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                                                                                                                                                               Retain for your records. 
2013 Ohio Income Tax TeleFile Worksheet                                                                                                                                DO NOT MAIL!

                                                            1a. Enter your Ohio fi ling status, which must be the same as your federal fi ling status.
                                                                       Single, head of household or qualifying widow(er)
                                                                       Married fi ling jointly
                                                                       Married fi ling separately
                                                            1b. Read the information on page Tel 1 to see if you qualify to TeleFile. Ohio TeleFile has new security enhancements and 
                                                                 will ask you to enter additional personal information to identify you and, if applicable, your spouse. If you have changed 
                                                                 your address, call the Ohio Department of Taxation at 1-800-282-1780 to update your address and ZIP code before using 
                                                                 TeleFile. Enter your Social Security number, then date of birth in MM/DD/YYYY format and your ZIP code. If married fi ling 
                                                                 jointly, enter your spouse's Social Security number and date of birth in MM/DD/YYYY format. 
                                                                       Your Social Security number                                    Date of birth                     ZIP code

                                                                                                                              /              /
                                                                 Spouse's SSN (only if married fi ling jointly)                        Date of birth

                                                                                                                              /              /
                                                             2.  Do you want $1 of your tax to go to the Ohio Political Party Fund?                 Yes        No
                                                                       If joint return, does your spouse want $1 to go to this fund?                Yes        No
                                                                 Note: Checking "Yes" will not increase your tax due or decrease your refund.
                  Fill in Lines 1a-7
                                                            3.  Enter the amount of your 2013 federal adjusted gross income from 
                                                                 IRS form 1040, line 37; 1040A, line 21; or 1040EZ, line 4 (cannot                                                 0 0
                                                                 exceed $999,999).                                                                                                                                TeleFile
                                                            4.   If you fi led a 2013 IRS form 1040A or 1040EZ, enter -0- on this line 
                                                                 because you are not entitled to this deduction. However, if you 
                                                                 fi led a 2013 IRS form 1040, enter here the amount from line 10 of that                                            0 0
                                                                 return. If line 10 is blank, enter -0-.

                                                            5.  Enter your federal earned income tax credit (see page Tel 3).                                                      0 0
                                                            6.  Enter the number of dependents, other than yourself and spouse, that 
                                                                 you claimed on your federal income tax return. If none, enter -0-.
                                                            7.  Enter the amount of unpaid use (sales) tax that you owe from line e 
                                                                 of the use tax worksheet on page 33. If none, enter -0-.                                                          0 0

                                                            8.  Read the W-2 instructