
|
|
|
| EstimatedPayment #1 - SD |
|
|
|
| PaymentAmount |
|
Amount |
$500.00 |
| AccountHolderName |
|
Account Name |
CALEB O'CONNER |
| RequestedPaymentDate |
|
Payment Date |
2023-04-18 |
| |
|
|
|
| EstimatedPayment#2 - SD |
|
|
|
| PaymentAmount |
|
Amount |
$600.00 |
| AccountHolderName |
|
Account Name |
CALEB O'CONNER |
| RequestedPaymentDate |
|
Payment Date |
2023-06-15 |
| |
|
|
|
| EstimatedPayment#3 - SD |
|
|
|
| PaymentAmount |
|
Amount |
$750.00 |
| AccountHolderName |
|
Account Name |
CALEB O'CONNER |
| RequestedPaymentDate |
|
Payment Date |
2023-09-15 |
| |
|
|
|
| EstimatedPayment#4 - SD |
|
|
|
| PaymentAmount |
|
Amount |
$925.00 |
| AccountHolderName |
|
Account Name |
CALEB O'CONNER |
| RequestedPaymentDate |
|
Payment Date |
2024-01-17 |
| |
|
|
|
| Return |
|
|
|
| IT1040 - Pages 1 & 2 |
| FederalAdjustedGrossIncome |
1 |
Federal Adjusted Gross Income |
$25,512,255.00 |
| TotalIncomeAddition |
2a |
Additions to federal adjusted gross income |
$650.00 |
| TotalIncomeDeduction |
2b |
Deductions from federal adjusted gross income |
$500.00 |
| OhioAdjustedGrossIncome |
3 |
Ohio Adjusted Gross Income (OAGI) |
$25,512,405.00 |
| ExemptionDeduction |
4 |
Personal and dependent exemption deduction |
$3,800.00 |
| TaxableIncome |
5 |
Ohio income tax base |
$25,508,605.00 |
| TaxableBusinessIncome |
6 |
Taxable business income (Ohio IT BUS, line 13) |
$0.00 |
| TaxableIncomeLessBusinessIncome |
7 |
Line 5 minus line 6 (if less than 0, enter 0) |
$25,508,605.00 |
| |
7a |
Amount from line 7 on page 1 |
$25,508,605.00 |
| NonBusinessIncomeTaxLiability |
8a |
Nonbusiness income tax liability |
$1,016,447.00 |
| BusinessIncomeTaxLiability |
8b |
Business income tax liability (Ohio IT BUS, line 14) |
$0.00 |
| IncomeTaxLiabilityBeforeCredits |
8c |
Income tax liability before credits (line 8a plus 8b) |
$1,016,447.00 |
| OhioNonRefundableCredits |
9 |
Ohio nonrefundable credits |
$2,150.00 |
| TaxLiabAfterNonrefundableCrdt |
10 |
Tax liability after nonrefundable credits |
$1,014,297.00 |
| UnderPaymentInterestPenalty |
11 |
Interest penalty on underpayment of estimated tax |
$917.00 |
| UnpaidUseTax |
12 |
Sales and use tax due on Internet, mail order or other out-of-state purchases |
$0.00 |
| TotalTaxLiability |
13 |
Total Ohio tax liability before withholding or estimated payments |
$1,015,214.00 |
| TaxWithheld |
14 |
Ohio income tax withheld |
$762,423.00 |
| InstallmentPayment |
15 |
Add the Ohio estimated & extension payments & credit carryforward from previous year return |
$2,000.00 |
| RefundableTaxCredits |
16 |
Refundable credits |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
17 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayment |
18 |
Total Ohio Tax Payments |
$764,423.00 |
| OverpymtRecdOnOrigAmendRtn |
19 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
20 |
Line 18 minus line 19 |
$764,423.00 |
| AmountUnderpaid |
21 |
Tax due |
$250,791.00 |
| InterestDueOnLatePayment |
22 |
Interest due on late payment of tax |
$2,096.00 |
| BalanceDue |
23 |
Total Amount Due |
$252,887.00 |
| AmountOverpaid |
24 |
Overpayment |
$0.00 |
| OverpymtCreditedNextYear |
25 |
Original return only - amount of line 24 to be carried forward to next year's tax liability |
$0.00 |
| CharityOrgName |
26a |
Amount of line 24 to be donated - Wildlife species |
$0.00 |
| CharityOrgName |
26b |
Amount of line 24 to be donated - Military injury relief |
$0.00 |
| CharityOrgName |
26c |
Amount of line 24 to be donated - Ohio History Fund |
$0.00 |
| CharityOrgName |
26d |
Amount of line 24 to be donated - Nature Preserves/Scenic Rivers |
$0.00 |
| CharityOrgName |
26e |
Amount of line 24 to be donated - Breast/cervical cancer |
$0.00 |
| CharityOrgName |
26a |
Amount of line 24 to be donated - Wishes for sick children |
$0.00 |
| TotalDonation |
26g |
Total |
$0.00 |
| Refund |
27 |
Your Refund |
$0.00 |
| |
|
|
|
| Schedule of Adjustments |
| Additions |
|
|
|
| NonOhioAndLocalGovIntAndDiv |
1 |
Non-Ohio state or local government interest and dividends |
$0.00 |
| PassThruEntityTaxesPaid |
2 |
Certain Ohio pass-through entity and financial institutions taxes paid |
$0.00 |
| TuitionExpenseReimbursement |
3 |
Reimbursement of college tutition expenses and fees deducted in any previous year(s) and noneducation expenditures from a college savings account |
$0.00 |
| SaleAndDispstnLossOfOhioOblig |
4 |
Losses from sale or disposition of Ohio public obligations |
$0.00 |
| NonMedicalWithdrawals |
5 |
Nonmedical withdrawals from a medical savings account |
$0.00 |
| ReimExpPrevDeducted |
6 |
Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if the reimbursement is not in federal adjusted gross income |
$650.00 |
| IRC168And179AdjAdd |
7 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| FederalInterestAndDividends |
8 |
Federal interest and dividends subject to state taxation |
$0.00 |
| FederalConformityAdditions |
9 |
Federal conformity additions |
$0.00 |
| TotalIncomeAddition |
10 |
Total additions |
$650.00 |
| |
|
|
|
| Deductions |
|
|
|
| BusinessIncomeDeduction |
11 |
Business income deduction (attach Ohio Schedule IT BUS, line 11) |
$0.00 |
| OHFullYrEmpCompEarnNeighState |
12 |
Employee compensation earned in Ohio by residents of neighboring states |
$0.00 |
| IRS1040StateMuniIncomeOverpymt |
13 |
State or municipal income tax overpayments shown on the federal 1040, Sch 1, line 1 |
$0.00 |
| SocialSecurityBenefits |
14 |
Taxable Social Security benefits |
$300.00 |
| RailroadRetirementBenefits |
15 |
Certain railroad retirement benefits |
$200.00 |
| ObligIntrstPublicServicePay |
16 |
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 state of Ohio or income from a transfer agreement |
$0.00 |
| IndDevAcct |
17 |
Amounts contributed to an individual development account |
$0.00 |
| STABLEAcct |
18 |
Amounts contributed to STABLE account; Ohio's ABLE plan |
$0.00 |
| OutOfStateDisasterWorkIncome |
19 |
Income earned in Ohio by a qualifying out-of-state business or employee for disaster work conducted during a disaster response period |
$0.00 |
| FederalIntAndDivExempt |
20 |
Federal interest and dividends exempt from state taxation |
$0.00 |
| IRC168And179AdjDed |
21 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| IRS1040RefundOrReimbursements |
22 |
Refund or reimbursements shown on the federal 1040, schedule 1 for itemized deductions claimed on a prior year federal income tax return |
$0.00 |
| RepaymentOfIncomeReported |
23 |
Repayment of income reported in a prior year |
$0.00 |
| NotDeductedWageExpense |
24 |
Wage expense not deducted due to claiming the federal work opportunity credit |
$0.00 |
| FederalConformityDeductions |
25 |
Federal conformity deductions |
$0.00 |
| MilitaryPayForResident |
26 |
Military pay for Ohio residents received while the military member was stationed outside Ohio |
$0.00 |
| IncomeErndMilitCivilianNRSpouse |
27 |
Certain income earned by military nonresidents and civilian nonresident spouses |
$0.00 |
| UniformedServcsRetirmtIncome |
28 |
Uniformed services retirement income |
$0.00 |
| MilitaryInjuryReliefFund |
29 |
Military injury relief fund |
$0.00 |
| NationalGuardReimAndBenft |
30 |
Certain Ohio National Guard reimbursements and benefits |
$0.00 |
| CollegeAdvSavAndTuitPurchCred |
31 |
Ohio 529 contributions, tuition credit purchases |
$0.00 |
| PellOhioCollegeOppTaxableGrant |
32 |
Pell/Ohio College Opportunity taxable grant amounts used to pay room and board |
$0.00 |
| OhioEducatorExpenses |
33 |
Ohio educator expenses in excess of federal deduction |
$0.00 |
| DisabilityBenefits |
34 |
Disability benefits |
$0.00 |
| SurvivorBenefits |
35 |
Survivor benefits |
$0.00 |
| UnsubsidizedMedicalExpense |
36 |
Unreimbursed long-term care insurance premiums, unsubsidized health care insurance premiums and excess health care expenses (see instructions for worksheet) |
$0.00 |
| HealthCareDepositedFunds |
37 |
Funds deposited into, and earnings of, a medical savings account for eligible health care expenses (see instructions for worksheet) |
$0.00 |
| QualOrganDonorExp |
38 |
Qualified organ donor expenses |
$0.00 |
| TotalIncomeDeduction |
39 |
Total deductions |
$500.00 |
| |
|
|
|
| Schedule IT BUS |
|
|
|
| |
|
Part 1 |
|
| BusScheduleB |
1 |
Sch B - Interest and Ordinary Dividends |
$0.00 |
| BusScheduleC |
2 |
Sch C - Profit or Loss From Business (Sole Proprietership) |
$0.00 |
| BusScheduleD |
3 |
Sch D - Capital Gains and Losses |
$0.00 |
| BusScheduleE |
4 |
Sch E - Supplemental Income and Loss |
$0.00 |
| GuaranteedPayments |
5 |
Guranteed payments, compensation and/or wages from each pass-through entity in which you have at least a 20% direct or indirect ownership interest |
$0.00 |
| BusScheduleF |
6 |
Sch F - Profit or Loss From Farming |
$0.00 |
| OtherItemsOfIncome |
7 |
Other items of income and gain separately stated on federal Schedule K-1, federal 4797 gains and/or losses reported on federal 4797 and miscellaneous federal income tax adjustments, if any |
$0.00 |
| TotalOfBusinessIncome |
8 |
Total of business income (add lines 1 through 7) |
$0.00 |
| |
|
Part 2 |
|
| AllBusinessIncome |
9 |
All business income (enter the lesser of line 8 above or Ohio IT1040, line 1). If zero or negative, stop here and do not complete Part 3. |
$0.00 |
| FilingStatusBusIncAmt |
10 |
Enter $250,000 if single or MFJ, enter $125,000 if MFS |
$0.00 |
| LessOfFilStatBusIncAmtOrAllBusInc |
11 |
Lesser of line 9 or line 10. Enter here and on Ohio Schedule of Adjustments, line 11 |
$0.00 |
| |
|
Part 3 |
|
| AllBusIncLessBusIncDeduction |
12 |
Line 9 minus line 11 (if less than -0-, enter -0-) |
$0.00 |
| TaxableBusinessIncome |
13 |
Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5) |
$0.00 |
| BusinessIncomeTaxLiability |
14 |
Business income tax liability. Multiply line 13 by 3%. Enter here and on Ohio IT 1040, line 8b. |
$0.00 |
| |
|
|
|
| Schedule of Credits - Nonrefundable |
| TaxLiabilityBeforeCredits |
1 |
Tax liability before credits (From IT1040, line 8c) |
$1,016,447.00 |
| RetireIncomeCredit |
2 |
Retirement income credit (limit $200 per return) |
$0.00 |
| LumpSumRetirementCredit |
3 |
Lump sum retirement credit (include Ohio LS WKS, line 6) |
$0.00 |
| SeniorCitizenCredit |
4 |
Senior citizen credit |
$0.00 |
| LumpSumDistributionCredit |
5 |
Lump sum distribution credit (include Ohio LS WKS, line 3) |
$0.00 |
| ChildAndDependCareCredit |
6 |
Child care and dependent care credit (see the worksheet in the instructions) |
$0.00 |
| DisplacedWorkerTrainingCredit |
7 |
Displaced worker training credit (see the worksheet in the instructions) |
$0.00 |
| CampaignContributionCredit |
8 |
Campaign contribution credit |
$0.00 |
| ExemptionCredit |
9 |
Income-based exemption credit |
$0.00 |
| TotCreditsBeforeJointFiling |
10 |
Total (add lines 2 through 9) |
$0.00 |
| TaxLessCredit |
11 |
Tax less credits (line 1 minus line 10; if less than -0-, enter -0-) |
$1,016,447.00 |
| JointFilingCredit |
12 |
Joint filing credit |
$650.00 |
| EarnedIncomeCredit |
13 |
Earned income credit (multiply Fed EITC by 30%) |
$0.00 |
| HomeSchoolExpensesCredit |
14 |
Home school expenses credit |
$0.00 |
| ScholarshipDonationCredit |
15 |
Scholarship donation credit |
$1,500.00 |
| NonCharterOrPublicSchoolCredit |
16 |
Nonchartered, nonpublic school tuition credit |
$0.00 |
| VocationalJobCredit |
17 |
Vocational job credit |
$0.00 |
| AdoptionCredit |
18 |
Ohio adoption credit |
$0.00 |
| JobRetentionCredit |
19 |
Nonrefundable job retention credit |
$0.00 |
| NewEmpInEntZoneCredit |
20 |
Credit for eligible new employees in an enterprise zone |
$0.00 |
| GrapeProdPropertyPurchCredit |
21 |
Credit for purchases of grape production property |
$0.00 |
| InvestOhioCredit |
22 |
InvestOhio credit |
$0.00 |
| LeadAbatementCredit |
23 |
Lead abatement credit |
$0.00 |
| OpportunityZoneCredit |
24 |
Opportunity zone investment credit |
$0.00 |
| TechInvestCreditCarryfrwd |
25 |
Technology investment credit carryforward |
$0.00 |
| EntZoneDayCareAndTrngCredit |
26 |
Enterprise zone day care and training credits |
$0.00 |
| ResearchAndDevelopmentCredit |
27 |
Research and development credit |
$0.00 |
| OhioHistoricPreservationCredit |
28 |
Nonrefundable Ohio historic preservation credit |
$0.00 |
| TotAdditionalCredits |
29 |
Total (add lines 12 through 27) |
$2,150.00 |
| TaxLessCrdtMinusTotAddlCrdts |
30 |
Tax less additional credits (line 11 minus line 28; if less than -0-, enter -0-) |
$1,014,297.00 |
| |
|
Nonresident Credit |
|
| NonOhioIncome |
31 |
Nonresident Portion of Ohio adjusted gross income |
$0.00 |
| OhioAdjustedGrossIncome |
32 |
Ohio adjusted gross income |
$0.00 |
| NonResIncomeCreditRatio |
33a |
Divide line 30 by line 31 |
0.0000 |
| NonresidentAndPartYearCredit |
33 |
Nonresident credit (line 29 times line 32a) |
$0.00 |
| |
|
Resident Credit |
|
| ResidentTaxCredit |
34 |
Resident Credit - Ohio IT RC, line 7 |
$0.00 |
| TotalNonrefundableCredits |
35 |
Total nonrefundable credits |
$2,150.00 |
| |
|
|
|
| Schedule of Credits - Refundable |
| HistoricPreservationCredit |
36 |
Refundable Ohio historic preservation credit |
$0.00 |
| JobCreationAndJobRetentionCrd |
37 |
Refundable job creation credit & job retention credit |
$0.00 |
| PassthroughEntityCredit |
38 |
Pass-through entity credit |
$0.00 |
| MotionPictureProductionCredit |
39 |
Motion Picture & Broadway theatrical production credit |
$0.00 |
| VentureCapitalCredit |
40 |
Venture Capital credit |
$0.00 |
| TotalRefundableCredit |
41 |
Total refundable credits |
$0.00 |
| |
|
|
|
| School District Return (#2605) |
|
|
|
| SchoolDistrictTaxableIncome |
1 |
School district taxable income: Traditional or Earned Income tax base |
$25,508,605.00 |
| TaxAmount |
2 |
School District Tax .____ times line 1. |
$255,086.00 |
| SeniorCitizenCredit |
3 |
Senior Citizen Credit |
$50.00 |
| TaxLessCredit |
4 |
School District Income Tax liability |
$255,036.00 |
| UnderPaymentInterestPenalty |
5 |
Interest penalty on underpayment of estimated tax |
$5,862.00 |
| TotalTax |
6 |
Total school district income tax liability (line 4 plus line 5) |
$260,898.00 |
| TotalTax |
6a |
Amount from line 6, page 1 |
$260,898.00 |
| TaxWithheld |
7 |
School district income tax withheld |
$0.00 |
| InstallmentPayments |
8 |
SD 100 ES & SD 40P, Extension Payments and Credit carryforward from previous year return |
$2,000.00 |
| AmtPrevPaidWithOrigAmendRtn |
9 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayments |
10 |
Total school district income tax payments (add lines 7, 8 and 9) |
$2,000.00 |
| OverpymtRecdOnOrigAmendRtn |
11 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
12 |
Line 10 minus line 11. Place a negative sign ("-") in the box if the amount is less than -0- |
$2,000.00 |
| AmountUnderpaid |
13 |
Tax due |
$258,898.00 |
| InterestDueOnLatePayment |
14 |
Interest due on late payment of tax |
$2,163.00 |
| BalanceDue |
15 |
Total Amount Due |
$261,061.00 |
| AmountOverpaid |
16 |
Overpayment |
$0.00 |
| OverpymtCreditedNextYear |
17 |
Original return only - amount of line 16 to be carried forward to next year's tax liability |
$0.00 |
| Refund |
18 |
Your Refund |
$0.00 |
| Traditional Tax Base School District Amounts |
|
|
|
| TaxableIncome |
19 |
Ohio income tax base (Ohio IT 1040, line 3 minus line 4) |
$25,508,605.00 |
| BusinessIncomeDeductionAddback |
20 |
Business income deduction add-back |
$0.00 |
| TotalTraditionalSDIncome |
21 |
Total Traditional Tax Base School District Income (Line 19 + Line 20) |
$25,508,605.00 |
| NonResidentIncome |
22 |
Amount of traditional tax base school district income that you earned while not a resident |
$0.00 |
| SchoolDistrictTaxableIncome |
23 |
School District Taxable Income (Enter here and on line 1) |
$25,508,605.00 |
| Earned Income Tax Base School District Amounts |
|
|
|
| WagesAndOtherCompensations |
24 |
Wages and other compensation as described in the instructions |
$0.00 |
| SelfEmploymentEarnings |
25 |
Net Earnings from Self Employment |
$0.00 |
| FederalConformityAdjustments |
26 |
Federal Conformity Adjustments |
$0.00 |
| SchoolDistrictTaxableIncome |
27 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| |
|
|
|
| What is Tested? |
|
If you do not support: |
|
| IT1040WithSD100 |
|
|
|
| Self Prepared |
|
|
|
| MFJ status |
|
|
|
| Ohio W2 |
|
|
|
| Ohio W-2G |
|
If you do not support the large amount, split into multiple W-2Gs. |
|
| 1099-R |
|
|
|
| 2022 Estimated Payments - IT |
|
Do not provide |
|
| 2022 Estimated Payments - SD |
|
Do not provide |
|
| |
|
|
|
| IT1040 |
|
|
|
| Full Year Resident |
|
|
|
| [more than $115,300] tax bracket |
|
|
|
| Maximum joint filing credit ($650) |
|
|
|
| Sch. of Adj - Reimbursement of expenses |
|
Move amount to a Sch. of Adj addition line you do support |
|
| Sch. of Adj - Taxable Social Security benefits |
|
Move amount to a Sch. of Adj deduction line you do support |
|
| Sch. of Adj - Certain railroad retirement benefits |
|
Move amount to a Sch. of Adj deduction line you do support |
|
| Sch of Credits - Scholarship donation credit |
|
Remove credit amount |
|
| Means Testing on Retirement Income and Senior Citizen Credits |
|
|
|
| 2210 Underpayment Interest penalty |
|
|
|
| Interest on late payment of tax due |
|
Remove if not able to support in testing |
|
| Tax due |
|
|
|
| |
|
|
|
| SD100 |
|
|
|
| Full Year Resident |
|
|
|
| 2210 Underpayment Interest penalty |
|
|
|
| Interest on late payment of tax due |
|
Remove if not able to support in testing |
|
| Tax due |
|
|
|
| Ohio Test #11 |
|
|
IT1040WithSD100 |
| Taxpayer Information |
|
Description |
|
| TaxpayerSSN |
|
Primary Social Security Number |
400-XX-7611 |
| FirstName |
|
Primary First Name |
BRUCE |
| MiddleInitial |
|
Primary Middle Initial |
A |
| LastName |
|
Primary Last Name |
LE |
| DateOfBirth |
|
Date of Birth - Primary |
1943-08-07 |
| |
|
|
|
| TaxpayerSSN |
|
Spouse's Social Security Number |
400-XX-7661 |
| FirstName |
|
Spouse First Name |
PATRICIA |
| MiddleInitial |
|
Spouse Middle Initial |
B |
| LastName |
|
Spouse Last Name |
LE-FLEUR |
| DateOfBirth |
|
Date of Birth - Spouse |
1956-02-21 |
| |
|
|
|
| USPhone |
|
Taxpayer's Phone Number |
[<=9999999]###-#### |
| EmailAddress |
|
Taxpayer's E-mail Address |
LE.FLEUR@FLORIST.COM |
| |
|
|
|
| AddressLine1Txt |
|
Address Line 1 |
40 S LINWOOD ST |
| CityNm |
|
City |
METAMORA |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43540 |
| |
|
|
|
| MailingAddressCounty |
|
Ohio County |
FULTON |
| SchoolDistrictNumber |
|
Ohio Public School District Number - Resident District |
2602 |
| |
|
|
|
| Preparer Information |
|
|
|
| Self-Prepared |
|
|
|
| SelfPrepared |
|
Return is self-prepared |
X |
| |
|
|
|
| Income Statements |
|
|
|
| W-2 #1 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
363456789-####### |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
KUNG FU INC |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
4821 VIOLET BLVD |
| AddressLine2Txt |
|
Employer Address Line 2 |
|
| CityNm |
|
City |
PICKERINGTON |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43147 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7611 |
| EmployeNm |
|
Employee's Name |
BRUCE A LE |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
40 S LINWOOD ST |
| AddressLine2Txt |
|
Employee Address Line 2 |
|
| CityNm |
|
City |
METAMORA |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43540 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$5,464.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$658.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$5,464.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$341.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$5,464.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$80.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
52-567890 |
| StateWagesAmt |
|
State Wages |
$5,464.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$139.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$5,464.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$57.00 |
| LocalityNm |
|
Name of Locality |
DANVILLE |
| |
|
|
|
| SchoolDistrictWages |
|
School District Wages |
$5,000.00 |
| SchoolDistrictTaxWithheld |
|
School District Tax Withheld |
$75.00 |
| SchoolDistrictNumber |
|
School District # |
5903 |
| |
|
|
|
| SchoolDistrictWages |
|
School District Wages |
$464.00 |
| SchoolDistrictTaxWithheld |
|
School District Tax Withheld |
$10.00 |
| SchoolDistrictNumber |
|
School District # |
2602 |
| |
|
|
|
| W-2 #2 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
379876543-####### |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
CC SOFTWARE SERVICES LLC |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
100 WASHINGTON ST |
| AddressLine2Txt |
|
Employer Address Line 2 |
|
| CityNm |
|
City |
LANCASTER |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43130 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7661 |
| EmployeeNm |
|
Employee's Name |
PATRICIA B LE-FLEUR |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
40 S LINWOOD ST |
| AddressLine2Txt |
|
Employee Address Line 2 |
|
| CityNm |
|
City |
METAMORA |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43540 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$5,728.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$687.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$5,728.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$355.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$5,728.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$83.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
51-678901 |
| StateWagesAmt |
|
State Wages |
$5,728.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$70.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$5,728.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$49.00 |
| LocalityNm |
|
Name of Locality |
NORTH BALTIMORE |
| |
|
|
|
| SchoolDistrictWages |
|
School District Wages |
$5,728.00 |
| SchoolDistrictTaxWithheld |
|
School District Tax Withheld |
$114.00 |
| SchoolDistrictNumber |
|
School District # |
2602 |
| |
|
|
|
| W-2 #3 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
379876547-####### |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
CB SOFTWARE SERVICES LLC |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
100 WASHINGTON ST |
| AddressLine2Txt |
|
Employer Address Line 2 |
|
| CityNm |
|
City |
LANCASTER |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43130 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7661 |
| EmployeNm |
|
Employee's Name |
PATRICIA B LE-FLEUR |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
40 S LINWOOD ST |
| AddressLine2Txt |
|
Employee Address Line 2 |
|
| CityNm |
|
City |
METAMORA |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43540 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$5,731.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$689.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$5,731.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$356.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$5,731.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$83.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
51-678907 |
| StateWagesAmt |
|
State Wages |
$5,731.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$70.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$5,731.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$49.00 |
| LocalityNm |
|
Name of Locality |
NORTH BALTIMORE |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
School District Wages |
$5,731.00 |
| LocalIncomeTaxAmt |
|
School District Tax Withheld |
$117.00 |
| LocalityNm |
|
School District # |
2602 |
| |
|
|
|
| W-2 #4 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
379876544-####### |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
CD SOFTWARE SERVICES LLC |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
100 WASHINGTON ST |
| AddressLine2Txt |
|
Employer Address Line 2 |
|
| CityNm |
|
City |
LANCASTER |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43130 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7661 |
| EmployeNm |
|
Employee's Name |
PATRICIA B LE-FLEUR |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
40 S LINWOOD ST |
| AddressLine2Txt |
|
Employee Address Line 2 |
|
| CityNm |
|
City |
METAMORA |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43540 |
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$5,728.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$687.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$5,728.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$355.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$5,728.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$83.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
51-678904 |
| StateWagesAmt |
|
State Wages |
$5,728.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$70.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$5,728.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$49.00 |
| LocalityNm |
|
Name of Locality |
NORTH BALTIMORE |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
School District Wages |
$5,728.00 |
| LocalIncomeTaxAmt |
|
School District Tax Withheld |
$114.00 |
| LocalityNm |
|
School District # |
2602 |
| |
|
|
|
| W-2 #5 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
379876545-####### |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
CE SOFTWARE SERVICES LLC |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
100 WASHINGTON ST |
| AddressLine2Txt |
|
Employer Address Line 2 |
|
| CityNm |
|
City |
LANCASTER |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43130 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7661 |
| EmployeNm |
|
Employee's Name |
PATRICIA B LE-FLEUR |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
40 S LINWOOD ST |
| AddressLine2Txt |
|
Employee Address Line 2 |
|
| CityNm |
|
City |
METAMORA |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43540 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$5,728.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$687.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$5,728.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$355.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$5,728.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$83.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
51-678905 |
| StateWagesAmt |
|
State Wages |
$5,728.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$70.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$5,728.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$49.00 |
| LocalityNm |
|
Name of Locality |
NORTH BALTIMORE |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
School District Wages |
$5,728.00 |
| LocalIncomeTaxAmt |
|
School District Tax Withheld |
$114.00 |
| LocalityNm |
|
School District # |
2602 |
| |
|
|
|
| W-2 #6 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
379876546-####### |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
CF SOFTWARE SERVICES LLC |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
100 WASHINGTON ST |
| AddressLine2Txt |
|
Employer Address Line 2 |
|
| CityNm |
|
City |
LANCASTER |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43130 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7661 |
| EmployeNm |
|
Employee's Name |
PATRICIA B LE-FLEUR |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
40 S LINWOOD ST |
| AddressLine2Txt |
|
Employee Address Line 2 |
|
| CityNm |
|
City |
METAMORA |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43540 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$5,728.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$687.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$5,728.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$355.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$5,728.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$83.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
51-678906 |
| StateWagesAmt |
|
State Wages |
$5,728.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$70.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$5,728.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$49.00 |
| LocalityNm |
|
Name of Locality |
NORTH BALTIMORE |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
School District Wages |
$5,728.00 |
| LocalIncomeTaxAmt |
|
School District Tax Withheld |
$114.00 |
| LocalityNm |
|
School District # |
2602 |
| |
|
|
|
| W-2 #7 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
363456791-####### |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
TAEKWONDO INC |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
4823 VIOLET BLVD |
| AddressLine2Txt |
|
Employer Address Line 2 |
|
| CityNm |
|
City |
PICKERINGTON |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43147 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7611 |
| EmployeNm |
|
Employee's Name |
BRUCE A LE |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
40 S LINWOOD ST |
| AddressLine2Txt |
|
Employee Address Line 2 |
|
| CityNm |
|
City |
METAMORA |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43540 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$5,464.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$655.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$5,464.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$338.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$5,464.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$79.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
51-567891 |
| StateWagesAmt |
|
State Wages |
$5,464.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$137.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$5,464.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$56.00 |
| LocalityNm |
|
Name of Locality |
DANVILLE |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
School District Wages |
$5,000.00 |
| LocalIncomeTaxAmt |
|
School District Tax Withheld |
$75.00 |
| LocalityNm |
|
School District # |
5903 |
| |
|
|
|
| StateAbbreviationCd |
|
School District Wages |
$464.00 |
| EmployerStateIdNum |
|
School District Tax Withheld |
$9.00 |
| StateWagesAmt |
|
School District # |
2602 |
| |
|
|
|
| W-2 #8 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
363456798-####### |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
JIU JITSU INC |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
4822 VIOLET BLVD |
| AddressLine2Txt |
|
Employer Address Line 2 |
|
| CityNm |
|
City |
PICKERINGTON |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43147 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7611 |
| EmployeNm |
|
Employee's Name |
BRUCE A LE |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
40 S LINWOOD ST |
| AddressLine2Txt |
|
Employee Address Line 2 |
|
| CityNm |
|
City |
METAMORA |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43540 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$5,464.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$655.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$5,464.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$338.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$5,464.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$79.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
52-567898 |
| StateWagesAmt |
|
State Wages |
$5,464.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$137.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$5,464.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$56.00 |
| LocalityNm |
|
Name of Locality |
DANVILLE |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
School District Wages |
$5,000.00 |
| LocalIncomeTaxAmt |
|
School District Tax Withheld |
$75.00 |
| LocalityNm |
|
School District # |
5903 |
| |
|
|
|
| StateAbbreviationCd |
|
School District Wages |
$464.00 |
| EmployerStateIdNum |
|
School District Tax Withheld |
$9.00 |
| StateWagesAmt |
|
School District # |
2602 |
| |
|
|
|
| W-2 #9 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
363456799-####### |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
KARATE INC |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
4822 VIOLET BLVD |
| AddressLine2Txt |
|
Employer Address Line 2 |
|
| CityNm |
|
City |
PICKERINGTON |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43147 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7611 |
| EmployeNm |
|
Employee's Name |
BRUCE A LE |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
40 S LINWOOD ST |
| AddressLine2Txt |
|
Employee Address Line 2 |
|
| CityNm |
|
City |
METAMORA |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43540 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$5,464.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$655.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$5,464.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$338.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$5,464.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$79.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
52-567899 |
| StateWagesAmt |
|
State Wages |
$5,464.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$137.00 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
Local Wages |
$5,464.00 |
| LocalIncomeTaxAmt |
|
Local Income Tax Withheld |
$56.00 |
| LocalityNm |
|
Name of Locality |
DANVILLE |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
School District Wages |
$5,000.00 |
| LocalIncomeTaxAmt |
|
School District Tax Withheld |
$75.00 |
| LocalityNm |
|
School District # |
5903 |
| |
|
|
|
| LocalWagesAndTipsAmt |
|
School District Wages |
$464.00 |
| LocalIncomeTaxAmt |
|
School District Tax Withheld |
$9.00 |
| LocalityNm |
|
School District # |
2602 |
| |
|
|
|
| 1099R #1 |
|
|
|
| PayerEIN |
|
Payer's Identification Number |
383456789-####### |
| PayerName / BusinessNameLine1Txt |
|
Payer's Name |
FIDELITY INSURANCE |
| |
|
|
|
| AddressLine1Txt |
|
Payer's Address |
123 MAIN ST |
| CityNm |
|
Payer's City |
DANVILLE |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZIPCd |
|
Payer's Zip Code |
43014 |
| |
|
|
|
| RecipientSSN |
|
Recipient's Social Security Number |
400-XX-7611 |
| RecipientNm |
|
Recipient's Name |
BRUCE A LE |
| AddressLine1Txt |
|
Recipient's Address Line 1 |
40 S LINWOOD ST |
| CityNm |
|
Recipient's City |
METAMORA |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
43540 |
| |
|
|
|
| GrossDistributionAmt |
|
Gross Distribution Amount |
$25,000.00 |
| TaxableAmt |
|
Taxable Amount |
$25,000.00 |
| TotalDistributionInd |
|
Total Distribution Indicator |
X |
| F1099RDistributionCd |
|
Distribution Code |
7 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| PayerStateIdNum |
|
State Payer ID |
52-789012 |
| StateDistributionAmt |
|
State Distribution |
$25,000.00 |
| StateTaxWithheldAmt |
|
State Income Tax Withheld |
$100.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
CT |
| PayerStateIdNum |
|
State Payer ID |
383456789-####### |
| StateDistributionAmt |
|
State Distribution |
$25,000.00 |
| StateTaxWithheldAmt |
|
State Income Tax Withheld |
$100.00 |
| |
|
|
|
| LocalTaxWithheldAmt |
|
Local Tax withheld |
$375.00 |
| LocalityNm |
|
Locality Name |
NEW HAVEN |
| LocalDistributionAmt |
|
Local Distribution Amount |
$25,000.00 |
| |
|
|
|
| SchoolDistrictWages |
|
School District Wages |
$25,000.00 |
| SchoolDistrictTaxWithheld |
|
School District Tax Withheld |
$75.00 |
| SchoolDistrictNumber |
|
School District # |
5903 |
| |
|
|
|
| 1099R #2 |
|
|
|
| PayerEIN |
|
Payer's Identification Number |
277766554-0000000 |
| PayerName / BusinessNameLine1Txt |
|
Payer's Name |
DISABILITY CARE LLC |
| |
|
|
|
| AddressLine1Txt |
|
Payer's Address |
3456 GETWELL LANE |
| CityNm |
|
Payer's City |
ANSONIA |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZIPCd |
|
Payer's Zip Code |
45303 |
| |
|
|
|
| RecipientSSN |
|
Recipient's Social Security Number |
400-XX-7661 |
| RecipientNm |
|
Recipient's Name |
PATRICIA B LE-FLEUR |
| AddressLine1Txt |
|
Recipient's Address Line 1 |
40 S LINWOOD ST |
| CityNm |
|
Recipient's City |
METAMORA |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
43540 |
| |
|
|
|
| GrossDistributionAmt |
|
Gross Distribution Amount |
$20,000.00 |
| TaxableAmt |
|
Taxable Amount |
$20,000.00 |
| TotalDistributionInd |
|
Total Distribution Indicator |
|
| F1099RDistributionCd |
|
Distribution Code |
7 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| PayerStateIdNum |
|
State Payer ID |
52-374575 |
| StateDistributionAmt |
|
State Distribution |
$20,000.00 |
| StateTaxWithheldAmt |
|
State Income Tax Withheld |
$125.00 |
| |
|
|
|
| Return Information |
|
|
|
| Federal Return Data |
|
|
|
| |
|
Filing Status |
Married Filing Joint |
| |
|
Exemptions, Self |
3 |
| |
|
Total Wages, Salaries, Tips, etc. |
$50,499.00 |
| |
|
Total Taxable Pensions and Annuities |
$45,000.00 |
| |
|
Taxable Refunds, credits or offsets of state and local income taxes |
$283.00 |
| |
|
Adjusted Gross Income |
$95,782.00 |
| |
|
Earned Income Tax Credit |
$0.00 |
| State Return Data |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| NOLCarryBack |
|
Is the amended return an NOL carryback? |
No |
| |
|
|
|
| FilingStatus |
|
|
|
| MarriedFilingJointly |
|
|
X |
| |
|
|
|
| Did you file federal extension Form 4868? |
|
|
Yes |
| |
|
|
|
| Did you take the Standard deduction or itemize? |
|
|
Standard |
| |
|
|
|
| Can someone else claim you (or your spouse) as a dependent? |
|
|
|
| ClaimedAsDependent |
|
|
No |
| |
|
|
|
| Schedule of Dependents |
|
Total Exemptions |
3 |
| NumberOfDependents |
|
|
1 |
| SSN |
|
|
400-XX-7684 |
| DateOfBirth |
|
|
2003-09-07 |
| Relationship |
|
|
GRANDCHILD |
| FirstName |
|
|
BRANDON |
| LastName |
|
|
LE |
| |
|
|
|
| Residency Status |
|
|
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| JointFilingCredit |
|
Eligible for JFC? |
Yes |
| |
|
|
|
| Lump Sum Distribution Credit Worksheet |
| AgeBasedMultiple |
1 |
Using Table 1, enter the multiple corresponding ot the lump sum recipient's age |
10 |
| LumpSumDistCredit |
2 |
Multiply line 1 times $50. This is your lump sum distribution credit |
$500.00 |
| |
|
|
|
| Additional Information |
|
|
|
| IRC168And179AdjAdd |
|
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$2,000.00 |
| CollegeAdvSavAndTuitPurchCred |
|
Contributions to a College Advantage 529 Savings Account and/or purchases of tuition credits |
$16,000.00 |
| QualOrganDonorExp |
|
Qualified organ donor expenses |
$800.00 |
| SeniorCitizenCredit |
|
Lump sum distribution credit is being taken by the Primary taxpayer, Spouse remains eligible to claim the Senior Citizen Credit. |
$50.00 |
| CampaignContributionCredit |
|
Campaign contribution for Ohio statewide office or General Assembly |
$100.00 |
| NonCharterOrPublicSchoolCredit |
|
Nonchartered, nonpublic school tuition credit |
$1,000.00 |
| |
|
|
|
| SD Return # 1 Information |
|
|
|
| SchoolDistrictNumber |
|
What is the school district number for which you are filing the SD 100? |
5903 |
| TaxType |
|
Tax Type |
Traditional |
| |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| Residency Status |
|
School district residency |
|
| PrimaryResidencyStatus |
|
|
|
| PartYearResident |
|
Part-Year Resident |
X |
| ResidentFromDate |
|
First date you were a resident |
2022-01-01 |
| ResidentToDate |
|
Last date you were a resident |
2022-04-30 |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| PartYearResident |
|
Part-Year Resident |
X |
| ResidentFromDate |
|
First date you were a resident |
2022-01-01 |
| ResidentToDate |
|
Last date you were a resident |
2022-04-30 |
| |
|
|
|
| Additional Information - SD #1 |
|
|
|
| NonResidentIncome |
|
Amount of traditional tax base school district income that you earned while not a resident |
$36,499.00 |
| |
|
|
|
| SD Return # 2 Information |
|
|
|
| SchoolDistrictNumber |
|
What is the school district number for which you are filing the SD 100? |
2602 |
| TaxType |
|
Tax Type |
Traditional |
| |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| Residency Status |
|
School district residency |
|
| PrimaryResidencyStatus |
|
|
|
| PartYearResident |
|
Part-Year Resident |
X |
| ResidentFromDate |
|
First date you were a resident |
2022-05-01 |
| ResidentToDate |
|
Last date you were a resident |
2022-12-31 |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| PartYearResident |
|
Part-Year Resident |
X |
| ResidentFromDate |
|
First date you were a resident |
2202-05-01 |
| ResidentToDate |
|
Last date you were a resident |
22022-12-31 |
| |
|
|
|
| Additional Information - SD #2 |
|
|
|
| NonResidentIncome |
|
Amount of traditional tax base school district income that you earned while not a resident |
$38,500.00 |
| |
|
|
|
| Return |
|
|
|
| IT1040 - Pages 1 & 2 |
| FederalAdjustedGrossIncome |
1 |
Federal Adjusted Gross Income |
$95,782.00 |
| TotalIncomeAddition |
2a |
Additions to federal adjusted gross income |
$2,000.00 |
| TotalIncomeDeduction |
2b |
Deductions from federal adjusted gross income |
$17,083.00 |
| OhioAdjustedGrossIncome |
3 |
Ohio Adjusted Gross Income (OAGI) |
$80,699.00 |
| ExemptionDeduction |
4 |
Personal and dependent exemption deduction |
$5,700.00 |
| TaxableIncome |
5 |
Ohio income tax base |
$74,999.00 |
| TaxableBusinessIncome |
6 |
Taxable business income (Ohio IT BUS, line 13) |
$0.00 |
| TaxableIncomeLessBusinessIncome |
7 |
Line 5 minus line 6 (if less than 0, enter 0) |
$74,999.00 |
| |
7a |
Amount from line 7 on page 1 |
$74,999.00 |
| NonBusinessIncomeTaxLiability |
8a |
Nonbusiness income tax liability |
$1,847.00 |
| BusinessIncomeTaxLiability |
8b |
Business income tax liability (Ohio IT BUS, line 14) |
$0.00 |
| IncomeTaxLiabilityBeforeCredits |
8c |
Income tax liability before credits (line 8a plus 8b) |
$1,847.00 |
| OhioNonRefundableCredits |
9 |
Ohio nonrefundable credits |
$1,950.00 |
| TaxLiabAfterNonrefundableCrdt |
10 |
Tax liability after nonrefundable credits |
$0.00 |
| UnderPaymentInterestPenalty |
11 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| UnpaidUseTax |
12 |
Sales and use tax due on Internet, mail order or other out-of-state purchases |
$0.00 |
| TotalTaxLiability |
13 |
Total Ohio tax liability before withholding or estimated payments |
$0.00 |
| TaxWithheld |
14 |
Ohio income tax withheld |
$1,125.00 |
| InstallmentPayment |
15 |
Add the Ohio estimated & extension payments & credit carryforward from previous year return |
$0.00 |
| RefundableTaxCredits |
16 |
Refundable credits |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
17 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayment |
18 |
Total Ohio Tax Payments |
$1,125.00 |
| OverpymtRecdOnOrigAmendRtn |
19 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
20 |
Line 18 minus line 19 |
$1,125.00 |
| AmountUnderpaid |
21 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
22 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
23 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
24 |
Overpayment |
$1,125.00 |
| OverpymtCreditedNextYear |
25 |
Original return only - amount of line 24 to be carried forward to next year's tax liability |
$0.00 |
| CharityOrgName |
26a |
Amount of line 24 to be donated - Wildlife species |
$0.00 |
| CharityOrgName |
26b |
Amount of line 24 to be donated - Military injury relief |
$0.00 |
| CharityOrgName |
26c |
Amount of line 24 to be donated - Ohio History Fund |
$0.00 |
| CharityOrgName |
26d |
Amount of line 24 to be donated - Nature Preserves/Scenic Rivers |
$0.00 |
| CharityOrgName |
26e |
Amount of line 24 to be donated - Breast/cervical cancer |
$0.00 |
| CharityOrgName |
26f |
Amount of line 24 to be donated - Wishes for sick children |
$0.00 |
| TotalDonation |
26g |
Total |
$0.00 |
| Refund |
27 |
Your Refund |
$1,125.00 |
| |
|
|
|
| Schedule of Adjustments |
| Additions |
|
|
|
| NonOhioAndLocalGovIntAndDiv |
1 |
Non-Ohio state or local government interest and dividends |
$0.00 |
| PassThruEntityTaxesPaid |
2 |
Certain Ohio pass-through entity and financial institutions taxes paid |
$0.00 |
| TuitionExpenseReimbursement |
3 |
Reimbursement of college tutition expenses and fees deducted in any previous year(s) and noneducation expenditures from a college savings account |
$0.00 |
| SaleAndDispstnLossOfOhioOblig |
4 |
Losses from sale or disposition of Ohio public obligations |
$0.00 |
| NonMedicalWithdrawals |
5 |
Nonmedical withdrawals from a medical savings account |
$0.00 |
| ReimExpPrevDeducted |
6 |
Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if the reimbursement is not in federal adjusted gross income |
$0.00 |
| IRC168And179AdjAdd |
7 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$2,000.00 |
| FederalInterestAndDividends |
8 |
Federal interest and dividends subject to state taxation |
$0.00 |
| FederalConformityAdditions |
9 |
Federal conformity additions |
$0.00 |
| TotalIncomeAddition |
10 |
Total additions |
$2,000.00 |
| |
|
|
|
| Deductions |
|
|
|
| BusinessIncomeDeduction |
11 |
Business income deduction (attach Ohio Schedule IT BUS, line 11) |
$0.00 |
| OHFullYrEmpCompEarnNeighState |
12 |
Employee compensation earned in Ohio by residents of neighboring states |
$0.00 |
| IRS1040StateMuniIncomeOverpymt |
13 |
State or municipal income tax overpayments shown on the federal 1040, Sch 1, line 1 |
$283.00 |
| SocialSecurityBenefits |
14 |
Taxable Social Security benefits |
$0.00 |
| RailroadRetirementBenefits |
15 |
Certain railroad retirement benefits |
$0.00 |
| ObligIntrstPublicServicePay |
16 |
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 state of Ohio or income from a transfer agreement |
$0.00 |
| IndDevAcct |
17 |
Amounts contributed to an individual development account |
$0.00 |
| STABLEAcct |
18 |
Amounts contributed to STABLE account; Ohio's ABLE plan |
$0.00 |
| OutOfStateDisasterWorkIncome |
19 |
Income earned in Ohio by a qualifying out-of-state business or employee for disaster work conducted during a disaster response period |
$0.00 |
| FederalIntAndDivExempt |
20 |
Federal interest and dividends exempt from state taxation |
$0.00 |
| IRC168And179AdjDed |
21 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| IRS1040RefundOrReimbursements |
22 |
Refund or reimbursements shown on the federal 1040, schedule 1 for itemized deductions claimed on a prior year federal income tax return |
$0.00 |
| RepaymentOfIncomeReported |
23 |
Repayment of income reported in a prior year |
$0.00 |
| NotDeductedWageExpense |
24 |
Wage expense not deducted due to claiming the federal work opportunity credit |
$0.00 |
| FederalConformityDeductions |
25 |
Federal conformity deductions |
$0.00 |
| MilitaryPayForResident |
26 |
Military pay for Ohio residents received while the military member was stationed outside Ohio |
$0.00 |
| IncomeErndMilitCivilianNRSpouse |
27 |
Certain income earned by military nonresidents and civilian nonresident spouses |
$0.00 |
| UniformedServcsRetirmtIncome |
28 |
Uniformed services retirement income |
$0.00 |
| MilitaryInjuryReliefFund |
29 |
Military injury relief fund |
$0.00 |
| NationalGuardReimAndBenft |
30 |
Certain Ohio National Guard reimbursements and benefits |
$0.00 |
| CollegeAdvSavAndTuitPurchCred |
31 |
Ohio 529 contributions, tuition credit purchases |
$16,000.00 |
| PellOhioCollegeOppTaxableGrant |
32 |
Pell/Ohio College Opportunity taxable grant amounts used to pay room and board |
$0.00 |
| OhioEducatorExpenses |
33 |
Ohio educator expenses in excess of federal deduction |
$0.00 |
| DisabilityBenefits |
34 |
Disability benefits |
$0.00 |
| SurvivorBenefits |
35 |
Survivor benefits |
$0.00 |
| UnsubsidizedMedicalExpense |
36 |
Unreimbursed long-term care insurance premiums, unsubsidized health care insurance premiums and excess health care expenses (see instructions for worksheet) |
$0.00 |
| HealthCareDepositedFunds |
37 |
Funds deposited into, and earnings of, a medical savings account for eligible health care expenses (see instructions for worksheet) |
$0.00 |
| QualOrganDonorExp |
38 |
Qualified organ donor expenses |
$800.00 |
| TotalIncomeDeduction |
39 |
Total deductions |
$17,083.00 |
| |
|
|
|
| Schedule IT BUS |
|
|
|
| |
|
Part 1 |
|
| BusScheduleB |
1 |
Sch B - Interest and Ordinary Dividends |
$0.00 |
| BusScheduleC |
2 |
Sch C - Profit or Loss From Business (Sole Proprietership) |
$0.00 |
| BusScheduleD |
3 |
Sch D - Capital Gains and Losses |
$0.00 |
| BusScheduleE |
4 |
Sch E - Supplemental Income and Loss |
$0.00 |
| GuaranteedPayments |
5 |
Guranteed payments, compensation and/or wages from each pass-through entity in which you have at least a 20% direct or indirect ownership interest |
$0.00 |
| BusScheduleF |
6 |
Sch F - Profit or Loss From Farming |
$0.00 |
| OtherItemsOfIncome |
7 |
Other items of income and gain separately stated on federal Schedule K-1, federal 4797 gains and/or losses reported on federal 4797 and miscellaneous federal income tax adjustments, if any |
$0.00 |
| TotalOfBusinessIncome |
8 |
Total of business income (add lines 1 through 7) |
$0.00 |
| |
|
Part 2 |
|
| AllBusinessIncome |
9 |
All business income (enter the lesser of line 8 above or Ohio IT1040, line 1). If zero or negative, stop here and do not complete Part 3. |
$0.00 |
| FilingStatusBusIncAmt |
10 |
Enter $250,000 if single or MFJ, enter $125,000 if MFS |
$0.00 |
| LessOfFilStatBusIncAmtOrAllBusInc |
11 |
Lesser of line 9 or line 10. Enter here and on Ohio Schedule of Adjustments, line 11 |
$0.00 |
| |
|
Part 3 |
|
| AllBusIncLessBusIncDeduction |
12 |
Line 9 minus line 11 (if less than -0-, enter -0-) |
$0.00 |
| TaxableBusinessIncome |
13 |
Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5) |
$0.00 |
| BusinessIncomeTaxLiability |
14 |
Business income tax liability. Multiply line 13 by 3%. Enter here and on Ohio IT 1040, line 8b. |
$0.00 |
| |
|
|
|
| Schedule of Credits - Nonrefundable |
| TaxLiabilityBeforeCredits |
1 |
Tax liability before credits (From IT1040, line 8c) |
$1,847.00 |
| RetireIncomeCredit |
2 |
Retirement income credit (limit $200 per return) |
$200.00 |
| LumpSumRetirementCredit |
3 |
Lump sum retirement credit (include Ohio LS WKS, line 6) |
$0.00 |
| SeniorCitizenCredit |
4 |
Senior citizen credit |
$50.00 |
| LumpSumDistributionCredit |
5 |
Lump sum distribution credit (include Ohio LS WKS, line 3) |
$500.00 |
| ChildAndDependCareCredit |
6 |
Child care and dependent care credit (see the worksheet in the instructions) |
$0.00 |
| DisplacedWorkerTrainingCredit |
7 |
Displaced worker training credit (see the worksheet in the instructions) |
$0.00 |
| CampaignContributionCredit |
8 |
Campaign contribution credit |
$100.00 |
| ExemptionCredit |
9 |
Income-based exemption credit |
$0.00 |
| TotCreditsBeforeJointFiling |
10 |
Total (add lines 2 through 9) |
$850.00 |
| TaxLessCredit |
11 |
Tax less credits (line 1 minus line 10; if less than -0-, enter -0-) |
$997.00 |
| JointFilingCredit |
12 |
Joint filing credit |
$100.00 |
| EarnedIncomeCredit |
13 |
Earned income credit (multiply Fed EITC by 30%) |
$0.00 |
| HomeSchoolExpensesCredit |
14 |
Home school expenses credit |
$0.00 |
| ScholarshipDonationCredit |
15 |
Scholarship donation credit |
$0.00 |
| NonCharterOrPublicSchoolCredit |
16 |
Nonchartered, nonpublic school tuition credit |
$1,000.00 |
| VocationalJobCredit |
17 |
Vocational job credit |
$0.00 |
| AdoptionCredit |
18 |
Ohio adoption credit |
$0.00 |
| JobRetentionCredit |
19 |
Nonrefundable job retention credit |
$0.00 |
| NewEmpInEntZoneCredit |
20 |
Credit for eligible new employees in an enterprise zone |
$0.00 |
| GrapeProdPropertyPurchCredit |
21 |
Credit for purchases of grape production property |
$0.00 |
| InvestOhioCredit |
22 |
InvestOhio credit |
$0.00 |
| LeadAbatementCredit |
23 |
Lead abatement credit |
$0.00 |
| OpportunityZoneCredit |
24 |
Opportunity zone investment credit |
$0.00 |
| TechInvestCreditCarryfrwd |
25 |
Technology investment credit carryforward |
$0.00 |
| EntZoneDayCareAndTrngCredit |
26 |
Enterprise zone day care and training credits |
$0.00 |
| ResearchAndDevelopmentCredit |
27 |
Research and development credit |
$0.00 |
| OhioHistoricPreservationCredit |
28 |
Nonrefundable Ohio historic preservation credit |
$0.00 |
| TotAdditionalCredits |
29 |
Total (add lines 12 through 28) |
$1,100.00 |
| TaxLessCrdtMinusTotAddlCrdts |
30 |
Tax less additional credits (line 11 minus line 29; if less than -0-, enter -0-) |
$0.00 |
| |
|
Nonresident Credit |
|
| NonOhioIncome |
31 |
Nonresident Portion of Ohio adjusted gross income |
$0.00 |
| OhioAdjustedGrossIncome |
32 |
Ohio adjusted gross income |
$0.00 |
| NonResIncomeCreditRatio |
33a |
Divide line 31 by line 32 |
0.0000 |
| NonresidentAndPartYearCredit |
33 |
Nonresident credit (line 30 times line 33a) |
$0.00 |
| |
|
Resident Credit |
|
| ResidentTaxCredit |
34 |
Resident Credit - Ohio IT RC, line 7 |
$0.00 |
| TotalNonrefundableCredits |
35 |
Total nonrefundable credits |
$1,950.00 |
| |
|
|
|
| Schedule of Credits - Refundable |
| HistoricPreservationCredit |
36 |
Refundable Ohio historic preservation credit |
$0.00 |
| JobCreationAndJobRetentionCrd |
37 |
Refundable job creation credit & job retention credit |
$0.00 |
| PassthroughEntityCredit |
38 |
Pass-through entity credit |
$0.00 |
| MotionPictureProductionCredit |
39 |
Motion Picture & Broadway theatrical production credit |
$0.00 |
| VentureCapitalCredit |
40 |
Venture Capital credit |
$0.00 |
| TotalRefundableCredit |
41 |
Total refundable credits |
$0.00 |
| |
|
|
|
| School District Return (#5903) |
|
|
|
| SchoolDistrictTaxableIncome |
1 |
School district taxable income: Traditional or Earned Income tax base |
$38,500.00 |
| TaxAmount |
2 |
School District Tax .____ times line 1. |
$578.00 |
| SeniorCitizenCredit |
3 |
Senior Citizen Credit |
$50.00 |
| TaxLessCredit |
4 |
School District Income Tax liability |
$528.00 |
| UnderPaymentInterestPenalty |
5 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| TotalTax |
6 |
Total school district income tax liability (line 4 plus line 5) |
$528.00 |
| TotalTax |
6a |
Amount from line 6, page 1 |
$528.00 |
| TaxWithheld |
7 |
School district income tax withheld |
$375.00 |
| InstallmentPayments |
8 |
SD 100 ES & SD 40P, Extension Payments and Credit carryforward from previous year return |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
9 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayments |
10 |
Total school district income tax payments (add lines 7, 8 and 9) |
$375.00 |
| OverpymtRecdOnOrigAmendRtn |
11 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
12 |
Line 10 minus line 11. Place a negative sign ("-") in the box if the amount is less than -0- |
$375.00 |
| AmountUnderpaid |
13 |
Tax due |
$153.00 |
| InterestDueOnLatePayment |
14 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
15 |
Total Amount Due |
$153.00 |
| AmountOverpaid |
16 |
Overpayment |
$0.00 |
| OverpymtCreditedNextYear |
17 |
Original return only - amount of line 16 to be carried forward to next year's tax liability |
$0.00 |
| Refund |
18 |
Your Refund |
$0.00 |
| Traditional Tax Base School District Amounts |
|
|
|
| TaxableIncome |
19 |
Ohio income tax base (Ohio IT 1040, line 3 minus line 4) |
$74,999.00 |
| BusinessIncomeDeductionAddback |
20 |
Business income deduction add-back |
$0.00 |
| TotalTraditionalSDIncome |
21 |
Total Traditional Tax Base School District Income (Line 19 + Line 20) |
$74,999.00 |
| NonResidentIncome |
22 |
Amount of traditional tax base school district income that you earned while not a resident |
$36,499.00 |
| SchoolDistrictTaxableIncome |
23 |
School District Taxable Income (Enter here and on line 1) |
$38,500.00 |
| Earned Income Tax Base School District Amounts |
|
|
|
| WagesAndOtherCompensations |
24 |
Wages and other compensation as described in the instructions |
$0.00 |
| SelfEmploymentEarnings |
25 |
Net Earnings from Self Employment |
$0.00 |
| FederalConformityAdjustments |
26 |
Federal Conformity Adjustments |
$0.00 |
| SchoolDistrictTaxableIncome |
27 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| |
|
|
|
| School District Return #2 (#2602) |
|
|
|
| SchoolDistrictTaxableIncome |
1 |
School district taxable income: Traditional or Earned Income tax base |
$36,499.00 |
| TaxAmount |
2 |
School District Tax .____ times line 1. |
$547.00 |
| SeniorCitizenCredit |
3 |
Senior Citizen Credit |
$50.00 |
| TaxLessCredit |
4 |
School District Income Tax liability |
$497.00 |
| UnderPaymentInterestPenalty |
5 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| TotalTax |
6 |
Total school district income tax liability (line 4 plus line 5) |
$497.00 |
| TotalTax |
6a |
Amount from line 6, page 1 |
$497.00 |
| TaxWithheld |
7 |
School district income tax withheld |
$610.00 |
| InstallmentPayments |
8 |
SD 100 ES & SD 40P, Extension Payments and Credit carryforward from previous year return |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
9 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayments |
10 |
Total school district income tax payments (add lines 7, 8 and 9) |
$610.00 |
| OverpymtRecdOnOrigAmendRtn |
11 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
12 |
Line 10 minus line 11. Place a negative sign ("-") in the box if the amount is less than -0- |
$0.00 |
| AmountUnderpaid |
13 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
14 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
15 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
16 |
Overpayment |
$113.00 |
| OverpymtCreditedNextYear |
17 |
Original return only - amount of line 16 to be carried forward to next year's tax liability |
$0.00 |
| Refund |
18 |
Your Refund |
$113.00 |
| Traditional Tax Base School District Amounts |
|
|
|
| TaxableIncome |
19 |
Ohio income tax base (Ohio IT 1040, line 3 minus line 4) |
$74,999.00 |
| BusinessIncomeDeductionAddback |
20 |
Business income deduction add-back |
$0.00 |
| TotalTraditionalSDIncome |
21 |
Total Traditional Tax Base School District Income (Line 19 + Line 20) |
$74,999.00 |
| NonResidentIncome |
22 |
Amount of traditional tax base school district income that you earned while not a resident |
$38,500.00 |
| SchoolDistrictTaxableIncome |
23 |
School District Taxable Income (Enter here and on line 1) |
$36,499.00 |
| Earned Income Tax Base School District Amounts |
|
|
|
| WagesAndOtherCompensations |
24 |
Wages and other compensation as described in the instructions |
$0.00 |
| SelfEmploymentEarnings |
25 |
Net Earnings from Self Employment |
$0.00 |
| FederalConformityAdjustments |
26 |
Federal Conformity Adjustments |
$0.00 |
| SchoolDistrictTaxableIncome |
27 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| |
|
|
|
| What is Tested? |
|
If you do not support: |
|
| IT1040WithSD100 |
|
|
|
| Self-Prepared |
|
|
|
| MFJ status |
|
|
|
| W-2 |
|
|
|
| 1099-R |
|
|
|
| |
|
|
|
| IT1040 |
|
|
|
| Full year resident |
|
|
|
| Sch of Adj - Depreciation Addback |
|
Move to a Sch. of Adj addition line you do support |
|
| Sch of Adj - Taxable refund |
|
Move to a Sch. of Adj deduction line you do support |
|
| Sch of Adj - 529 Contribution |
|
Move to a Sch. of Adj deduction line you do support |
|
| Sch of Adj - Qualifying Organ donor |
|
Move to a Sch. of Adj deduction line you do support |
|
| Sch of Credits - Retirement Income Credit |
|
Move to a Sch of Credits line you do support |
|
| Sch of Credits - Senior Citizen Credit |
|
Move to a Sch of Credits line you do support |
|
| Sch of Credits - Lump Sum Distribution Credit |
Move to a Sch of Credits line you do support |
|
| Sch of Credits - Campaign Contribution Credit |
Move to a Sch of Credits line you do support |
|
| Sch of Credits - Joint Filing Credit (10%) |
|
|
|
| Sch of Credits - Nonchartered, nonpublic school tuition credit |
|
Remove credit amount |
|
| Page 3 Schd of W/H |
|
|
|
| |
|
|
|
| SD100 |
|
|
|
| Multiple SD100s |
|
|
|
| SD Withholding on a 1099-R |
|
|
|
| Part-year resident |
|
|
|
| Page 3 Schd of W/H |
|
|
|
| Ohio Test #12 |
|
|
IT1040WithSD100 |
| Taxpayer Information |
|
Description |
|
| TaxpayerSSN |
|
Primary Social Security Number |
400-XX-7612 |
| FirstName |
|
Primary First Name |
LOIS |
| LastName |
|
Primary Last Name |
LANE |
| DateOfBirth |
|
Date of Birth - Primary |
1955-11-14 |
| |
|
|
|
| USPhone |
|
Taxpayer's Phone Number |
[<=9999999]###-#### |
| EmailAddress |
|
Taxpayer's E-mail Address |
LANE@MSN.COM |
| |
|
|
|
| AddressLine1Txt |
|
Address Line 1 |
1234 METROPOLIS LANE |
| CityNm |
|
City |
EAST PALESTINE |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
44413 |
| |
|
|
|
| MailingAddressCounty |
|
Ohio County |
COLUMBIANA |
| SchoolDistrictNumber |
|
Ohio Public School District Number - Resident District |
1505 |
| |
|
|
|
| Preparer Information |
|
|
|
| Self-Prepared |
|
|
|
| SelfPrepared |
|
Return is self-prepared |
X |
| |
|
|
|
| Income Statements |
|
|
|
| |
|
|
|
| 1099R #1 |
|
|
|
| PayerEIN |
|
Payer's Identification Number |
659518524-0000000 |
| PayerName / BusinessNameLine1Txt |
|
Payer's Name |
PACIFIC LIFE |
| |
|
|
|
| AddressLine1Txt |
|
Payer's Address |
573 DIVING WHALE CIR |
| CityNm |
|
Payer's City |
SAN FRANCISCO |
| StateAbbreviationCd |
|
Payer's State |
CA |
| ZIPCd |
|
Payer's Zip Code |
94016 |
| |
|
|
|
| RecipientSSN |
|
Recipient's Social Security Number |
400-XX-7612 |
| RecipientNm |
|
Recipient's Name |
LOIS LANE |
| AddressLine1Txt |
|
Recipient's Address Line 1 |
1234 METROPOLIS LANE |
| AddressLine2Txt |
|
Recipient's Address Line 2 |
|
| CityNm |
|
Recipient's City |
EAST PALESTINE |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
44413 |
| |
|
|
|
| GrossDistributionAmt |
|
Gross Distribution Amount |
$25,000.00 |
| TaxableAmt |
|
Taxable Amount |
$25,000.00 |
| TotalDistributionInd |
|
Total Distribution Indicator |
|
| F1099RDistributionCd |
|
Distribution Code |
7K |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| PayerStateIdNum |
|
State Payer ID |
53-601854 |
| StateDistributionAmt |
|
State Distribution |
$25,000.00 |
| StateTaxWithheldAmt |
|
State Income Tax Withheld |
$1,500.00 |
| |
|
|
|
| K-1 |
|
Description |
|
| ShareholderSSN |
|
Shareholder's SSN |
400-XX-7612 |
| CorporationEIN |
|
Corporation's EIN |
345678909-0000000 |
| CorporationName / BusinessNameLine1Txt |
|
Corporation's Name |
THE DAILY PLANET |
| PTEFormType |
|
Pass-through entity / Fiduciary Filing |
IT4708 |
| PercentageStockOwnership |
|
Percentage of Stock Ownership |
25% |
| TaxableIncome |
|
Shareholder's Ohio Total Taxable Income |
$117,000.00 |
| WithholdingAmount |
|
Ohio PTE Credit Amount |
$5,850.00 |
| TotalIndirectPassThroughCredit |
|
Total Indirect Pass Through Credit |
$400.00 |
| TotalIndirectPassThroughFEIN |
|
Total Indirect Pass Through FEIN |
343456789-0000000 |
| |
|
Partner's Name |
LOIS LANE |
| |
|
Ordinary business income |
$80,000.00 |
| |
|
Guaranteed Payments |
$5,000.00 |
| |
|
Interest Income |
$10,000.00 |
| |
|
Ordinary dividends |
$10,000.00 |
| |
|
Net long-term capital gain (loss) |
($3,000.00) |
| |
|
Other income (loss) |
$15,000.00 |
| Entity # 1 |
|
|
|
| ShareholderSSN |
|
Shareholder's SSN |
XX0-00-7612 |
| CorporationEIN |
|
Corporation's EIN |
34-5678901 |
| CorporationName / BusinessNameLine1Txt |
|
Corporation's Name |
DAILY PLANET 1 |
| PercentageStockOwnership |
|
Percentage of Stock Ownership |
25% |
| WithholdingAmount |
|
Ohio PTE Credit Amount |
$450.00 |
| TotalIndirectPassThroughCredit |
|
Total Indirect Pass Through Credit |
$31.00 |
| TotalIndirectPassThroughFEIN |
|
Total Indirect Pass Through FEIN |
34-3456789 |
| |
|
Interest Income |
$10,000.00 |
| |
|
Ordinary dividends |
$10,000.00 |
| |
|
Partner's Name |
LOIS LANE |
| |
|
Ordinary business income |
$10,000.00 |
| |
|
Other Income (loss) |
$15,000.00 |
| Entity # 2 |
|
|
|
| ShareholderSSN |
|
Shareholder's SSN |
XX0-00-7612 |
| CorporationEIN |
|
Corporation's EIN |
34-5678902 |
| CorporationName / BusinessNameLine1Txt |
|
Corporation's Name |
DAILY PLANET 2 |
| PercentageStockOwnership |
|
Percentage of Stock Ownership |
25% |
| WithholdingAmount |
|
Ohio PTE Credit Amount |
$450.00 |
| TotalIndirectPassThroughCredit |
|
Total Indirect Pass Through Credit |
$31.00 |
| TotalIndirectPassThroughFEIN |
|
Total Indirect Pass Through FEIN |
34-3456789 |
| |
|
Partner's Name |
LOIS LANE |
| |
|
Ordinary business income |
$10,000.00 |
| Entity # 3 |
|
|
|
| ShareholderSSN |
|
Shareholder's SSN |
XX0-00-7612 |
| CorporationEIN |
|
Corporation's EIN |
34-5678903 |
| CorporationName / BusinessNameLine1Txt |
|
Corporation's Name |
DAILY PLANET 3 |
| PercentageStockOwnership |
|
Percentage of Stock Ownership |
25% |
| WithholdingAmount |
|
Ohio PTE Credit Amount |
$450.00 |
| TotalIndirectPassThroughCredit |
|
Total Indirect Pass Through Credit |
$31.00 |
| TotalIndirectPassThroughFEIN |
|
Total Indirect Pass Through FEIN |
34-3456789 |
| |
|
Partner's Name |
LOIS LANE |
| |
|
Ordinary business income |
$10,000.00 |
| |
|
Guaranteed Payments |
$5,000.00 |
| Entity # 4 |
|
|
|
| ShareholderSSN |
|
Shareholder's SSN |
XX0-00-7612 |
| CorporationEIN |
|
Corporation's EIN |
34-5678904 |
| CorporationName / BusinessNameLine1Txt |
|
Corporation's Name |
DAILY PLANET 4 |
| PercentageStockOwnership |
|
Percentage of Stock Ownership |
25% |
| WithholdingAmount |
|
Ohio PTE Credit Amount |
$450.00 |
| TotalIndirectPassThroughCredit |
|
Total Indirect Pass Through Credit |
$31.00 |
| TotalIndirectPassThroughFEIN |
|
Total Indirect Pass Through FEIN |
34-3456789 |
| |
|
Partner's Name |
LOIS LANE |
| |
|
Ordinary business income |
$5,000.00 |
| Entity # 5 |
|
|
|
| ShareholderSSN |
|
Shareholder's SSN |
XX0-00-7612 |
| CorporationEIN |
|
Corporation's EIN |
34-5678905 |
| CorporationName / BusinessNameLine1Txt |
|
Corporation's Name |
DAILY PLANET 5 |
| PercentageStockOwnership |
|
Percentage of Stock Ownership |
25% |
| WithholdingAmount |
|
Ohio PTE Credit Amount |
$450.00 |
| TotalIndirectPassThroughCredit |
|
Total Indirect Pass Through Credit |
$30.00 |
| TotalIndirectPassThroughFEIN |
|
Total Indirect Pass Through FEIN |
34-3456789 |
| |
|
Partner's Name |
LOIS LANE |
| |
|
Ordinary business income |
$5,000.00 |
| Entity # 6 |
|
|
|
| ShareholderSSN |
|
Shareholder's SSN |
XX0-00-7612 |
| CorporationEIN |
|
Corporation's EIN |
34-5678906 |
| CorporationName / BusinessNameLine1Txt |
|
Corporation's Name |
DAILY PLANET 6 |
| PercentageStockOwnership |
|
Percentage of Stock Ownership |
25% |
| WithholdingAmount |
|
Ohio PTE Credit Amount |
$450.00 |
| TotalIndirectPassThroughCredit |
|
Total Indirect Pass Through Credit |
$30.00 |
| TotalIndirectPassThroughFEIN |
|
Total Indirect Pass Through FEIN |
34-3456789 |
| |
|
Partner's Name |
LOIS LANE |
| |
|
Ordinary business income |
$5,000.00 |
| Entity # 7 |
|
|
|
| ShareholderSSN |
|
Shareholder's SSN |
XX0-00-7612 |
| CorporationEIN |
|
Corporation's EIN |
34-5678907 |
| CorporationName / BusinessNameLine1Txt |
|
Corporation's Name |
DAILY PLANET 7 |
| PercentageStockOwnership |
|
Percentage of Stock Ownership |
25% |
| WithholdingAmount |
|
Ohio PTE Credit Amount |
$450.00 |
| TotalIndirectPassThroughCredit |
|
Total Indirect Pass Through Credit |
$30.00 |
| TotalIndirectPassThroughFEIN |
|
Total Indirect Pass Through FEIN |
34-3456789 |
| |
|
Partner's Name |
LOIS LANE |
| |
|
Ordinary business income |
$5,000.00 |
| Entity # 8 |
|
|
|
| ShareholderSSN |
|
Shareholder's SSN |
XX0-00-7612 |
| CorporationEIN |
|
Corporation's EIN |
34-5678908 |
| CorporationName / BusinessNameLine1Txt |
|
Corporation's Name |
DAILY PLANET 8 |
| PercentageStockOwnership |
|
Percentage of Stock Ownership |
25% |
| WithholdingAmount |
|
Ohio PTE Credit Amount |
$450.00 |
| TotalIndirectPassThroughCredit |
|
Total Indirect Pass Through Credit |
$31.00 |
| TotalIndirectPassThroughFEIN |
|
Total Indirect Pass Through FEIN |
34-3456789 |
| |
|
Partner's Name |
LOIS LANE |
| |
|
Ordinary business income |
$5,000.00 |
| Entity # 9 |
|
|
|
| ShareholderSSN |
|
Shareholder's SSN |
XX0-00-7612 |
| CorporationEIN |
|
Corporation's EIN |
34-5678909 |
| CorporationName / BusinessNameLine1Txt |
|
Corporation's Name |
DAILY PLANET 9 |
| PercentageStockOwnership |
|
Percentage of Stock Ownership |
25% |
| WithholdingAmount |
|
Ohio PTE Credit Amount |
$450.00 |
| TotalIndirectPassThroughCredit |
|
Total Indirect Pass Through Credit |
$31.00 |
| TotalIndirectPassThroughFEIN |
|
Total Indirect Pass Through FEIN |
34-3456789 |
| |
|
Partner's Name |
LOIS LANE |
| |
|
Ordinary business income |
$5,000.00 |
| Entity # 10 |
|
|
|
| ShareholderSSN |
|
Shareholder's SSN |
XX0-00-7612 |
| CorporationEIN |
|
Corporation's EIN |
34-5678910 |
| CorporationName / BusinessNameLine1Txt |
|
Corporation's Name |
DAILY PLANET 10 |
| PercentageStockOwnership |
|
Percentage of Stock Ownership |
25% |
| WithholdingAmount |
|
Ohio PTE Credit Amount |
$450.00 |
| TotalIndirectPassThroughCredit |
|
Total Indirect Pass Through Credit |
$31.00 |
| TotalIndirectPassThroughFEIN |
|
Total Indirect Pass Through FEIN |
34-3456789 |
| |
|
Partner's Name |
LOIS LANE |
| |
|
Ordinary business income |
$5,000.00 |
| |
|
Net long-term capital gain (loss) |
-$3,000.00 |
| Entity # 11 |
|
|
|
| ShareholderSSN |
|
Shareholder's SSN |
XX0-00-7612 |
| CorporationEIN |
|
Corporation's EIN |
34-5678911 |
| CorporationName / BusinessNameLine1Txt |
|
Corporation's Name |
DAILY PLANET 11 |
| PercentageStockOwnership |
|
Percentage of Stock Ownership |
25% |
| WithholdingAmount |
|
Ohio PTE Credit Amount |
$450.00 |
| TotalIndirectPassThroughCredit |
|
Total Indirect Pass Through Credit |
$31.00 |
| TotalIndirectPassThroughFEIN |
|
Total Indirect Pass Through FEIN |
34-3456789 |
| |
|
Partner's Name |
LOIS LANE |
| |
|
Ordinary business income |
$5,000.00 |
| Entity # 12 |
|
|
|
| ShareholderSSN |
|
Shareholder's SSN |
XX0-00-7612 |
| CorporationEIN |
|
Corporation's EIN |
34-5678912 |
| CorporationName / BusinessNameLine1Txt |
|
Corporation's Name |
DAILY PLANET 12 |
| PercentageStockOwnership |
|
Percentage of Stock Ownership |
25% |
| WithholdingAmount |
|
Ohio PTE Credit Amount |
$450.00 |
| TotalIndirectPassThroughCredit |
|
Total Indirect Pass Through Credit |
$31.00 |
| TotalIndirectPassThroughFEIN |
|
Total Indirect Pass Through FEIN |
34-3456789 |
| |
|
Partner's Name |
LOIS LANE |
| |
|
Ordinary business income |
$5,000.00 |
| Entity # 13 |
|
|
|
| ShareholderSSN |
|
Shareholder's SSN |
XX0-00-7612 |
| CorporationEIN |
|
Corporation's EIN |
34-5678913 |
| CorporationName / BusinessNameLine1Txt |
|
Corporation's Name |
DAILY PLANET 13 |
| PercentageStockOwnership |
|
Percentage of Stock Ownership |
25% |
| WithholdingAmount |
|
Ohio PTE Credit Amount |
$450.00 |
| TotalIndirectPassThroughCredit |
|
Total Indirect Pass Through Credit |
$31.00 |
| TotalIndirectPassThroughFEIN |
|
Total Indirect Pass Through FEIN |
34-3456789 |
| |
|
Partner's Name |
LOIS LANE |
| |
|
Ordinary business income |
$5,000.00 |
| |
|
|
|
| Return Information |
|
|
|
| Federal Return Data |
|
|
|
| |
|
Filing Status |
Single |
| |
|
Exemptions, Self |
1 |
| |
|
Total Taxable Pensions and Annunities |
$25,000.00 |
| |
|
Total Taxable Interest and Dividends - Business Income |
$20,000.00 |
| |
|
Total Business Income or (Loss) |
$250,000.00 |
| |
|
Total Capital Gain or (Loss) - Business Income |
($3,000.00) |
| |
|
Rental real estate, royalties, partnerships, S corporations, trusts, etc. (includes $5000 of guaranteed payments separately stated on federal Schedule K-1) |
$85,000.00 |
| |
|
Farm Income or (Loss) |
($50,000.00) |
| |
|
Other income (loss) - Business Income |
$15,000.00 |
| |
|
Alimony Paid |
($56,082.00) |
| |
|
Self Employment Tax Deduction |
($11,792.00) |
| |
|
Adjusted Gross Income |
$274,126.00 |
| |
|
|
|
| State Return Data |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| FilingStatus |
|
|
|
| Single |
|
|
X |
| |
|
|
|
| Did you file federal extension Form 4868? |
|
|
No |
| |
|
|
|
| Did you take the Standard deduction or itemize? |
|
|
Standard |
| |
|
|
|
| Can someone else claim you (or your spouse) as a dependent? |
|
|
|
| ClaimedAsDependent |
|
|
No |
| |
|
|
|
| Residency Status |
|
|
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| JointFilingCredit |
|
Eligible for JFC? |
no |
| |
|
|
|
| SD Return # 1 Information |
|
|
|
| SchoolDistrictNumber |
|
What is the school district number for which you are filing the SD 100? |
1505 |
| TaxType |
|
Tax Type |
Earned Income Only |
| |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| NOLCarryBack |
|
Is the amended return an NOL carryback? |
No |
| |
|
|
|
| Residency Status |
|
School district residency |
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| Additional Information - SD #1 |
|
|
|
| InstallmentPayments |
|
Estimated Payments |
$1,200.00 |
| SeniorCitizenCredit |
|
Senior Citizen Credit |
$50.00 |
| |
|
|
|
| Return |
|
|
|
| IT1040 - Pages 1 & 2 |
| FederalAdjustedGrossIncome |
1 |
Federal Adjusted Gross Income |
$274,126.00 |
| TotalIncomeAddition |
2a |
Additions to federal adjusted gross income |
$0.00 |
| TotalIncomeDeduction |
2b |
Deductions from federal adjusted gross income |
$250,000.00 |
| OhioAdjustedGrossIncome |
3 |
Ohio Adjusted Gross Income (OAGI) |
$24,126.00 |
| ExemptionDeduction |
4 |
Personal and dependent exemption deduction |
$1,900.00 |
| TaxableIncome |
5 |
Ohio income tax base |
$22,226.00 |
| TaxableBusinessIncome |
6 |
Taxable business income (Ohio IT BUS, line 13) |
$22,226.00 |
| TaxableIncomeLessBusinessIncome |
7 |
Line 5 minus line 6 (if less than 0, enter 0) |
$0.00 |
| |
7a |
Amount from line 7 on page 1 |
$0.00 |
| NonBusinessIncomeTaxLiability |
8a |
Nonbusiness income tax liability |
$0.00 |
| BusinessIncomeTaxLiability |
8b |
Business income tax liability (Ohio IT BUS, line 14) |
$667.00 |
| IncomeTaxLiabilityBeforeCredits |
8c |
Income tax liability before credits (line 8a plus 8b) |
$667.00 |
| OhioNonRefundableCredits |
9 |
Ohio nonrefundable credits |
$500.00 |
| TaxLiabAfterNonrefundableCrdt |
10 |
Tax liability after nonrefundable credits |
$167.00 |
| UnderPaymentInterestPenalty |
11 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| UnpaidUseTax |
12 |
Sales and use tax due on Internet, mail order or other out-of-state purchases |
$0.00 |
| TotalTaxLiability |
13 |
Total Ohio tax liability before withholding or estimated payments |
$167.00 |
| TaxWithheld |
14 |
Ohio income tax withheld |
$1,500.00 |
| InstallmentPayment |
15 |
Add the Ohio estimated & extension payments & credit carryforward from previous year return |
$0.00 |
| RefundableTaxCredits |
16 |
Refundable credits |
$6,250.00 |
| AmtPrevPaidWithOrigAmendRtn |
17 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayment |
18 |
Total Ohio Tax Payments |
$7,750.00 |
| OverpymtRecdOnOrigAmendRtn |
19 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
20 |
Line 18 minus line 19 |
$7,750.00 |
| AmountUnderpaid |
21 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
22 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
23 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
24 |
Overpayment |
$7,583.00 |
| OverpymtCreditedNextYear |
25 |
Original return only - amount of line 24 to be carried forward to next year's tax liability |
$0.00 |
| CharityOrgName |
26a |
Amount of line 24 to be donated - Wildlife species |
$0.00 |
| CharityOrgName |
26b |
Amount of line 24 to be donated - Military injury relief |
$0.00 |
| CharityOrgName |
26c |
Amount of line 24 to be donated - Ohio History Fund |
$0.00 |
| CharityOrgName |
26d |
Amount of line 24 to be donated - Nature Preserves/Scenic Rivers |
$0.00 |
| CharityOrgName |
26e |
Amount of line 24 to be donated - Breast/cervical cancer |
$0.00 |
| CharityOrgName |
26f |
Amount of line 24 to be donated - Wishes for sick children |
$0.00 |
| TotalDonation |
26g |
Total |
$0.00 |
| Refund |
27 |
Your Refund |
$7,583.00 |
| |
|
|
|
| Schedule of Adjustments |
| Additions |
|
|
|
| NonOhioAndLocalGovIntAndDiv |
1 |
Non-Ohio state or local government interest and dividends |
$0.00 |
| PassThruEntityTaxesPaid |
2 |
Certain Ohio pass-through entity and financial institutions taxes paid |
$0.00 |
| TuitionExpenseReimbursement |
3 |
Reimbursement of college tutition expenses and fees deducted in any previous year(s) and noneducation expenditures from a college savings account |
$0.00 |
| SaleAndDispstnLossOfOhioOblig |
4 |
Losses from sale or disposition of Ohio public obligations |
$0.00 |
| NonMedicalWithdrawals |
5 |
Nonmedical withdrawals from a medical savings account |
$0.00 |
| ReimExpPrevDeducted |
6 |
Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if the reimbursement is not in federal adjusted gross income |
$0.00 |
| IRC168And179AdjAdd |
7 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| FederalInterestAndDividends |
8 |
Federal interest and dividends subject to state taxation |
$0.00 |
| FederalConformityAdditions |
9 |
Federal conformity additions |
$0.00 |
| TotalIncomeAddition |
10 |
Total additions |
$0.00 |
| |
|
|
|
| Deductions |
|
|
|
| BusinessIncomeDeduction |
11 |
Business income deduction (attach Ohio Schedule IT BUS, line 11) |
$250,000.00 |
| OHFullYrEmpCompEarnNeighState |
12 |
Employee compensation earned in Ohio by residents of neighboring states |
$0.00 |
| IRS1040StateMuniIncomeOverpymt |
13 |
State or municipal income tax overpayments shown on the federal 1040, Sch 1, line 1 |
$0.00 |
| SocialSecurityBenefits |
14 |
Taxable Social Security benefits |
$0.00 |
| RailroadRetirementBenefits |
15 |
Certain railroad retirement benefits |
$0.00 |
| ObligIntrstPublicServicePay |
16 |
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 state of Ohio or income from a transfer agreement |
$0.00 |
| IndDevAcct |
17 |
Amounts contributed to an individual development account |
$0.00 |
| STABLEAcct |
18 |
Amounts contributed to STABLE account; Ohio's ABLE plan |
$0.00 |
| OutOfStateDisasterWorkIncome |
19 |
Income earned in Ohio by a qualifying out-of-state business or employee for disaster work conducted during a disaster response period |
$0.00 |
| FederalIntAndDivExempt |
20 |
Federal interest and dividends exempt from state taxation |
$0.00 |
| IRC168And179AdjDed |
21 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| IRS1040RefundOrReimbursements |
22 |
Refund or reimbursements shown on the federal 1040, schedule 1 for itemized deductions claimed on a prior year federal income tax return |
$0.00 |
| RepaymentOfIncomeReported |
23 |
Repayment of income reported in a prior year |
$0.00 |
| NotDeductedWageExpense |
24 |
Wage expense not deducted due to claiming the federal work opportunity credit |
$0.00 |
| FederalConformityDeductions |
25 |
Federal conformity deductions |
$0.00 |
| MilitaryPayForResident |
26 |
Military pay for Ohio residents received while the military member was stationed outside Ohio |
$0.00 |
| IncomeErndMilitCivilianNRSpouse |
27 |
Certain income earned by military nonresidents and civilian nonresident spouses |
$0.00 |
| UniformedServcsRetirmtIncome |
28 |
Uniformed services retirement income |
$0.00 |
| MilitaryInjuryReliefFund |
29 |
Military injury relief fund |
$0.00 |
| NationalGuardReimAndBenft |
30 |
Certain Ohio National Guard reimbursements and benefits |
$0.00 |
| CollegeAdvSavAndTuitPurchCred |
31 |
Ohio 529 contributions, tuition credit purchases |
$0.00 |
| PellOhioCollegeOppTaxableGrant |
32 |
Pell/Ohio College Opportunity taxable grant amounts used to pay room and board |
$0.00 |
| OhioEducatorExpenses |
33 |
Ohio educator expenses in excess of federal deduction |
$0.00 |
| DisabilityBenefits |
34 |
Disability benefits |
$0.00 |
| SurvivorBenefits |
35 |
Survivor benefits |
$0.00 |
| UnsubsidizedMedicalExpense |
36 |
Unreimbursed long-term care insurance premiums, unsubsidized health care insurance premiums and excess health care expenses (see instructions for worksheet) |
$0.00 |
| HealthCareDepositedFunds |
37 |
Funds deposited into, and earnings of, a medical savings account for eligible health care expenses (see instructions for worksheet) |
$0.00 |
| QualOrganDonorExp |
38 |
Qualified organ donor expenses |
$0.00 |
| TotalIncomeDeduction |
39 |
Total deductions |
$250,000.00 |
| |
|
|
|
| Schedule IT BUS |
|
|
|
| |
|
Part 1 |
|
| BusScheduleB |
1 |
Sch B - Interest and Ordinary Dividends |
$20,000.00 |
| BusScheduleC |
2 |
Sch C - Profit or Loss From Business (Sole Proprietership) |
$250,000.00 |
| BusScheduleD |
3 |
Sch D - Capital Gains and Losses |
($3,000.00) |
| BusScheduleE |
4 |
Sch E - Supplemental Income and Loss |
$80,000.00 |
| GuaranteedPayments |
5 |
Guranteed payments, compensation and/or wages from each pass-through entity in which you have at least a 20% direct or indirect ownership interest |
$5,000.00 |
| BusScheduleF |
6 |
Sch F - Profit or Loss From Farming |
($50,000.00) |
| OtherItemsOfIncome |
7 |
Other items of income and gain separately stated on federal Schedule K-1, federal 4797 gains and/or losses reported on federal 4797 and miscellaneous federal income tax adjustments, if any |
$15,000.00 |
| TotalOfBusinessIncome |
8 |
Total of business income (add lines 1 through 7) |
$317,000.00 |
| |
|
Part 2 |
|
| AllBusinessIncome |
9 |
All business income (enter the lesser of line 8 above or Ohio IT1040, line 1). If zero or negative, stop here and do not complete Part 3. |
$274,126.00 |
| FilingStatusBusIncAmt |
10 |
Enter $250,000 if single or MFJ, enter $125,000 if MFS |
$250,000.00 |
| LessOfFilStatBusIncAmtOrAllBusInc |
11 |
Lesser of line 9 or line 10. Enter here and on Ohio Schedule of Adjustments, line 11 |
$250,000.00 |
| |
|
Part 3 |
|
| AllBusIncLessBusIncDeduction |
12 |
Line 9 minus line 11 (if less than -0-, enter -0-) |
$24,126.00 |
| TaxableBusinessIncome |
13 |
Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5) |
$22,226.00 |
| BusinessIncomeTaxLiability |
14 |
Business income tax liability. Multiply line 13 by 3%. Enter here and on Ohio IT 1040, line 8b. |
$667.00 |
| |
|
Part 4 |
|
| NameOfEntity |
1 |
Name of Entity |
DAILY PLANET 1 |
| FEINOrSSN |
|
FEIN/SS# |
34-5678901 |
| PercentageOfOwnership |
|
Percentage of Ownership |
0.25 |
| Income Earned By Primary |
|
Primary |
X |
| Income Earned By Spouse |
|
Spouse |
|
| NameOfEntity |
2 |
Name of Entity |
DAILY PLANET 2 |
| FEINOrSSN |
|
FEIN/SS# |
34-5678902 |
| PercentageOfOwnership |
|
Percentage of Ownership |
0.25 |
| Income Earned By Primary |
|
Primary |
X |
| Income Earned By Spouse |
|
Spouse |
|
| NameOfEntity |
3 |
Name of Entity |
DAILY PLANET 3 |
| FEINOrSSN |
|
FEIN/SS# |
34-5678903 |
| PercentageOfOwnership |
|
Percentage of Ownership |
0.25 |
| Income Earned By Primary |
|
Primary |
X |
| Income Earned By Spouse |
|
Spouse |
|
| NameOfEntity |
4 |
Name of Entity |
DAILY PLANET 4 |
| FEINOrSSN |
|
FEIN/SS# |
34-5678904 |
| PercentageOfOwnership |
|
Percentage of Ownership |
0.25 |
| Income Earned By Primary |
|
Primary |
X |
| Income Earned By Spouse |
|
Spouse |
|
| NameOfEntity |
5 |
Name of Entity |
DAILY PLANET 5 |
| FEINOrSSN |
|
FEIN/SS# |
34-5678905 |
| PercentageOfOwnership |
|
Percentage of Ownership |
0.25 |
| Income Earned By Primary |
|
Primary |
X |
| Income Earned By Spouse |
|
Spouse |
|
| NameOfEntity |
6 |
Name of Entity |
DAILY PLANET 6 |
| FEINOrSSN |
|
FEIN/SS# |
34-5678906 |
| PercentageOfOwnership |
|
Percentage of Ownership |
0.25 |
| Income Earned By Primary |
|
Primary |
X |
| Income Earned By Spouse |
|
Spouse |
|
| NameOfEntity |
7 |
Name of Entity |
DAILY PLANET 7 |
| FEINOrSSN |
|
FEIN/SS# |
34-5678907 |
| PercentageOfOwnership |
|
Percentage of Ownership |
0.25 |
| Income Earned By Primary |
|
Primary |
X |
| Income Earned By Spouse |
|
Spouse |
|
| NameOfEntity |
8 |
Name of Entity |
DAILY PLANET 8 |
| FEINOrSSN |
|
FEIN/SS# |
34-5678908 |
| PercentageOfOwnership |
|
Percentage of Ownership |
0.25 |
| Income Earned By Primary |
|
Primary |
X |
| Income Earned By Spouse |
|
Spouse |
|
| NameOfEntity |
9 |
Name of Entity |
DAILY PLANET 9 |
| FEINOrSSN |
|
FEIN/SS# |
34-5678909 |
| PercentageOfOwnership |
|
Percentage of Ownership |
0.25 |
| Income Earned By Primary |
|
Primary |
X |
| Income Earned By Spouse |
|
Spouse |
|
| NameOfEntity |
10 |
Name of Entity |
DAILY PLANET 10 |
| FEINOrSSN |
|
FEIN/SS# |
34-5678910 |
| PercentageOfOwnership |
|
Percentage of Ownership |
0.25 |
| Income Earned By Primary |
|
Primary |
X |
| Income Earned By Spouse |
|
Spouse |
|
| NameOfEntity |
11 |
Name of Entity |
DAILY PLANET 11 |
| FEINOrSSN |
|
FEIN/SS# |
34-5678911 |
| PercentageOfOwnership |
|
Percentage of Ownership |
0.25 |
| Income Earned By Primary |
|
Primary |
X |
| Income Earned By Spouse |
|
Spouse |
|
| NameOfEntity |
12 |
Name of Entity |
DAILY PLANET 12 |
| FEINOrSSN |
|
FEIN/SS# |
34-5678912 |
| PercentageOfOwnership |
|
Percentage of Ownership |
0.25 |
| Income Earned By Primary |
|
Primary |
X |
| Income Earned By Spouse |
|
Spouse |
|
| NameOfEntity |
13 |
Name of Entity |
DAILY PLANET 13 |
| FEINOrSSN |
|
FEIN/SS# |
34-5678913 |
| PercentageOfOwnership |
|
Percentage of Ownership |
0.25 |
| Income Earned By Primary |
|
Primary |
X |
| Income Earned By Spouse |
|
Spouse |
|
| |
|
|
|
| Schedule of Credits - Nonrefundable |
| TaxLiabilityBeforeCredits |
1 |
Tax liability before credits (From IT1040, line 8c) |
$667.00 |
| RetireIncomeCredit |
2 |
Retirement income credit (limit $200 per return) |
$0.00 |
| LumpSumRetirementCredit |
3 |
Lump sum retirement credit (include Ohio LS WKS, line 6) |
$0.00 |
| SeniorCitizenCredit |
4 |
Senior citizen credit |
$0.00 |
| LumpSumDistributionCredit |
5 |
Lump sum distribution credit (include Ohio LS WKS, line 3) |
$0.00 |
| ChildAndDependCareCredit |
6 |
Child care and dependent care credit (see the worksheet in the instructions) |
$0.00 |
| DisplacedWorkerTrainingCredit |
7 |
Displaced worker training credit (see the worksheet in the instructions) |
$0.00 |
| CampaignContributionCredit |
8 |
Campaign contribution credit |
$0.00 |
| ExemptionCredit |
9 |
Income-based exemption credit |
$0.00 |
| TotCreditsBeforeJointFiling |
10 |
Total (add lines 2 through 9) |
$0.00 |
| TaxLessCredit |
11 |
Tax less credits (line 1 minus line 10; if less than -0-, enter -0-) |
$667.00 |
| JointFilingCredit |
12 |
Joint filing credit |
$0.00 |
| EarnedIncomeCredit |
13 |
Earned income credit (multiply Fed EITC by 30%) |
$0.00 |
| HomeSchoolExpensesCredit |
14 |
Home school expenses credit |
$0.00 |
| ScholarshipDonationCredit |
15 |
Scholarship donation credit |
$0.00 |
| NonCharterOrPublicSchoolCredit |
16 |
Nonchartered, nonpublic school tuition credit |
$0.00 |
| VocationalJobCredit |
17 |
Vocational job credit |
$500.00 |
| AdoptionCredit |
18 |
Ohio adoption credit |
$0.00 |
| JobRetentionCredit |
19 |
Nonrefundable job retention credit |
$0.00 |
| NewEmpInEntZoneCredit |
20 |
Credit for eligible new employees in an enterprise zone |
$0.00 |
| GrapeProdPropertyPurchCredit |
21 |
Credit for purchases of grape production property |
$0.00 |
| InvestOhioCredit |
22 |
InvestOhio credit |
$0.00 |
| LeadAbatementCredit |
23 |
Lead abatement credit |
$0.00 |
| OpportunityZoneCredit |
24 |
Opportunity zone investment credit |
$0.00 |
| TechInvestCreditCarryfrwd |
25 |
Technology investment credit carryforward |
$0.00 |
| EntZoneDayCareAndTrngCredit |
26 |
Enterprise zone day care and training credits |
$0.00 |
| ResearchAndDevelopmentCredit |
27 |
Research and development credit |
$0.00 |
| OhioHistoricPreservationCredit |
28 |
Nonrefundable Ohio historic preservation credit |
$0.00 |
| TotAdditionalCredits |
29 |
Total (add lines 12 through 28) |
$500.00 |
| TaxLessCrdtMinusTotAddlCrdts |
30 |
Tax less additional credits (line 11 minus line 29; if less than -0-, enter -0-) |
$167.00 |
| |
|
Nonresident Credit |
|
| NonOhioIncome |
31 |
Nonresident Portion of Ohio adjusted gross income |
$0.00 |
| OhioAdjustedGrossIncome |
32 |
Ohio adjusted gross income |
$0.00 |
| NonResIncomeCreditRatio |
33a |
Divide line 31 by line 32 |
0.0000 |
| NonresidentAndPartYearCredit |
33 |
Nonresident credit (line 30 times line 33a) |
$0.00 |
| |
|
Resident Credit |
|
| ResidentTaxCredit |
34 |
Resident Credit - Ohio IT RC, line 7 |
$0.00 |
| TotalNonrefundableCredits |
35 |
Total nonrefundable credits |
$500.00 |
| |
|
|
|
| Schedule of Credits - Refundable |
| HistoricPreservationCredit |
36 |
Refundable Ohio historic preservation credit |
$0.00 |
| JobCreationAndJobRetentionCrd |
37 |
Refundable job creation credit & job retention credit |
$0.00 |
| PassthroughEntityCredit |
38 |
Pass-through entity credit |
$6,250.00 |
| MotionPictureProductionCredit |
39 |
Motion Picture & Broadway theatrical production credit |
$0.00 |
| VentureCapitalCredit |
40 |
Venture Capital credit |
$0.00 |
| TotalRefundableCredit |
41 |
Total refundable credits |
$6,250.00 |
| |
|
|
|
| School District Return (#1505) |
|
|
|
| SchoolDistrictTaxableIncome |
1 |
School district taxable income: Traditional or Earned Income tax base |
$200,000.00 |
| TaxAmount |
2 |
School District Tax .____ times line 1. |
$1,000.00 |
| SeniorCitizenCredit |
3 |
Senior Citizen Credit |
$50.00 |
| TaxLessCredit |
4 |
School District Income Tax liability |
$950.00 |
| UnderPaymentInterestPenalty |
5 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| TotalTax |
6 |
Total school district income tax liability (line 4 plus line 5) |
$950.00 |
| TotalTax |
6a |
Amount from line 6, page 1 |
$950.00 |
| TaxWithheld |
7 |
School district income tax withheld |
$0.00 |
| InstallmentPayments |
8 |
SD 100 ES & SD 40P, Extension Payments and Credit carryforward from previous year return |
$1,200.00 |
| AmtPrevPaidWithOrigAmendRtn |
9 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayments |
10 |
Total school district income tax payments (add lines 7, 8 and 9) |
$1,200.00 |
| OverpymtRecdOnOrigAmendRtn |
11 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
12 |
Line 10 minus line 11. Place a negative sign ("-") in the box if the amount is less than -0- |
$1,200.00 |
| AmountUnderpaid |
13 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
14 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
15 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
16 |
Overpayment |
$250.00 |
| OverpymtCreditedNextYear |
17 |
Original return only - amount of line 16 to be carried forward to next year's tax liability |
$0.00 |
| Refund |
18 |
Your Refund |
$250.00 |
| Traditional Tax Base School District Amounts |
|
|
|
| TaxableIncome |
19 |
Ohio income tax base (Ohio IT 1040, line 3 minus line 4) |
$0.00 |
| BusinessIncomeDeductionAddback |
20 |
Business income deduction add-back |
$0.00 |
| TotalTraditionalSDIncome |
21 |
Total Traditional Tax Base School District Income (Line 19 + Line 20) |
$0.00 |
| NonResidentIncome |
22 |
Amount of traditional tax base school district income that you earned while not a resident |
$0.00 |
| SchoolDistrictTaxableIncome |
23 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| Earned Income Tax Base School District Amounts |
|
|
|
| WagesAndOtherCompensations |
24 |
Wages and other compensation as described in the instructions |
$0.00 |
| SelfEmploymentEarnings |
25 |
Net Earnings from Self Employment |
$200,000.00 |
| FederalConformityAdjustments |
26 |
Federal Conformity Adjustments |
$0.00 |
| SchoolDistrictTaxableIncome |
27 |
School District Taxable Income (Enter here and on line 1) |
$200,000.00 |
| |
|
|
|
| What is Tested? |
If you do not support: |
|
| IT1040WithSD100 |
|
|
|
| K-1 |
|
|
| |
|
|
|
| IT1040 |
|
|
|
| Sch. Of Adj - Business income deduction |
|
|
| IT BUS - Business Income schedule |
|
|
|
| Sch of Credits - MAGI less exemptions is over the limit for Retirement Income Credit |
|
|
| Sch of Credits - Refundable PTE credit |
Remove PTE credit |
|
| |
|
|
|
| SD100 |
|
|
|
| Business Income deduction add-back |
|
|
| Ohio Test #13 |
|
|
SD100 |
| Taxpayer Information |
|
Description |
|
| TaxpayerSSN |
|
Primary Social Security Number |
400-XX-7613 |
| FirstName |
|
Primary First Name |
GEORGE |
| LastName |
|
Primary Last Name |
JETSON |
| DateOfBirth |
|
Date of Birth - Primary |
1982-10-21 |
| |
|
|
|
| TaxpayerSSN |
|
Spouse's Social Security Number |
400-XX-7663 |
| FirstName |
|
Spouse First Name |
JANE |
| LastName |
|
Spouse Last Name |
JETSON |
| DateOfBirth |
|
Date of Birth - Spouse |
1976-07-18 |
| |
|
|
|
| USPhone |
|
Taxpayer's Phone Number |
[<=9999999]###-#### |
| EmailAddress |
|
Taxpayer's E-mail Address |
JETSON@JETSON.COM |
| |
|
|
|
| AddressLine1Txt |
|
Address Line 1 |
5 CARTOON RD |
| CityNm |
|
City |
JOHNSTOWN |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43031 |
| |
|
|
|
| MailingAddressCounty |
|
Ohio County |
LICKING |
| SchoolDistrictNumber |
|
Ohio Public School District Number - Resident District |
4509 |
| |
|
|
|
| Preparer Information |
|
|
|
| Self-Prepared |
|
|
|
| SelfPrepared |
|
Return is self-prepared |
X |
| |
|
|
|
| Income Statements |
| Return Information |
|
|
|
| Federal Return Data |
|
|
|
| |
|
Filing Status |
Married Filing Jointly |
| |
|
Exemptions, Self |
2 |
| |
|
Total Business Income or (Loss) |
$275,000.00 |
| |
|
Self Employment Tax Deduction |
($12,797.00) |
| |
|
Adjusted Gross Income |
$262,203.00 |
| |
|
|
|
| State Return Data |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| FilingStatus |
|
|
|
| MarriedFilingJointly |
|
|
X |
| |
|
|
|
| Did you file federal extension Form 4868? |
|
|
Yes |
| |
|
|
|
| Can someone else claim you (or your spouse) as a dependent? |
|
|
|
| ClaimedAsDependent |
|
|
No |
| |
|
|
|
| Residency Status |
|
|
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| JointFilingCredit |
|
Eligible for JFC? |
No |
| |
|
|
|
| Additional Information |
|
|
|
| |
|
Business Income Deduction |
$250,000.00 |
| |
|
Ohio Income Tax Base |
$8,664.00 |
| |
|
|
|
| SD Return # 1 Information |
|
|
|
| SchoolDistrictNumber |
|
What is the school district number for which you are filing the SD 100? |
4509 |
| TaxType |
|
Tax Type |
Earned Income Only |
| |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| Residency Status |
|
School district residency |
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| Additional Information - SD #1 (4509) |
|
|
|
| SelfEmploymentEarnings |
|
Net Earnings from Self Employment |
$275,000.00 |
| |
|
Note: This amount must be reduced in order to limit School District Taxable Income to the extent included in modified adjusted gross income |
|
| |
|
Estimated Payments |
$1,500.00 |
| |
|
|
|
| SD Return # 2 Information |
|
|
|
| SchoolDistrictNumber |
|
What is the school district number for which you are filing the SD 100? |
5503 |
| TaxType |
|
Tax Type |
Traditional |
| |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| Residency Status |
|
School district residency |
|
| PrimaryResidencyStatus |
|
|
|
| FullYearNonResident |
|
Full-Year NonResident |
X |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| FullYearNonResident |
|
Full-Year NonResident |
X |
| |
|
|
|
| Additional Information - SD #2 (5503) |
|
|
|
| |
|
Estimated Payments |
$1,000.00 |
| |
|
|
|
| School District Return (#4509) |
|
|
|
| SchoolDistrictTaxableIncome |
1 |
School district taxable income: Traditional or Earned Income tax base |
$262,203.00 |
| TaxAmount |
2 |
School District Tax .____ times line 1. |
$1,311.00 |
| SeniorCitizenCredit |
3 |
Senior Citizen Credit |
$0.00 |
| TaxLessCredit |
4 |
School District Income Tax liability |
$1,311.00 |
| UnderPaymentInterestPenalty |
5 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| TotalTax |
6 |
Total school district income tax liability (line 4 plus line 5) |
$1,311.00 |
| TotalTax |
6a |
Amount from line 6, page 1 |
$1,311.00 |
| TaxWithheld |
7 |
School district income tax withheld |
$0.00 |
| InstallmentPayments |
8 |
SD 100 ES & SD 40P, Extension Payments and Credit carryforward from previous year return |
$1,500.00 |
| AmtPrevPaidWithOrigAmendRtn |
9 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayments |
10 |
Total school district income tax payments (add lines 7, 8 and 9) |
$1,500.00 |
| OverpymtRecdOnOrigAmendRtn |
11 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
12 |
Line 10 minus line 11. Place a negative sign ("-") in the box if the amount is less than -0- |
$1,500.00 |
| AmountUnderpaid |
13 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
14 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
15 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
16 |
Overpayment |
$189.00 |
| OverpymtCreditedNextYear |
17 |
Original return only - amount of line 16 to be carried forward to next year's tax liability |
$0.00 |
| Refund |
18 |
Your Refund |
$189.00 |
| Traditional Tax Base School District Amounts |
|
|
|
| TaxableIncome |
19 |
Ohio income tax base (Ohio IT 1040, line 3 minus line 4) |
$0.00 |
| BusinessIncomeDeductionAddback |
20 |
Business income deduction add-back |
$0.00 |
| TotalTraditionalSDIncome |
21 |
Total Traditional Tax Base School District Income (Line 19 + Line 20) |
$0.00 |
| NonResidentIncome |
22 |
Amount of traditional tax base school district income that you earned while not a resident |
$0.00 |
| SchoolDistrictTaxableIncome |
23 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| Earned Income Tax Base School District Amounts |
|
|
|
| WagesAndOtherCompensations |
24 |
Wages and other compensation as described in the instructions |
$0.00 |
| SelfEmploymentEarnings |
25 |
Net Earnings from Self Employment |
$262,203.00 |
| FederalConformityAdjustments |
26 |
Federal Conformity Adjustments |
$0.00 |
| SchoolDistrictTaxableIncome |
27 |
School District Taxable Income (Enter here and on line 1) |
$262,203.00 |
| |
|
|
|
| School District Return #2 Information (#5503) |
|
|
|
| SchoolDistrictTaxableIncome |
1 |
School district taxable income: Traditional or Earned Income tax base |
$0.00 |
| TaxAmount |
2 |
School District Tax .____ times line 1. |
$0.00 |
| SeniorCitizenCredit |
3 |
Senior Citizen Credit |
$0.00 |
| TaxLessCredit |
4 |
School District Income Tax liability |
$0.00 |
| UnderPaymentInterestPenalty |
5 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| TotalTax |
6 |
Total school district income tax liability (line 4 plus line 5) |
$0.00 |
| TotalTax |
6a |
Amount from line 6, page 1 |
$0.00 |
| TaxWithheld |
7 |
School district income tax withheld |
$0.00 |
| InstallmentPayments |
8 |
SD 100 ES & SD 40P, Extension Payments and Credit carryforward from previous year return |
$1,000.00 |
| AmtPrevPaidWithOrigAmendRtn |
9 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayments |
10 |
Total school district income tax payments (add lines 7, 8 and 9) |
$1,000.00 |
| OverpymtRecdOnOrigAmendRtn |
11 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
12 |
Line 10 minus line 11. Place a negative sign ("-") in the box if the amount is less than -0- |
$1,000.00 |
| AmountUnderpaid |
13 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
14 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
15 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
16 |
Overpayment |
$1,000.00 |
| OverpymtCreditedNextYear |
17 |
Original return only - amount of line 16 to be carried forward to next year's tax liability |
$0.00 |
| Refund |
18 |
Your Refund |
$1,000.00 |
| Traditional Tax Base School District Amounts |
|
|
|
| TaxableIncome |
19 |
Ohio income tax base (Ohio IT 1040, line 3 minus line 4) |
$8,403.00 |
| BusinessIncomeDeductionAddback |
20 |
Business income deduction add-back |
$250,000.00 |
| TotalTraditionalSDIncome |
21 |
Total Traditional Tax Base School District Income (Line 19 + Line 20) |
$258,403.00 |
| NonResidentIncome |
22 |
Amount of traditional tax base school district income that you earned while not a resident |
$258,403.00 |
| SchoolDistrictTaxableIncome |
23 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| Earned Income Tax Base School District Amounts |
|
|
|
| WagesAndOtherCompensations |
24 |
Wages and other compensation as described in the instructions |
$0.00 |
| SelfEmploymentEarnings |
25 |
Net Earnings from Self Employment |
$0.00 |
| FederalConformityAdjustments |
26 |
Federal Conformity Adjustments |
$0.00 |
| SchoolDistrictTaxableIncome |
27 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| |
|
|
|
| What is Tested? |
|
If you do not support: |
|
| SD100 (stand alone) |
|
Do not send test |
|
| Nonresident |
|
Send only Resident return (SD 4509) |
|
| Resident |
|
|
|
| Earned Income Tax Base |
|
|
|
| Traditional Tax Base |
|
|
|
| Ohio Test #14 |
|
|
IT1040 |
| Taxpayer Information |
|
Description |
|
| TaxpayerSSN |
|
Primary Social Security Number |
400-XX-7614 |
| FirstName |
|
Primary First Name |
MICKEY |
| LastName |
|
Primary Last Name |
MOUSE |
| DateOfBirth |
|
Date of Birth - Primary |
1947-02-14 |
| DateOfDeath |
|
Date of Death - Primary |
2022-12-31 |
| |
|
|
|
| TaxpayerSSN |
|
Spouse's Social Security Number |
400-XX-7664 |
| FirstName |
|
Spouse First Name |
DAISY |
| LastName |
|
Spouse Last Name |
DUCK |
| DateOfBirth |
|
Date of Birth - Spouse |
1977-07-18 |
| |
|
|
|
| USPhone |
|
Taxpayer's Phone Number |
[<=9999999]###-#### |
| EmailAddress |
|
Taxpayer's E-mail Address |
MOUSE@GMAIL.COM |
| |
|
|
|
| InCareOfNm |
|
In Care Of Name |
% DAISY DUCK |
| |
|
|
|
| AddressLine1Txt |
|
Address Line 1 |
455 CLUBHOUSE CIR |
| CityNm |
|
City |
COLUMBUS |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43215 |
| |
|
|
|
| MailingAddressCounty |
|
Ohio County |
FRANKLIN |
| SchoolDistrictNumber |
|
Ohio Public School District Number - Resident District |
2503 |
| |
|
|
|
| Preparer Information |
|
|
|
| Self-Prepared |
|
|
|
| SelfPrepared |
|
Return is self-prepared |
X |
| |
|
|
|
| Income Statements |
|
|
|
| W-2 #1 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
163456789-0000000 |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
ON-TECH CONSULTING |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
4821 VIOLET BLVD |
| CityNm |
|
City |
COLUMBUS |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43229 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7664 |
| EmployeNm |
|
Employee's Name |
DAISY DUCK |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
455 CLUBHOUSE CIR |
| CityNm |
|
City |
COLUMBUS |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43215 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$21,856.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$2,623.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$21,856.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$1,355.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$21,856.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$317.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
52-567891 |
| StateWagesAmt |
|
State Wages |
$21,856.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$657.00 |
| |
|
|
|
| W-2 #2 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
521963849-0000000 |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
MICKEY'S DUCK CALLS |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
28674 BUENA VISTA DRIVE |
| CityNm |
|
City |
BAY LAKE |
| StateAbbreviationCd |
|
State |
FL |
| ZIPCd |
|
Zip Code |
34747 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7614 |
| EmployeeNm |
|
Employee's Name |
MICKEY MOUSE |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
455 CLUBHOUSE CIR |
| CityNm |
|
City |
COLUMBUS |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43215 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$20,000.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$2,000.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$20,000.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$1,240.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$20,000.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$290.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
54298657-000000 |
| StateWagesAmt |
|
State Wages |
$20,000.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$200.00 |
| |
|
|
|
| 1099R #1 |
|
|
|
| PayerEIN |
|
Payer's Identification Number |
219876543-0000000 |
| PayerName / BusinessNameLine1Txt |
|
Payer's Name |
SUNSET INC |
| |
|
|
|
| AddressLine1Txt |
|
Payer's Address |
98 N OBERLIN DR |
| CityNm |
|
Payer's City |
OBERLIN |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZIPCd |
|
Payer's Zip Code |
44074 |
| |
|
|
|
| RecipientSSN |
|
Recipient's Social Security Number |
400-XX-7614 |
| RecipientNm |
|
Recipient's Name |
MICKEY MOUSE |
| AddressLine1Txt |
|
Recipient's Address Line 1 |
455 CLUBHOUSE CIR |
| CityNm |
|
Recipient's City |
COLUMBUS |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
43215 |
| |
|
|
|
| GrossDistributionAmt |
|
Gross Distribution Amount |
$38,125.00 |
| TaxableAmt |
|
Taxable Amount |
$38,125.00 |
| TotalDistributionInd |
|
Total Distribution Indicator |
X |
| F1099RDistributionCd |
|
Distribution Code |
7 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| PayerStateIdNum |
|
State Payer ID |
52-234567 |
| StateDistributionAmt |
|
State Distribution |
$38,125.00 |
| StateTaxWithheldAmt |
|
State Income Tax Withheld |
$100.00 |
| |
|
|
|
| 1099R #2 |
|
|
|
| PayerEIN |
|
Payer's Identification Number |
277766554-0000000 |
| PayerName / BusinessNameLine1Txt |
|
Payer's Name |
DISABILITY CARE LLC |
| |
|
|
|
| AddressLine1Txt |
|
Payer's Address |
3456 GETWELL LANE |
| CityNm |
|
Payer's City |
ANSONIA |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZIPCd |
|
Payer's Zip Code |
45303 |
| |
|
|
|
| RecipientSSN |
|
Recipient's Social Security Number |
400-XX-7614 |
| RecipientNm |
|
Recipient's Name |
MICKEY MOUSE |
| AddressLine1Txt |
|
Recipient's Address Line 1 |
455 CLUBHOUSE CIR |
| CityNm |
|
Recipient's City |
COLUMBUS |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
43215 |
| |
|
|
|
| GrossDistributionAmt |
|
Gross Distribution Amount |
$20,000.00 |
| TaxableAmt |
|
Taxable Amount |
$20,000.00 |
| TotalDistributionInd |
|
Total Distribution Indicator |
|
| F1099RDistributionCd |
|
Distribution Code |
3 |
| |
|
|
|
| 1099R #3 |
|
|
|
| PayerEIN |
|
Payer's Identification Number |
81-9876541 |
| PayerName / BusinessNameLine1Txt |
|
Payer's Name |
DUCK INVESTMENT CORP |
| |
|
|
|
| AddressLine1Txt |
|
Payer's Address |
846 DONALD DR |
| CityNm |
|
Payer's City |
ORLANDO |
| StateAbbreviationCd |
|
Payer's State |
FL |
| ZIPCd |
|
Payer's Zip Code |
32789 |
| |
|
|
|
| RecipientSSN |
|
Recipient's Social Security Number |
400-XX-7664 |
| RecipientNm |
|
Recipient's Name |
DAISY DUCK |
| AddressLine1Txt |
|
Recipient's Address Line 1 |
455 CLUBHOUSE CIR |
| AddressLine2Txt |
|
Recipient's Address Line 2 |
|
| CityNm |
|
Recipient's City |
COLUMBUS |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
43215 |
| |
|
|
|
| GrossDistributionAmt |
|
Gross Distribution Amount |
$10,000.00 |
| TaxableAmt |
|
Taxable Amount |
$10,000.00 |
| TotalDistributionInd |
|
|
|
| F1099RDistributionCd |
|
Distribution Code |
7 |
| |
|
|
|
| 1099-MISC |
|
|
|
| PayerName / BusinessNameLine1Txt |
|
Payer's Name |
MICE UNLIMITED |
| AddressLine1Txt |
|
Payer's US Address |
123 MICKEY LN |
| CityNm |
|
Payer's City |
COLUMBUS |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZIPCd |
|
Payer's Zip Code |
43229 |
| |
|
|
|
| PayerEIN |
|
Payer's Identification Number |
403456789-0000000 |
| |
|
|
|
| IndividualRecipient / SSN |
|
Recipient's SSN |
400-XX-7614 |
| IndividualRecipient / Name |
|
Recipient's Name |
MICKEY MOUSE |
| AddressLine1Txt |
|
Recipient's US Address Line 1 Text |
455 CLUBHOUSE CIR |
| CityNm |
|
Recipient's City |
COLUMBUS |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
43215 |
| |
|
|
|
| OtherIncome |
|
Box 3 Other Income |
$32,000.00 |
| |
|
|
|
| StateTaxWithheldAmt |
|
Box 15 State tax withheld |
$1,200.00 |
| StateAbbreviationCd |
|
Box 16 State |
OH |
| PayersStateIdNumber |
|
Box 16 Payer's state no. |
52-801923 |
| StateDistributionAmt |
|
State Distribution Amount |
$32,000.00 |
| |
|
|
|
| Return Information |
|
|
|
| Federal Return Data |
|
|
|
| |
|
Filing Status |
Married Filing Joint |
| |
|
Exemptions, Self |
2 |
| |
|
Total Wages, Salaries, Tips, etc. |
$41,856.00 |
| |
|
Total Taxable Pensions and Annuities |
$68,125.00 |
| |
|
Other Income |
$32,000.00 |
| |
|
Adjusted Gross Income |
$141,981.00 |
| |
|
Earned Income Tax Credit |
$0.00 |
| |
|
|
|
| State Return Data |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
No |
| |
|
|
|
| FilingStatus |
|
|
|
| MarriedFilingJointly |
|
|
X |
| |
|
|
|
| Did you file federal extension Form 4868? |
|
|
No |
| |
|
|
|
| Did you take the Standard deduction or itemize? |
|
|
Standard |
| |
|
|
|
| Can someone else claim you (or your spouse) as a dependent? |
|
|
|
| ClaimedAsDependent |
|
|
No |
| |
|
|
|
| Residency Status |
|
|
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| FullYearNonResident |
|
Full-Year NonResident |
X |
| NonResidentState |
|
State of Residence |
IN |
| |
|
|
|
| JointFilingCredit |
|
Eligible for JFC? |
yes |
| |
|
|
|
| Lump Sum Retirement Credit Worksheet |
|
| RetirementIncomeAmt |
1a |
For primary, enter all retirement income included in your Ohio adjusted gross income |
$38,125.00 |
| AgeBasedMultiple |
2a |
For primary, using Table 1, enter the multiple cooresponding to the lump sum recipient's age |
12.5 |
| RetirementIncomeAmtDivByMultiple |
3a |
For primary, divide line 1 by line 2 |
$3,050.00 |
| RetIncCreditAmt |
4a |
For primary, using Table 2, enter the retirement income credit based on the amount on line 3 |
$80.00 |
| LumpSumRetCredit |
5a |
For primary, multiply line 2 times line 4. This is your lump sum retirement credit |
$1,000.00 |
| RetirementIncomeAmt |
1b |
For spouse, enter all retirement income included in your Ohio adjusted gross income |
$0.00 |
| AgeBasedMultiple |
2b |
For spouse, using Table 1, enter the multiple cooresponding to the lump sum recipient's age |
0 |
| RetirementIncomeAmtDivByMultiple |
3b |
For spouse, divide line 1 by line 2 |
$0.00 |
| RetIncCreditAmt |
4b |
For spouse, using Table 2, enter the retirement income credit based on the amount on line 3 |
$0.00 |
| LumpSumRetCredit |
5b |
For spouse, multiply line 2 times line 4. This is your lump sum retirement credit |
$0.00 |
| LumpSumRetTotCredit |
6 |
Add amounts from line 5a and 5b |
$1,000.00 |
| TaxLessRetireIncCred |
7 |
Line 1 Ohio Sch of Credits minus Line 2 Ohio Sch of Credits |
$2,355.00 |
| LumpSumRetCreditLessTaxAmt |
8a |
Line 6 minus Line 7 |
($1,355.00) |
| MultipleMinusOne |
8b |
Subtract 1 from the amount from line 2 |
0 |
| FutureLumpSumRetCredit |
8c |
Divide line 8a by line 8b. This is your lump sum retirement credit for future tax years. |
$0.00 |
| |
|
|
|
| Additional Information |
|
|
|
| OHFullYrEmpCompEarnNeighState |
|
Employee compensation earned in Ohio by residents of neighboring states |
$21,856.00 |
| DisabilityBenefits |
|
Disability benefits |
$20,000.00 |
| |
|
|
|
| Return |
|
|
|
| IT1040 - Pages 1 & 2 |
| FederalAdjustedGrossIncome |
1 |
Federal Adjusted Gross Income |
$141,981.00 |
| TotalIncomeAddition |
2a |
Additions to federal adjusted gross income |
$0.00 |
| TotalIncomeDeduction |
2b |
Deductions from federal adjusted gross income |
$41,856.00 |
| OhioAdjustedGrossIncome |
3 |
Ohio Adjusted Gross Income (OAGI) |
$100,125.00 |
| ExemptionDeduction |
4 |
Personal and dependent exemption deduction |
$3,800.00 |
| TaxableIncome |
5 |
Ohio income tax base |
$96,325.00 |
| TaxableBusinessIncome |
6 |
Taxable business income (Ohio IT BUS, line 13) |
$0.00 |
| TaxableIncomeLessBusinessIncome |
7 |
Line 5 minus line 6 (if less than 0, enter 0) |
$96,325.00 |
| |
7a |
Amount from line 7 on page 1 |
$96,325.00 |
| NonBusinessIncomeTaxLiability |
8a |
Nonbusiness income tax liability |
$2,555.00 |
| BusinessIncomeTaxLiability |
8b |
Business income tax liability (Ohio IT BUS, line 14) |
$0.00 |
| IncomeTaxLiabilityBeforeCredits |
8c |
Income tax liability before credits (line 8a plus 8b) |
$2,555.00 |
| OhioNonRefundableCredits |
9 |
Ohio nonrefundable credits |
$1,439.00 |
| TaxLiabAfterNonrefundableCrdt |
10 |
Tax liability after nonrefundable credits |
$1,116.00 |
| UnderPaymentInterestPenalty |
11 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| UnpaidUseTax |
12 |
Sales and use tax due on Internet, mail order or other out-of-state purchases |
$0.00 |
| TotalTaxLiability |
13 |
Total Ohio tax liability before withholding or estimated payments |
$1,116.00 |
| TaxWithheld |
14 |
Ohio income tax withheld |
$2,157.00 |
| InstallmentPayment |
15 |
Add the Ohio estimated & extension payments & credit carryforward from previous year return |
$0.00 |
| RefundableTaxCredits |
16 |
Refundable credits |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
17 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayment |
18 |
Total Ohio Tax Payments |
$2,157.00 |
| OverpymtRecdOnOrigAmendRtn |
19 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
20 |
Line 18 minus line 19 |
$2,157.00 |
| AmountUnderpaid |
21 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
22 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
23 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
24 |
Overpayment |
$1,041.00 |
| OverpymtCreditedNextYear |
25 |
Original return only - amount of line 24 to be carried forward to next year's tax liability |
$0.00 |
| CharityOrgName |
26a |
Amount of line 24 to be donated - Wildlife species |
$0.00 |
| CharityOrgName |
26b |
Amount of line 24 to be donated - Military injury relief |
$0.00 |
| CharityOrgName |
26c |
Amount of line 24 to be donated - Ohio History Fund |
$0.00 |
| CharityOrgName |
26d |
Amount of line 24 to be donated - Nature Preserves/Scenic Rivers |
$0.00 |
| CharityOrgName |
26e |
Amount of line 24 to be donated - Breast/cervical cancer |
$0.00 |
| CharityOrgName |
26f |
Amount of line 24 to be donated - Wishes for sick children |
$0.00 |
| TotalDonation |
26g |
Total |
$0.00 |
| Refund |
27 |
Your Refund |
$1,041.00 |
| |
|
|
|
| Schedule of Adjustments |
| Additions |
|
|
|
| NonOhioAndLocalGovIntAndDiv |
1 |
Non-Ohio state or local government interest and dividends |
$0.00 |
| PassThruEntityTaxesPaid |
2 |
Certain Ohio pass-through entity and financial institutions taxes paid |
$0.00 |
| TuitionExpenseReimbursement |
3 |
Reimbursement of college tutition expenses and fees deducted in any previous year(s) and noneducation expenditures from a college savings account |
$0.00 |
| SaleAndDispstnLossOfOhioOblig |
4 |
Losses from sale or disposition of Ohio public obligations |
$0.00 |
| NonMedicalWithdrawals |
5 |
Nonmedical withdrawals from a medical savings account |
$0.00 |
| ReimExpPrevDeducted |
6 |
Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if the reimbursement is not in federal adjusted gross income |
$0.00 |
| IRC168And179AdjAdd |
7 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| FederalInterestAndDividends |
8 |
Federal interest and dividends subject to state taxation |
$0.00 |
| FederalConformityAdditions |
9 |
Federal conformity additions |
$0.00 |
| TotalIncomeAddition |
10 |
Total additions |
$0.00 |
| |
|
|
|
| Deductions |
|
|
|
| BusinessIncomeDeduction |
11 |
Business income deduction (attach Ohio Schedule IT BUS, line 11) |
$0.00 |
| OHFullYrEmpCompEarnNeighState |
12 |
Employee compensation earned in Ohio by residents of neighboring states |
$21,856.00 |
| IRS1040StateMuniIncomeOverpymt |
13 |
State or municipal income tax overpayments shown on the federal 1040, Sch 1, line 1 |
$0.00 |
| SocialSecurityBenefits |
14 |
Taxable Social Security benefits |
$0.00 |
| RailroadRetirementBenefits |
15 |
Certain railroad retirement benefits |
$0.00 |
| ObligIntrstPublicServicePay |
16 |
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 state of Ohio or income from a transfer agreement |
$0.00 |
| IndDevAcct |
17 |
Amounts contributed to an individual development account |
$0.00 |
| STABLEAcct |
18 |
Amounts contributed to STABLE account; Ohio's ABLE plan |
$0.00 |
| OutOfStateDisasterWorkIncome |
19 |
Income earned in Ohio by a qualifying out-of-state business or employee for disaster work conducted during a disaster response period |
$0.00 |
| FederalIntAndDivExempt |
20 |
Federal interest and dividends exempt from state taxation |
$0.00 |
| IRC168And179AdjDed |
21 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| IRS1040RefundOrReimbursements |
22 |
Refund or reimbursements shown on the federal 1040, schedule 1 for itemized deductions claimed on a prior year federal income tax return |
$0.00 |
| RepaymentOfIncomeReported |
23 |
Repayment of income reported in a prior year |
$0.00 |
| NotDeductedWageExpense |
24 |
Wage expense not deducted due to claiming the federal work opportunity credit |
$0.00 |
| FederalConformityDeductions |
25 |
Federal conformity deductions |
$0.00 |
| MilitaryPayForResident |
26 |
Military pay for Ohio residents received while the military member was stationed outside Ohio |
$0.00 |
| IncomeErndMilitCivilianNRSpouse |
27 |
Certain income earned by military nonresidents and civilian nonresident spouses |
$0.00 |
| UniformedServcsRetirmtIncome |
28 |
Uniformed services retirement income |
$0.00 |
| MilitaryInjuryReliefFund |
29 |
Military injury relief fund |
$0.00 |
| NationalGuardReimAndBenft |
30 |
Certain Ohio National Guard reimbursements and benefits |
$0.00 |
| CollegeAdvSavAndTuitPurchCred |
31 |
Ohio 529 contributions, tuition credit purchases |
$0.00 |
| PellOhioCollegeOppTaxableGrant |
32 |
Pell/Ohio College Opportunity taxable grant amounts used to pay room and board |
$0.00 |
| OhioEducatorExpenses |
33 |
Ohio educator expenses in excess of federal deduction |
$0.00 |
| DisabilityBenefits |
34 |
Disability benefits |
$20,000.00 |
| SurvivorBenefits |
35 |
Survivor benefits |
$0.00 |
| UnsubsidizedMedicalExpense |
36 |
Unreimbursed long-term care insurance premiums, unsubsidized health care insurance premiums and excess health care expenses (see instructions for worksheet) |
$0.00 |
| HealthCareDepositedFunds |
37 |
Funds deposited into, and earnings of, a medical savings account for eligible health care expenses (see instructions for worksheet) |
$0.00 |
| QualOrganDonorExp |
38 |
Qualified organ donor expenses |
$0.00 |
| TotalIncomeDeduction |
39 |
Total deductions |
$41,856.00 |
| |
|
|
|
| Schedule IT BUS |
|
|
|
| |
|
Part 1 |
|
| BusScheduleB |
1 |
Sch B - Interest and Ordinary Dividends |
$0.00 |
| BusScheduleC |
2 |
Sch C - Profit or Loss From Business (Sole Proprietership) |
$0.00 |
| BusScheduleD |
3 |
Sch D - Capital Gains and Losses |
$0.00 |
| BusScheduleE |
4 |
Sch E - Supplemental Income and Loss |
$0.00 |
| GuaranteedPayments |
5 |
Guranteed payments, compensation and/or wages from each pass-through entity in which you have at least a 20% direct or indirect ownership interest |
$0.00 |
| BusScheduleF |
6 |
Sch F - Profit or Loss From Farming |
$0.00 |
| OtherItemsOfIncome |
7 |
Other items of income and gain separately stated on federal Schedule K-1, federal 4797 gains and/or losses reported on federal 4797 and miscellaneous federal income tax adjustments, if any |
$0.00 |
| TotalOfBusinessIncome |
8 |
Total of business income (add lines 1 through 7) |
$0.00 |
| |
|
Part 2 |
|
| AllBusinessIncome |
9 |
All business income (enter the lesser of line 8 above or Ohio IT1040, line 1). If zero or negative, stop here and do not complete Part 3. |
$0.00 |
| FilingStatusBusIncAmt |
10 |
Enter $250,000 if single or MFJ, enter $125,000 if MFS |
$0.00 |
| LessOfFilStatBusIncAmtOrAllBusInc |
11 |
Lesser of line 9 or line 10. Enter here and on Ohio Schedule of Adjustments, line 11 |
$0.00 |
| |
|
Part 3 |
|
| AllBusIncLessBusIncDeduction |
12 |
Line 9 minus line 11 (if less than -0-, enter -0-) |
$0.00 |
| TaxableBusinessIncome |
13 |
Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5) |
$0.00 |
| BusinessIncomeTaxLiability |
14 |
Business income tax liability. Multiply line 13 by 3%. Enter here and on Ohio IT 1040, line 8b. |
$0.00 |
| |
|
|
|
| Schedule of Credits - Nonrefundable |
| TaxLiabilityBeforeCredits |
1 |
Tax liability before credits (From IT1040, line 8c) |
$2,555.00 |
| RetireIncomeCredit |
2 |
Retirement income credit (limit $200 per return) |
$200.00 |
| LumpSumRetirementCredit |
3 |
Lump sum retirement credit (include Ohio LS WKS, line 6) |
$1,000.00 |
| SeniorCitizenCredit |
4 |
Senior citizen credit |
$50.00 |
| LumpSumDistributionCredit |
5 |
Lump sum distribution credit (include Ohio LS WKS, line 3) |
$0.00 |
| ChildAndDependCareCredit |
6 |
Child care and dependent care credit (see the worksheet in the instructions) |
$0.00 |
| DisplacedWorkerTrainingCredit |
7 |
Displaced worker training credit (see the worksheet in the instructions) |
$0.00 |
| CampaignContributionCredit |
8 |
Campaign contribution credit |
$0.00 |
| ExemptionCredit |
9 |
Income-based exemption credit |
$0.00 |
| TotCreditsBeforeJointFiling |
10 |
Total (add lines 2 through 9) |
$1,250.00 |
| TaxLessCredit |
11 |
Tax less credits (line 1 minus line 10; if less than -0-, enter -0-) |
$1,305.00 |
| JointFilingCredit |
12 |
Joint filing credit |
$65.00 |
| EarnedIncomeCredit |
13 |
Earned income credit (multiply Fed EITC by 30%) |
$0.00 |
| HomeSchoolExpensesCredit |
14 |
Home school expenses credit |
$0.00 |
| ScholarshipDonationCredit |
15 |
Scholarship donation credit |
$0.00 |
| NonCharterOrPublicSchoolCredit |
16 |
Nonchartered, nonpublic school tuition credit |
$0.00 |
| VocationalJobCredit |
17 |
Vocational job credit |
$0.00 |
| AdoptionCredit |
18 |
Ohio adoption credit |
$0.00 |
| JobRetentionCredit |
19 |
Nonrefundable job retention credit |
$0.00 |
| NewEmpInEntZoneCredit |
20 |
Credit for eligible new employees in an enterprise zone |
$0.00 |
| GrapeProdPropertyPurchCredit |
21 |
Credit for purchases of grape production property |
$0.00 |
| InvestOhioCredit |
22 |
InvestOhio credit |
$0.00 |
| LeadAbatementCredit |
23 |
Lead abatement credit |
$0.00 |
| OpportunityZoneCredit |
24 |
Opportunity zone investment credit |
$0.00 |
| TechInvestCreditCarryfrwd |
25 |
Technology investment credit carryforward |
$0.00 |
| EntZoneDayCareAndTrngCredit |
26 |
Enterprise zone day care and training credits |
$0.00 |
| ResearchAndDevelopmentCredit |
27 |
Research and development credit |
$0.00 |
| OhioHistoricPreservationCredit |
28 |
Nonrefundable Ohio historic preservation credit |
$0.00 |
| TotAdditionalCredits |
29 |
Total (add lines 12 through 28) |
$65.00 |
| TaxLessCrdtMinusTotAddlCrdts |
30 |
Tax less additional credits (line 11 minus line 29; if less than -0-, enter -0-) |
$1,240.00 |
| |
|
Nonresident Credit |
|
| NonOhioIncome |
31 |
Nonresident Portion of Ohio adjusted gross income |
$10,000.00 |
| OhioAdjustedGrossIncome |
32 |
Ohio adjusted gross income |
$100,125.00 |
| NonResIncomeCreditRatio |
33a |
Divide line 31 by line 32 |
0.0998 |
| NonresidentAndPartYearCredit |
33 |
Nonresident credit (line 30 times line 33a) |
$124.00 |
| |
|
Resident Credit |
|
| ResidentTaxCredit |
34 |
Resident Credit - Ohio IT RC, line 7 |
$0.00 |
| TotalNonrefundableCredits |
35 |
Total nonrefundable credits |
$1,439.00 |
| |
|
|
|
| Schedule of Credits - Refundable |
| HistoricPreservationCredit |
36 |
Refundable Ohio historic preservation credit |
$0.00 |
| JobCreationAndJobRetentionCrd |
37 |
Refundable job creation credit & job retention credit |
$0.00 |
| PassthroughEntityCredit |
38 |
Pass-through entity credit |
$0.00 |
| MotionPictureProductionCredit |
39 |
Motion Picture & Broadway theatrical production credit |
$0.00 |
| VentureCapitalCredit |
40 |
Venture Capital credit |
$0.00 |
| TotalRefundableCredit |
41 |
Total refundable credits |
$0.00 |
| |
|
|
|
| What is Tested? |
If you do not support: |
|
| IT1040 |
|
|
|
| Self-Prepared |
|
|
| MFJ status |
|
|
| W-2 |
|
|
|
| 1099-R |
|
|
| 1099-MISC |
|
Change to 1099R with a distribution code of 1 (early distribution). This will not create a retirement income credit. |
|
| |
|
|
|
| IT1040 |
|
|
| Primary - Full year resident |
|
|
| Spouse - Full year non-resident |
|
|
|
| Sch. of Adj Neighboring state deduction |
Move amount to a Sch. of Adj deduction line you do support |
|
| Sch. of Adj Disability Benefits |
|
Move amount to a Sch. of Adj deduction line you do support |
|
| Sch of Credits - Lump Sum Retirement Credit |
|
|
|
| |
|
|
| Ohio Test #15 |
|
|
IT1040WithSD100 |
| Taxpayer Information |
|
Description |
|
| TaxpayerSSN |
|
Primary Social Security Number |
400-XX-7615 |
| FirstName |
|
Primary First Name |
PETER |
| LastName |
|
Primary Last Name |
O'PARKER |
| DateOfBirth |
|
Date of Birth - Primary |
1986-01-01 |
| |
|
|
|
| TaxpayerSSN |
|
Spouse's Social Security Number |
400-XX-7665 |
| FirstName |
|
Spouse First Name |
MARY JANE |
| LastName |
|
Spouse Last Name |
O'PARKER-WATSON |
| DateOfBirth |
|
Date of Birth - Spouse |
1987-05-30 |
| |
|
|
|
| USPhone |
|
Taxpayer's Phone Number |
[<=9999999]###-#### |
| EmailAddress |
|
Taxpayer's E-mail Address |
SPIDERMAN@GMAIL.COM |
| |
|
|
|
| AddressLine1Txt |
|
Address Line 1 |
1 SPIDER LN |
| CityNm |
|
City |
BEXLEY |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43209 |
| |
|
|
|
| MailingAddressCounty |
|
Ohio County |
FRANKLIN |
| SchoolDistrictNumber |
|
Ohio Public School District Number - Resident District |
2501 |
| |
|
|
|
| Preparer Information |
|
|
|
| |
|
|
|
| Self-Prepared |
|
|
|
| SelfPrepared |
|
Return is self-prepared |
X |
| |
|
|
|
| Income Statements |
|
|
|
| 1099R #1 |
|
|
|
| PayerEIN |
|
Payer's Identification Number |
383456789-0000000 |
| PayerName / BusinessNameLine1Txt |
|
Payer's Name |
FIDELITY INSURANCE |
| |
|
|
|
| AddressLine1Txt |
|
Payer's Address |
123 MAIN ST |
| CityNm |
|
Payer's City |
DANVILLE |
| StateAbbreviationCd |
|
Payer's State |
OH |
| ZIPCd |
|
Payer's Zip Code |
43014 |
| |
|
|
|
| RecipientSSN |
|
Recipient's Social Security Number |
400-XX-7615 |
| RecipientNm |
|
Recipient's Name |
PETER O'PARKER |
| AddressLine1Txt |
|
Recipient's Address Line 1 |
1 SPIDER LN |
| CityNm |
|
Recipient's City |
BEXLEY |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
43209 |
| |
|
|
|
| GrossDistributionAmt |
|
Gross Distribution Amount |
$30,000.00 |
| TaxableAmt |
|
Taxable Amount |
$30,000.00 |
| TotalDistributionInd |
|
Total Distribution Indicator |
|
| F1099RDistributionCd |
|
Distribution Code |
7 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| PayerStateIdNum |
|
State Payer ID |
52-789012 |
| StateDistributionAmt |
|
State Distribution |
$30,000.00 |
| StateTaxWithheldAmt |
|
State Income Tax Withheld |
$700.00 |
| |
|
|
|
| 1099-OID |
|
|
|
| PayersName - BusinessNameLine1Txt |
|
Payer's Name |
MORGAN STANLEY SMITH BARNEY |
| AddressLine1Txt |
|
Payer's US Address |
124 WALL STREET |
| CityNm |
|
Payer's City |
NEW YORK |
| StateAbbreviationCd |
|
Payer's State |
NY |
| ZIPCd |
|
Payer's Zip Code |
10004 |
| PayerFederalIdNumber |
|
Payer's Federal Identification Number |
453216574-0000000 |
| |
|
|
|
| RecipientsIdNumber |
|
Recipient's Identification Number |
400-XX-7615 |
| RecipientsName |
|
Recipient's Name |
PETER O'PARKER |
| |
|
|
|
| AddressLine1Txt |
|
Recipient's US Address Line 1 Text |
1 SPIDER LN |
| AddressLine2Txt |
|
Recipient's Address Line 2 Text |
|
| CityNm |
|
Recipient's City |
BEXLEY |
| StateAbbreviationCd |
|
Recipient's State |
OH |
| ZIPCd |
|
Recipient's Zip Code |
43209 |
| |
|
|
|
| OrigIssueDiscount |
|
Box 1 Original Issue Discount |
$500.00 |
| FedIncomeTaxWithheld |
|
Federal Income Tax Withheld |
$0.00 |
| |
|
|
|
| StateTaxWithheldAmt |
|
Box 12 State Tax Withheld |
$17.00 |
| StateAbbreviationCd |
|
Box 10 State |
OH |
| PayersStateIdNumber |
|
Box 11 State Identification no |
52-7539514 |
| StateDistributionAmt |
|
State Distribution Amount |
$500.00 |
| |
|
|
|
| Return Information |
|
|
|
| Federal Return Data |
|
|
|
| |
|
Filing Status |
Married Filing Jointly |
| |
|
Exemptions, Self |
3 |
| |
|
Federal Interest - Schedule B |
$500.00 |
| |
|
Taxable Pension and Annuities |
$30,000.00 |
| |
|
Total Business Income or (Loss) |
$150,000.00 |
| |
|
Self Employment Tax Deduction |
($10,597.00) |
| |
|
Adjusted Gross Income |
$169,903.00 |
| |
|
Earned Income Tax Credit |
$0.00 |
| |
|
|
|
| State Return Data |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
Yes |
| NOLCarryBack |
|
Is the amended return an NOL carryback? |
No |
| Reason |
|
Reason for Corrections |
FAGI increased |
| DetailedExplanation |
|
Explanation of Corrections |
ADDITIONAL INCOME ON SCHEDULE C |
| |
|
|
|
| FilingStatus |
|
|
|
| MarriedFilingJointly |
|
|
X |
| |
|
|
|
| Did you file federal extension Form 4868? |
|
|
No |
| |
|
|
|
| Did you take the Standard deduction or itemize? |
|
|
Standard |
| |
|
|
|
| Can someone else claim you (or your spouse) as a dependent? |
|
|
|
| ClaimedAsDependent |
|
|
No |
| |
|
|
|
| Schedule of Dependents |
|
Total Exemptions |
3 |
| NumberOfDependents |
|
|
1 |
| SSN |
|
|
400-XX-7690 |
| DateOfBirth |
|
|
1981-05-13 |
| Relationship |
|
|
BROTHER |
| FirstName |
|
|
BENJAMIN ELLIOT |
| MiddleInitial |
|
|
|
| LastName |
|
|
O'PARKER-WATSON |
| NameSuffix |
|
|
|
| |
|
|
|
| Residency Status |
|
|
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| SpouseResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| JointFilingCredit |
|
Eligible for JFC? |
No |
| |
|
|
|
| Additional Information |
|
|
|
| OverpymtRecdOnOrigAmendRtn |
|
Overpayment previously requested on original/amended return |
$800.00 |
| |
|
|
|
| SD Return # 1 Information |
|
|
|
| SchoolDistrictNumber |
|
What is the school district number for which you are filing the SD 100? |
2501 |
| TaxType |
|
Tax Type |
Traditional |
| |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
Yes |
| NOLCarryBack |
|
Is the amended return an NOL carryback? |
No |
| Reason |
|
Reason for Corrections |
Ohio income tax base change |
| DetailedExplanation |
|
Explanation of Corrections |
ADDITIONAL INCOME ON SCHEDULE C, CLAIMED CITY W/H TAX AS SD ON ORIGINAL |
| |
|
|
|
| Residency Status |
|
School district residency |
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| SpouseResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| Additional Information - SD |
|
|
|
| OverpymtRecdOnOrigAmendRtn |
|
Amended return only - overpayment previously requested on original/amended return |
$16.00 |
| |
|
|
|
| Return |
|
|
|
| IT1040 - Pages 1 & 2 |
| FederalAdjustedGrossIncome |
1 |
Federal Adjusted Gross Income |
$169,903.00 |
| TotalIncomeAddition |
2a |
Additions to federal adjusted gross income |
$0.00 |
| TotalIncomeDeduction |
2b |
Deductions from federal adjusted gross income |
$150,000.00 |
| OhioAdjustedGrossIncome |
3 |
Ohio Adjusted Gross Income (OAGI) |
$19,903.00 |
| ExemptionDeduction |
4 |
Personal and dependent exemption deduction |
$5,700.00 |
| TaxableIncome |
5 |
Ohio income tax base |
$14,203.00 |
| TaxableBusinessIncome |
6 |
Taxable business income (Ohio IT BUS, line 13) |
$0.00 |
| TaxableIncomeLessBusinessIncome |
7 |
Line 5 minus line 6 (if less than 0, enter 0) |
$14,203.00 |
| |
7a |
Amount from line 7 on page 1 |
$14,203.00 |
| NonBusinessIncomeTaxLiability |
8a |
Nonbusiness income tax liability |
$0.00 |
| BusinessIncomeTaxLiability |
8b |
Business income tax liability (Ohio IT BUS, line 14) |
$0.00 |
| IncomeTaxLiabilityBeforeCredits |
8c |
Income tax liability before credits (line 8a plus 8b) |
$0.00 |
| OhioNonRefundableCredits |
9 |
Ohio nonrefundable credits |
$0.00 |
| TaxLiabAfterNonrefundableCrdt |
10 |
Tax liability after nonrefundable credits |
$0.00 |
| UnderPaymentInterestPenalty |
11 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| UnpaidUseTax |
12 |
Sales and use tax due on Internet, mail order or other out-of-state purchases |
$0.00 |
| TotalTaxLiability |
13 |
Total Ohio tax liability before withholding or estimated payments |
$0.00 |
| TaxWithheld |
14 |
Ohio income tax withheld |
$717.00 |
| InstallmentPayment |
15 |
Add the Ohio estimated & extension payments & credit carryforward from previous year return |
$0.00 |
| RefundableTaxCredits |
16 |
Refundable credits |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
17 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayment |
18 |
Total Ohio Tax Payments |
$717.00 |
| OverpymtRecdOnOrigAmendRtn |
19 |
Amended return only - overpayment previously requested on original/amended return |
$800.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
20 |
Line 18 minus line 19 |
($83.00) |
| AmountUnderpaid |
21 |
Tax due |
$83.00 |
| InterestDueOnLatePayment |
22 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
23 |
Total Amount Due |
$83.00 |
| AmountOverpaid |
24 |
Overpayment |
$0.00 |
| OverpymtCreditedNextYear |
25 |
Original return only - amount of line 24 to be carried forward to next year's tax liability |
$0.00 |
| CharityOrgName |
26f |
Amount of line 24 to be donated - Wildlife species |
$0.00 |
| CharityOrgName |
26a |
Amount of line 24 to be donated - Military injury relief |
$0.00 |
| CharityOrgName |
26b |
Amount of line 24 to be donated - Ohio History Fund |
$0.00 |
| CharityOrgName |
26c |
Amount of line 24 to be donated - Nature Preserves/Scenic Rivers |
$0.00 |
| CharityOrgName |
26d |
Amount of line 24 to be donated - Breast/cervical cancer |
$0.00 |
| CharityOrgName |
26e |
Amount of line 24 to be donated - Wishes for sick children |
$0.00 |
| TotalDonation |
26g |
Total |
$0.00 |
| Refund |
27 |
Your Refund |
$0.00 |
| |
|
|
|
| Schedule of Adjustments |
| Additions |
|
|
|
| NonOhioAndLocalGovIntAndDiv |
1 |
Non-Ohio state or local government interest and dividends |
$0.00 |
| PassThruEntityTaxesPaid |
2 |
Certain Ohio pass-through entity and financial institutions taxes paid |
$0.00 |
| TuitionExpenseReimbursement |
3 |
Reimbursement of college tutition expenses and fees deducted in any previous year(s) and noneducation expenditures from a college savings account |
$0.00 |
| SaleAndDispstnLossOfOhioOblig |
4 |
Losses from sale or disposition of Ohio public obligations |
$0.00 |
| NonMedicalWithdrawals |
5 |
Nonmedical withdrawals from a medical savings account |
$0.00 |
| ReimExpPrevDeducted |
6 |
Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if the reimbursement is not in federal adjusted gross income |
$0.00 |
| IRC168And179AdjAdd |
7 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| FederalInterestAndDividends |
8 |
Federal interest and dividends subject to state taxation |
$0.00 |
| FederalConformityAdditions |
9 |
Federal conformity additions |
$0.00 |
| TotalIncomeAddition |
10 |
Total additions |
$0.00 |
| |
|
|
|
| Deductions |
|
|
|
| BusinessIncomeDeduction |
11 |
Business income deduction (attach Ohio Schedule IT BUS, line 11) |
$150,000.00 |
| OHFullYrEmpCompEarnNeighState |
12 |
Employee compensation earned in Ohio by residents of neighboring states |
$0.00 |
| IRS1040StateMuniIncomeOverpymt |
13 |
State or municipal income tax overpayments shown on the federal 1040, Sch 1, line 1 |
$0.00 |
| SocialSecurityBenefits |
14 |
Taxable Social Security benefits |
$0.00 |
| RailroadRetirementBenefits |
15 |
Certain railroad retirement benefits |
$0.00 |
| ObligIntrstPublicServicePay |
16 |
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 state of Ohio or income from a transfer agreement |
$0.00 |
| IndDevAcct |
17 |
Amounts contributed to an individual development account |
$0.00 |
| STABLEAcct |
18 |
Amounts contributed to STABLE account; Ohio's ABLE plan |
$0.00 |
| OutOfStateDisasterWorkIncome |
19 |
Income earned in Ohio by a qualifying out-of-state business or employee for disaster work conducted during a disaster response period |
$0.00 |
| FederalIntAndDivExempt |
20 |
Federal interest and dividends exempt from state taxation |
$0.00 |
| IRC168And179AdjDed |
21 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| IRS1040RefundOrReimbursements |
22 |
Refund or reimbursements shown on the federal 1040, schedule 1 for itemized deductions claimed on a prior year federal income tax return |
$0.00 |
| RepaymentOfIncomeReported |
23 |
Repayment of income reported in a prior year |
$0.00 |
| NotDeductedWageExpense |
24 |
Wage expense not deducted due to claiming the federal work opportunity credit |
$0.00 |
| FederalConformityDeductions |
25 |
Federal conformity deductions |
$0.00 |
| MilitaryPayForResident |
26 |
Military pay for Ohio residents received while the military member was stationed outside Ohio |
$0.00 |
| IncomeErndMilitCivilianNRSpouse |
27 |
Certain income earned by military nonresidents and civilian nonresident spouses |
$0.00 |
| UniformedServcsRetirmtIncome |
28 |
Uniformed services retirement income |
$0.00 |
| MilitaryInjuryReliefFund |
29 |
Military injury relief fund |
$0.00 |
| NationalGuardReimAndBenft |
30 |
Certain Ohio National Guard reimbursements and benefits |
$0.00 |
| CollegeAdvSavAndTuitPurchCred |
31 |
Ohio 529 contributions, tuition credit purchases |
$0.00 |
| PellOhioCollegeOppTaxableGrant |
32 |
Pell/Ohio College Opportunity taxable grant amounts used to pay room and board |
$0.00 |
| OhioEducatorExpenses |
33 |
Ohio educator expenses in excess of federal deduction |
$0.00 |
| DisabilityBenefits |
34 |
Disability benefits |
$0.00 |
| SurvivorBenefits |
35 |
Survivor benefits |
$0.00 |
| UnsubsidizedMedicalExpense |
36 |
Unreimbursed long-term care insurance premiums, unsubsidized health care insurance premiums and excess health care expenses (see instructions for worksheet) |
$0.00 |
| HealthCareDepositedFunds |
37 |
Funds deposited into, and earnings of, a medical savings account for eligible health care expenses (see instructions for worksheet) |
$0.00 |
| QualOrganDonorExp |
38 |
Qualified organ donor expenses |
$0.00 |
| TotalIncomeDeduction |
39 |
Total deductions |
$150,000.00 |
| |
|
|
|
| Schedule IT BUS |
|
|
|
| |
|
Part 1 |
|
| BusScheduleB |
1 |
Sch B - Interest and Ordinary Dividends |
$0.00 |
| BusScheduleC |
2 |
Sch C - Profit or Loss From Business (Sole Proprietership) |
$150,000.00 |
| BusScheduleD |
3 |
Sch D - Capital Gains and Losses |
$0.00 |
| BusScheduleE |
4 |
Sch E - Supplemental Income and Loss |
$0.00 |
| GuaranteedPayments |
5 |
Guranteed payments, compensation and/or wages from each pass-through entity in which you have at least a 20% direct or indirect ownership interest |
$0.00 |
| BusScheduleF |
6 |
Sch F - Profit or Loss From Farming |
$0.00 |
| OtherItemsOfIncome |
7 |
Other items of income and gain separately stated on federal Schedule K-1, federal 4797 gains and/or losses reported on federal 4797 and miscellaneous federal income tax adjustments, if any |
$0.00 |
| TotalOfBusinessIncome |
8 |
Total of business income (add lines 1 through 7) |
$150,000.00 |
| |
|
Part 2 |
|
| AllBusinessIncome |
9 |
All business income (enter the lesser of line 8 above or Ohio IT1040, line 1). If zero or negative, stop here and do not complete Part 3. |
$150,000.00 |
| FilingStatusBusIncAmt |
10 |
Enter $250,000 if single or MFJ, enter $125,000 if MFS |
$250,000.00 |
| LessOfFilStatBusIncAmtOrAllBusInc |
11 |
Lesser of line 9 or line 10. Enter here and on Ohio Schedule of Adjustments, line 11 |
$150,000.00 |
| |
|
Part 3 |
|
| AllBusIncLessBusIncDeduction |
12 |
Line 9 minus line 11 (if less than -0-, enter -0-) |
$0.00 |
| TaxableBusinessIncome |
13 |
Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5) |
$0.00 |
| BusinessIncomeTaxLiability |
14 |
Business income tax liability. Multiply line 13 by 3%. Enter here and on Ohio IT 1040, line 8b. |
$0.00 |
| |
|
Part 4 |
|
| NameOfEntity |
1 |
Name of Entity |
GREEN GOBLIN'S DONUTS |
| FEINOrSSN |
|
FEIN/SS# |
805507652-0000000 |
| PercentageOfOwnership |
|
Percentage of Ownership |
0.9900 |
| Income Earned By Primary |
|
Primary |
X |
| |
|
|
|
| NameOfEntity |
2 |
Name of Entity |
GREEN GOBLIN'S DONUTS |
| FEINOrSSN |
|
FEIN/SS# |
805507652-0000000 |
| PercentageOfOwnership |
|
Percentage of Ownership |
0.0100 |
| Income Earned By Spouse |
|
Spouse |
X |
| |
|
|
|
| Schedule of Credits - Nonrefundable |
| TaxLiabilityBeforeCredits |
1 |
Tax liability before credits (From IT1040, line 8c) |
$0.00 |
| RetireIncomeCredit |
2 |
Retirement income credit (limit $200 per return) |
$0.00 |
| LumpSumRetirementCredit |
3 |
Lump sum retirement credit (include Ohio LS WKS, line 6) |
$0.00 |
| SeniorCitizenCredit |
4 |
Senior citizen credit |
$0.00 |
| LumpSumDistributionCredit |
5 |
Lump sum distribution credit (include Ohio LS WKS, line 3) |
$0.00 |
| ChildAndDependCareCredit |
6 |
Child care and dependent care credit (see the worksheet in the instructions) |
$0.00 |
| DisplacedWorkerTrainingCredit |
7 |
Displaced worker training credit (see the worksheet in the instructions) |
$0.00 |
| CampaignContributionCredit |
8 |
Campaign contribution credit |
$0.00 |
| ExemptionCredit |
9 |
Income-based exemption credit |
$0.00 |
| TotCreditsBeforeJointFiling |
10 |
Total (add lines 2 through 9) |
$0.00 |
| TaxLessCredit |
11 |
Tax less credits (line 1 minus line 10; if less than -0-, enter -0-) |
$0.00 |
| JointFilingCredit |
12 |
Joint filing credit |
$0.00 |
| EarnedIncomeCredit |
13 |
Earned income credit (multiply Fed EITC by 30%) |
$0.00 |
| HomeSchoolExpensesCredit |
14 |
Home school expenses credit |
$0.00 |
| ScholarshipDonationCredit |
15 |
Scholarship donation credit |
$0.00 |
| NonCharterOrPublicSchoolCredit |
16 |
Nonchartered, nonpublic school tuition credit |
$0.00 |
| VocationalJobCredit |
17 |
Vocational job credit |
$0.00 |
| AdoptionCredit |
18 |
Ohio adoption credit |
$0.00 |
| JobRetentionCredit |
19 |
Nonrefundable job retention credit |
$0.00 |
| NewEmpInEntZoneCredit |
20 |
Credit for eligible new employees in an enterprise zone |
$0.00 |
| GrapeProdPropertyPurchCredit |
21 |
Credit for purchases of grape production property |
$0.00 |
| InvestOhioCredit |
22 |
InvestOhio credit |
$0.00 |
| LeadAbatementCredit |
23 |
Lead abatement credit |
$0.00 |
| OpportunityZoneCredit |
24 |
Opportunity zone investment credit |
$0.00 |
| TechInvestCreditCarryfrwd |
25 |
Technology investment credit carryforward |
$0.00 |
| EntZoneDayCareAndTrngCredit |
26 |
Enterprise zone day care and training credits |
$0.00 |
| ResearchAndDevelopmentCredit |
27 |
Research and development credit |
$0.00 |
| OhioHistoricPreservationCredit |
28 |
Nonrefundable Ohio historic preservation credit |
$0.00 |
| TotAdditionalCredits |
29 |
Total (add lines 12 through 28) |
$0.00 |
| TaxLessCrdtMinusTotAddlCrdts |
30 |
Tax less additional credits (line 11 minus line 29; if less than -0-, enter -0-) |
$0.00 |
| |
|
Nonresident Credit |
|
| NonOhioIncome |
31 |
Nonresident Portion of Ohio adjusted gross income |
$0.00 |
| OhioAdjustedGrossIncome |
32 |
Ohio adjusted gross income |
$0.00 |
| NonResIncomeCreditRatio |
33a |
Divide line 31 by line 32 |
0.0000 |
| NonresidentAndPartYearCredit |
33 |
Nonresident credit (line 30 times line 33a) |
$0.00 |
| |
|
Resident Credit |
|
| ResidentTaxCredit |
34 |
Resident Credit - Ohio IT RC, line 7 |
$0.00 |
| TotalNonrefundableCredits |
35 |
Total nonrefundable credits |
$0.00 |
| |
|
|
|
| Schedule of Credits - Refundable |
| HistoricPreservationCredit |
36 |
Refundable Ohio historic preservation credit |
$0.00 |
| JobCreationAndJobRetentionCrd |
37 |
Refundable job creation credit & job retention credit |
$0.00 |
| PassthroughEntityCredit |
38 |
Pass-through entity credit |
$0.00 |
| MotionPictureProductionCredit |
39 |
Motion Picture & Broadway theatrical production credit |
$0.00 |
| VentureCapitalCredit |
40 |
Venture Capital credit |
$0.00 |
| TotalRefundableCredit |
41 |
Total refundable credits |
$0.00 |
| |
|
|
|
| School District Return (#2501) |
|
|
|
| SchoolDistrictTaxableIncome |
1 |
School district taxable income: Traditional or Earned Income tax base |
$164,203.00 |
| TaxAmount |
2 |
School District Tax .____ times line 1. |
$1,232.00 |
| SeniorCitizenCredit |
3 |
Senior Citizen Credit |
$0.00 |
| TaxLessCredit |
4 |
School District Income Tax liability |
$1,232.00 |
| UnderPaymentInterestPenalty |
5 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| TotalTax |
6 |
Total school district income tax liability (line 4 plus line 5) |
$1,232.00 |
| TotalTax |
6a |
Amount from line 6, page 1 |
$1,232.00 |
| TaxWithheld |
7 |
School district income tax withheld |
$0.00 |
| InstallmentPayments |
8 |
SD 100 ES & SD 40P, Extension Payments and Credit carryforward from previous year return |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
9 |
Amended return only - amount previously paid with original/amended return |
$0.00 |
| TotalPayments |
10 |
Total school district income tax payments (add lines 7, 8 and 9) |
$0.00 |
| OverpymtRecdOnOrigAmendRtn |
11 |
Amended return only - overpayment previously requested on original/amended return |
$16.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
12 |
Line 10 minus line 11. Place a negative sign ("-") in the box if the amount is less than -0- |
($16.00) |
| AmountUnderpaid |
13 |
Tax due |
$1,248.00 |
| InterestDueOnLatePayment |
14 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
15 |
Total Amount Due |
$1,248.00 |
| AmountOverpaid |
16 |
Overpayment |
$0.00 |
| OverpymtCreditedNextYear |
17 |
Original return only - amount of line 16 to be carried forward to next year's tax liability |
$0.00 |
| Refund |
18 |
Your Refund |
$0.00 |
| Traditional Tax Base School District Amounts |
|
|
|
| TaxableIncome |
19 |
Ohio income tax base (Ohio IT 1040, line 3 minus line 4) |
$14,203.00 |
| BusinessIncomeDeductionAddback |
20 |
Business income deduction add-back |
$150,000.00 |
| TotalTraditionalSDIncome |
21 |
Total Traditional Tax Base School District Income (Line 19 + Line 20) |
$164,203.00 |
| NonResidentIncome |
22 |
Amount of traditional tax base school district income that you earned while not a resident |
$0.00 |
| SchoolDistrictTaxableIncome |
23 |
School District Taxable Income (Enter here and on line 1) |
$164,203.00 |
| Earned Income Tax Base School District Amounts |
|
|
|
| WagesAndOtherCompensations |
24 |
Wages and other compensation as described in the instructions |
$0.00 |
| SelfEmploymentEarnings |
25 |
Net Earnings from Self Employment |
$0.00 |
| FederalConformityAdjustments |
26 |
Federal Conformity Adjustments |
$0.00 |
| SchoolDistrictTaxableIncome |
27 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| |
|
|
|
| What is Tested? |
|
If you do not support: |
|
| IT1040WithSD100 |
|
|
|
| 1099-OID |
|
Change to 1099-R with a distribution code of 1 (early distribution). This will not create a retirement income credit. |
|
| |
|
|
|
| IT1040X |
|
Do not send test |
|
| Overpayment previously recvd. on original/amended |
|
|
|
| IT BUS - Business Income Schedule |
|
|
|
| Reason and explanation of corrections |
|
|
|
| |
|
|
|
| SD100X |
|
Omit SD100X |
|
| Business income deduction add-back |
|
|
|
| Overpayment previously recvd. on original/amended |
|
|
|
| Reason and explanation of corrections |
|
|
|
| |
|
|
|
| Ohio Test #16 |
|
|
IT1040WithSD100 |
| Taxpayer Information |
|
Description |
|
| TaxpayerSSN |
|
Primary Social Security Number |
400-XX-7616 |
| FirstName |
|
Primary First Name |
HARMONY |
| LastName |
|
Primary Last Name |
CAREBEAR |
| DateOfBirth |
|
Date of Birth - Primary |
1981-01-01 |
| |
|
|
|
| USPhone |
|
Taxpayer's Phone Number |
[<=9999999]###-#### |
| EmailAddress |
|
Taxpayer's E-mail Address |
CARE@BEAR.COM |
| |
|
|
|
| AddressLine1Txt |
|
Address Line 1 |
10 STUFFED ANIMAL LN |
| CityNm |
|
City |
GRANVILLE |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43023 |
| |
|
|
|
| MailingAddressCounty |
|
Ohio County |
LICKING |
| SchoolDistrictNumber |
|
Ohio Public School District Number - Resident District |
4501 |
| |
|
|
|
| Preparer Information |
|
|
|
| |
|
|
|
| Self-Prepared |
|
|
|
| SelfPrepared |
|
Return is self-prepared |
X |
| |
|
|
|
| Income Statements |
|
|
|
| W-2 #1 |
|
|
|
| EmployerEIN |
|
Employers Identification Number |
339876543-0000000 |
| EmployerName / BusinessNameLine1Txt |
|
Employer's Name |
BIRDS UNLMTD |
| |
|
|
|
| Employer US Address |
|
|
|
| AddressLine1Txt |
|
Employer Address Line 1 |
25 E 5TH ST APT 2 |
| CityNm |
|
City |
CANARY |
| StateAbbreviationCd |
|
State |
NE |
| ZIPCd |
|
Zip Code |
68792 |
| |
|
|
|
| EmployeeSSN |
|
Employee's Social Security Number |
400-XX-7616 |
| EmployeNm |
|
Employee's Name |
HARMONY CAREBEAR |
| |
|
|
|
| Employee US Address |
|
|
|
| AddressLine1Txt |
|
Employee Address Line 1 |
10 STUFFED ANIMAL LN |
| CityNm |
|
City |
GRANVILLE |
| StateAbbreviationCd |
|
State |
OH |
| ZIPCd |
|
Zip Code |
43023 |
| |
|
|
|
| WagesAmt |
|
Box 1 Wages, Tips, etc |
$15,000.00 |
| WithholdingAmt |
|
Box 2 Federal Income Tax Withheld |
$1,500.00 |
| SocialSecurityWagesAmt |
|
Box 3 Social Security Wages |
$15,000.00 |
| SocialSecurityTaxAmt |
|
Box 4 Social Security Tax Withheld |
$930.00 |
| MedicareWagesAndTipsAmt |
|
Box 5 Medicare Wages and Tips |
$15,000.00 |
| MedicareTaxWithheldAmt |
|
Box 6 Medicare Withheld |
$218.00 |
| |
|
|
|
| StateAbbreviationCd |
|
Box 15 State |
OH |
| EmployerStateIdNum |
|
State ID Number |
51-479623 |
| StateWagesAmt |
|
State Wages |
$15,000.00 |
| StateIncomeTaxAmt |
|
State Income Tax Withheld |
$200.00 |
| |
|
|
|
| SchoolDistrictWages |
|
School District Wages |
$15,000.00 |
| SchoolDistrictTaxWithheld |
|
School District Tax Withheld |
$113.00 |
| SchoolDistrictNumber |
|
School District # |
4501 |
| |
|
|
|
| Return Information |
|
|
|
| Federal Return Data |
|
|
|
| |
|
Filing Status |
Single |
| |
|
Exemptions, Self |
1 |
| |
|
Total Wages, Salaries, Tips, etc. |
$15,000.00 |
| |
|
Student Loan Interest Deduction |
($1,000.00) |
| |
|
Adjusted Gross Income |
$14,000.00 |
| |
|
Earned Income Tax Credit |
$111.00 |
| State Return Data |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
Yes |
| NOLCarryBack |
|
Is the amended return an NOL carryback? |
No |
| Reason |
|
Reason for Corrections |
Other |
| DetailedExplanation |
|
Explanation of Corrections |
CORRECTED W2 RECEIVED |
| |
|
|
|
| FilingStatus |
|
|
|
| Single |
|
|
X |
| |
|
|
|
| Did you file federal extension Form 4868? |
|
|
No |
| |
|
|
|
| Did you take the Standard deduction or itemize? |
|
|
Standard |
| |
|
|
|
| Can someone else claim you (or your spouse) as a dependent? |
|
|
|
| ClaimedAsDependent |
|
|
No |
| |
|
|
|
| Residency Status |
|
|
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| Additional Information |
|
|
|
| AmtPrevPaidWithOrigAmendRtn |
|
Amount previously paid with original/amended return |
$83.00 |
| |
|
|
|
| SD Return # 1 Information |
|
|
|
| SchoolDistrictNumber |
|
What is the school district number for which you are filing the SD 100? |
4501 |
| TaxType |
|
Tax Type |
Traditional |
| |
|
|
|
| AmendedReturn |
|
Is this an amended return? |
Yes |
| NOLCarryBack |
|
Is the amended return an NOL carryback? |
No |
| Reason |
|
Reason for Corrections |
Ohio income tax base change |
| DetailedExplanation |
|
Explanation of Corrections |
CORRECTED W2 RECEIVED |
| |
|
|
|
| Residency Status |
|
School district residency |
|
| PrimaryResidencyStatus |
|
|
|
| FullYearResident |
|
Full-Year Resident |
X |
| |
|
|
|
| Additional Information - SD |
|
|
|
| AmtPrevPaidWithOrigAmendRtn |
|
Amended return only - amount previously paid with original/amended return |
$88.00 |
| |
|
|
|
| Return |
|
|
|
| IT1040 - Pages 1 & 2 |
| FederalAdjustedGrossIncome |
1 |
Federal Adjusted Gross Income |
$14,000.00 |
| TotalIncomeAddition |
2a |
Additions to federal adjusted gross income |
$0.00 |
| TotalIncomeDeduction |
2b |
Deductions from federal adjusted gross income |
$0.00 |
| OhioAdjustedGrossIncome |
3 |
Ohio Adjusted Gross Income (OAGI) |
$14,000.00 |
| ExemptionDeduction |
4 |
Personal and dependent exemption deduction |
$2,400.00 |
| TaxableIncome |
5 |
Ohio income tax base |
$11,600.00 |
| TaxableBusinessIncome |
6 |
Taxable business income (Ohio IT BUS, line 13) |
$0.00 |
| TaxableIncomeLessBusinessIncome |
7 |
Line 5 minus line 6 (if less than 0, enter 0) |
$11,600.00 |
| |
7a |
Amount from line 7 on page 1 |
$11,600.00 |
| NonBusinessIncomeTaxLiability |
8a |
Nonbusiness income tax liability |
$0.00 |
| BusinessIncomeTaxLiability |
8b |
Business income tax liability (Ohio IT BUS, line 14) |
$0.00 |
| IncomeTaxLiabilityBeforeCredits |
8c |
Income tax liability before credits (line 8a plus 8b) |
$0.00 |
| OhioNonRefundableCredits |
9 |
Ohio nonrefundable credits |
$53.00 |
| TaxLiabAfterNonrefundableCrdt |
10 |
Tax liability after nonrefundable credits |
$0.00 |
| UnderPaymentInterestPenalty |
11 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| UnpaidUseTax |
12 |
Sales and use tax due on Internet, mail order or other out-of-state purchases |
$0.00 |
| TotalTaxLiability |
13 |
Total Ohio tax liability before withholding or estimated payments |
$0.00 |
| TaxWithheld |
14 |
Ohio income tax withheld |
$200.00 |
| InstallmentPayment |
15 |
Add the Ohio estimated & extension payments & credit carryforward from previous year return |
$0.00 |
| RefundableTaxCredits |
16 |
Refundable credits |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
17 |
Amended return only - amount previously paid with original/amended return |
$83.00 |
| TotalPayment |
18 |
Total Ohio Tax Payments |
$283.00 |
| OverpymtRecdOnOrigAmendRtn |
19 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
20 |
Line 18 minus line 19 |
$283.00 |
| AmountUnderpaid |
21 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
22 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
23 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
24 |
Overpayment |
$283.00 |
| OverpymtCreditedNextYear |
25 |
Original return only - amount of line 24 to be carried forward to next year's tax liability |
$0.00 |
| CharityOrgName |
26a |
Amount of line 24 to be donated - Wildlife species |
$0.00 |
| CharityOrgName |
26b |
Amount of line 24 to be donated - Military injury relief |
$0.00 |
| CharityOrgName |
26c |
Amount of line 24 to be donated - Ohio History Fund |
$0.00 |
| CharityOrgName |
26d |
Amount of line 24 to be donated - Nature Preserves/Scenic Rivers |
$0.00 |
| CharityOrgName |
26e |
Amount of line 24 to be donated - Breast/cervical cancer |
$0.00 |
| CharityOrgName |
26f |
Amount of line 24 to be donated - Wishes for sick children |
$0.00 |
| TotalDonation |
26g |
Total |
$0.00 |
| Refund |
27 |
Your Refund |
$283.00 |
| |
|
|
|
| Schedule of Adjustments |
| Additions |
|
|
|
| NonOhioAndLocalGovIntAndDiv |
1 |
Non-Ohio state or local government interest and dividends |
$0.00 |
| PassThruEntityTaxesPaid |
2 |
Certain Ohio pass-through entity and financial institutions taxes paid |
$0.00 |
| TuitionExpenseReimbursement |
3 |
Reimbursement of college tutition expenses and fees deducted in any previous year(s) and noneducation expenditures from a college savings account |
$0.00 |
| SaleAndDispstnLossOfOhioOblig |
4 |
Losses from sale or disposition of Ohio public obligations |
$0.00 |
| NonMedicalWithdrawals |
5 |
Nonmedical withdrawals from a medical savings account |
$0.00 |
| ReimExpPrevDeducted |
6 |
Reimbursement of expenses previously deducted for Ohio income tax purposes, but only if the reimbursement is not in federal adjusted gross income |
$0.00 |
| IRC168And179AdjAdd |
7 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| FederalInterestAndDividends |
8 |
Federal interest and dividends subject to state taxation |
$0.00 |
| FederalConformityAdditions |
9 |
Federal conformity additions |
$0.00 |
| TotalIncomeAddition |
10 |
Total additions |
$0.00 |
| |
|
|
|
| Deductions |
|
|
|
| BusinessIncomeDeduction |
11 |
Business income deduction (attach Ohio Schedule IT BUS, line 11) |
$0.00 |
| OHFullYrEmpCompEarnNeighState |
12 |
Employee compensation earned in Ohio by residents of neighboring states |
$0.00 |
| IRS1040StateMuniIncomeOverpymt |
13 |
State or municipal income tax overpayments shown on the federal 1040, Sch 1, line 1 |
$0.00 |
| SocialSecurityBenefits |
14 |
Taxable Social Security benefits |
$0.00 |
| RailroadRetirementBenefits |
15 |
Certain railroad retirement benefits |
$0.00 |
| ObligIntrstPublicServicePay |
16 |
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 state of Ohio or income from a transfer agreement |
$0.00 |
| IndDevAcct |
17 |
Amounts contributed to an individual development account |
$0.00 |
| STABLEAcct |
18 |
Amounts contributed to STABLE account; Ohio's ABLE plan |
$0.00 |
| OutOfStateDisasterWorkIncome |
19 |
Income earned in Ohio by a qualifying out-of-state business or employee for disaster work conducted during a disaster response period |
$0.00 |
| FederalIntAndDivExempt |
20 |
Federal interest and dividends exempt from state taxation |
$0.00 |
| IRC168And179AdjDed |
21 |
Adjustment for Internal Revenue Code sections 168(k) and 179 depreciation expense |
$0.00 |
| IRS1040RefundOrReimbursements |
22 |
Refund or reimbursements shown on the federal 1040, schedule 1 for itemized deductions claimed on a prior year federal income tax return |
$0.00 |
| RepaymentOfIncomeReported |
23 |
Repayment of income reported in a prior year |
$0.00 |
| NotDeductedWageExpense |
24 |
Wage expense not deducted due to claiming the federal work opportunity credit |
$0.00 |
| FederalConformityDeductions |
25 |
Federal conformity deductions |
$0.00 |
| MilitaryPayForResident |
26 |
Military pay for Ohio residents received while the military member was stationed outside Ohio |
$0.00 |
| IncomeErndMilitCivilianNRSpouse |
27 |
Certain income earned by military nonresidents and civilian nonresident spouses |
$0.00 |
| UniformedServcsRetirmtIncome |
28 |
Uniformed services retirement income |
$0.00 |
| MilitaryInjuryReliefFund |
29 |
Military injury relief fund |
$0.00 |
| NationalGuardReimAndBenft |
30 |
Certain Ohio National Guard reimbursements and benefits |
$0.00 |
| CollegeAdvSavAndTuitPurchCred |
31 |
Ohio 529 contributions, tuition credit purchases |
$0.00 |
| PellOhioCollegeOppTaxableGrant |
32 |
Pell/Ohio College Opportunity taxable grant amounts used to pay room and board |
$0.00 |
| OhioEducatorExpenses |
33 |
Ohio educator expenses in excess of federal deduction |
$0.00 |
| DisabilityBenefits |
33 |
Disability benefits |
$0.00 |
| SurvivorBenefits |
34 |
Survivor benefits |
$0.00 |
| UnsubsidizedMedicalExpense |
35 |
Unreimbursed long-term care insurance premiums, unsubsidized health care insurance premiums and excess health care expenses (see instructions for worksheet) |
$0.00 |
| HealthCareDepositedFunds |
36 |
Funds deposited into, and earnings of, a medical savings account for eligible health care expenses (see instructions for worksheet) |
$0.00 |
| QualOrganDonorExp |
37 |
Qualified organ donor expenses |
$0.00 |
| TotalIncomeDeduction |
38 |
Total deductions |
$0.00 |
| |
|
|
|
| Schedule IT BUS |
|
|
|
| |
|
Part 1 |
|
| BusScheduleB |
1 |
Sch B - Interest and Ordinary Dividends |
$0.00 |
| BusScheduleC |
2 |
Sch C - Profit or Loss From Business (Sole Proprietership) |
$0.00 |
| BusScheduleD |
3 |
Sch D - Capital Gains and Losses |
$0.00 |
| BusScheduleE |
4 |
Sch E - Supplemental Income and Loss |
$0.00 |
| GuaranteedPayments |
5 |
Guranteed payments, compensation and/or wages from each pass-through entity in which you have at least a 20% direct or indirect ownership interest |
$0.00 |
| BusScheduleF |
6 |
Sch F - Profit or Loss From Farming |
$0.00 |
| OtherItemsOfIncome |
7 |
Other items of income and gain separately stated on federal Schedule K-1, federal 4797 gains and/or losses reported on federal 4797 and miscellaneous federal income tax adjustments, if any |
$0.00 |
| TotalOfBusinessIncome |
8 |
Total of business income (add lines 1 through 7) |
$0.00 |
| |
|
Part 2 |
|
| AllBusinessIncome |
9 |
All business income (enter the lesser of line 8 above or Ohio IT1040, line 1). If zero or negative, stop here and do not complete Part 3. |
$0.00 |
| FilingStatusBusIncAmt |
10 |
Enter $250,000 if single or MFJ, enter $125,000 if MFS |
$0.00 |
| LessOfFilStatBusIncAmtOrAllBusInc |
11 |
Lesser of line 9 or line 10. Enter here and on Ohio Schedule of Adjustments, line 11 |
$0.00 |
| |
|
Part 3 |
|
| AllBusIncLessBusIncDeduction |
12 |
Line 9 minus line 11 (if less than -0-, enter -0-) |
$0.00 |
| TaxableBusinessIncome |
13 |
Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5) |
$0.00 |
| BusinessIncomeTaxLiability |
14 |
Business income tax liability. Multiply line 13 by 3%. Enter here and on Ohio IT 1040, line 8b. |
$0.00 |
| |
|
|
|
| Schedule of Credits - Nonrefundable |
| TaxLiabilityBeforeCredits |
1 |
Tax liability before credits (From IT1040, line 8c) |
$0.00 |
| RetireIncomeCredit |
2 |
Retirement income credit (limit $200 per return) |
$0.00 |
| LumpSumRetirementCredit |
3 |
Lump sum retirement credit (include Ohio LS WKS, line 6) |
$0.00 |
| SeniorCitizenCredit |
4 |
Senior citizen credit |
$0.00 |
| LumpSumDistributionCredit |
5 |
Lump sum distribution credit (include Ohio LS WKS, line 3) |
$0.00 |
| ChildAndDependCareCredit |
6 |
Child care and dependent care credit (see the worksheet in the instructions) |
$0.00 |
| DisplacedWorkerTrainingCredit |
7 |
Displaced worker training credit (see the worksheet in the instructions) |
$0.00 |
| CampaignContributionCredit |
8 |
Campaign contribution credit |
$0.00 |
| ExemptionCredit |
9 |
Income-based exemption credit |
$20.00 |
| TotCreditsBeforeJointFiling |
10 |
Total (add lines 2 through 9) |
$20.00 |
| TaxLessCredit |
11 |
Tax less credits (line 1 minus line 10; if less than -0-, enter -0-) |
$0.00 |
| JointFilingCredit |
12 |
Joint filing credit |
$0.00 |
| EarnedIncomeCredit |
13 |
Earned income credit (multiply Fed EITC by 30%) |
$33.00 |
| HomeSchoolExpensesCredit |
14 |
Home school expenses credit |
$0.00 |
| ScholarshipDonationCredit |
15 |
Scholarship donation credit |
$0.00 |
| NonCharterOrPublicSchoolCredit |
16 |
Nonchartered, nonpublic school tuition credit |
$0.00 |
| VocationalJobCredit |
17 |
Vocational job credit |
$0.00 |
| AdoptionCredit |
18 |
Ohio adoption credit |
$0.00 |
| JobRetentionCredit |
19 |
Nonrefundable job retention credit |
$0.00 |
| NewEmpInEntZoneCredit |
20 |
Credit for eligible new employees in an enterprise zone |
$0.00 |
| GrapeProdPropertyPurchCredit |
21 |
Credit for purchases of grape production property |
$0.00 |
| InvestOhioCredit |
22 |
InvestOhio credit |
$0.00 |
| LeadAbatementCredit |
23 |
Lead abatement credit |
$0.00 |
| OpportunityZoneCredit |
24 |
Opportunity zone investment credit |
$0.00 |
| TechInvestCreditCarryfrwd |
25 |
Technology investment credit carryforward |
$0.00 |
| EntZoneDayCareAndTrngCredit |
26 |
Enterprise zone day care and training credits |
$0.00 |
| ResearchAndDevelopmentCredit |
27 |
Research and development credit |
$0.00 |
| OhioHistoricPreservationCredit |
28 |
Nonrefundable Ohio historic preservation credit |
$0.00 |
| TotAdditionalCredits |
29 |
Total (add lines 12 through 28) |
$33.00 |
| TaxLessCrdtMinusTotAddlCrdts |
30 |
Tax less additional credits (line 11 minus line 29; if less than -0-, enter -0-) |
$0.00 |
| |
|
Nonresident Credit |
|
| NonOhioIncome |
31 |
Nonresident Portion of Ohio adjusted gross income |
$0.00 |
| OhioAdjustedGrossIncome |
32 |
Ohio adjusted gross income |
$0.00 |
| NonResIncomeCreditRatio |
33a |
Divide line 31 by line 32 |
0.0000 |
| NonresidentAndPartYearCredit |
33 |
Nonresident credit (line 30 times line 33a) |
$0.00 |
| |
|
Resident Credit |
|
| ResidentTaxCredit |
34 |
Resident Credit - Ohio IT RC, line 7 |
$0.00 |
| TotalNonrefundableCredits |
35 |
Total nonrefundable credits |
$53.00 |
| |
|
|
|
| Schedule of Credits - Refundable |
| HistoricPreservationCredit |
36 |
Refundable Ohio historic preservation credit |
$0.00 |
| JobCreationAndJobRetentionCrd |
37 |
Refundable job creation credit & job retention credit |
$0.00 |
| PassthroughEntityCredit |
38 |
Pass-through entity credit |
$0.00 |
| MotionPictureProductionCredit |
39 |
Motion Picture & Broadway theatrical production credit |
$0.00 |
| VentureCapitalCredit |
40 |
Venture Capital credit |
$0.00 |
| TotalRefundableCredit |
41 |
Total refundable credits |
$0.00 |
| |
|
|
|
| School District Return (#4501) |
|
|
|
| SchoolDistrictTaxableIncome |
1 |
School district taxable income: Traditional or Earned Income tax base |
$11,600.00 |
| TaxAmount |
2 |
School District Tax .____ times line 1. |
$87.00 |
| SeniorCitizenCredit |
3 |
Senior Citizen Credit |
$0.00 |
| TaxLessCredit |
4 |
School District Income Tax liability |
$87.00 |
| UnderPaymentInterestPenalty |
5 |
Interest penalty on underpayment of estimated tax |
$0.00 |
| TotalTax |
6 |
Total school district income tax liability (line 4 plus line 5) |
$87.00 |
| TotalTax |
6a |
Amount from line 6, page 1 |
$87.00 |
| TaxWithheld |
7 |
School district income tax withheld |
$113.00 |
| InstallmentPayments |
8 |
SD 100 ES & SD 40P, Extension Payments and Credit carryforward from previous year return |
$0.00 |
| AmtPrevPaidWithOrigAmendRtn |
9 |
Amended return only - amount previously paid with original/amended return |
$88.00 |
| TotalPayments |
10 |
Total school district income tax payments (add lines 7, 8 and 9) |
$201.00 |
| OverpymtRecdOnOrigAmendRtn |
11 |
Amended return only - overpayment previously requested on original/amended return |
$0.00 |
| TotPymtMinusOverPymtOnOrigAmendRtn |
12 |
Line 10 minus line 11. Place a negative sign ("-") in the box if the amount is less than -0- |
$201.00 |
| AmountUnderpaid |
13 |
Tax due |
$0.00 |
| InterestDueOnLatePayment |
14 |
Interest due on late payment of tax |
$0.00 |
| BalanceDue |
15 |
Total Amount Due |
$0.00 |
| AmountOverpaid |
16 |
Overpayment |
$114.00 |
| OverpymtCreditedNextYear |
17 |
Original return only - amount of line 16 to be carried forward to next year's tax liability |
$0.00 |
| Refund |
18 |
Your Refund |
$114.00 |
| Traditional Tax Base School District Amounts |
|
|
|
| TaxableIncome |
19 |
Ohio income tax base (Ohio IT 1040, line 3 minus line 4) |
$11,600.00 |
| BusinessIncomeDeductionAddback |
20 |
Business income deduction add-back |
$0.00 |
| TotalTraditionalSDIncome |
21 |
Total Traditional Tax Base School District Income (Line 19 + Line 20) |
$11,600.00 |
| NonResidentIncome |
22 |
Amount of traditional tax base school district income that you earned while not a resident |
$0.00 |
| SchoolDistrictTaxableIncome |
23 |
School District Taxable Income (Enter here and on line 1) |
$11,600.00 |
| Earned Income Tax Base School District Amounts |
|
|
|
| WagesAndOtherCompensations |
24 |
Wages and other compensation as described in the instructions |
$0.00 |
| SelfEmploymentEarnings |
25 |
Net Earnings from Self Employment |
$0.00 |
| FederalConformityAdjustments |
26 |
Federal Conformity Adjustments |
$0.00 |
| SchoolDistrictTaxableIncome |
27 |
School District Taxable Income (Enter here and on line 1) |
$0.00 |
| |
|
|
|
| What is Tested? |
|
If you do not support: |
|
| IT1040X |
|
Do not send test |
|
| Amount previously paid with original/amended return |
|
|
|
| Reason and explanation of corrections |
|
|
|
| Sch of Credits - Earned Income Credit |
|
|
|
| |
|
|
|
| SD100X |
|
Omit SD100X |
|
| Amount previously paid with original/amended return |
|
|
|
| Reason and explanation of corrections |
|
|
|
| |
|
|
|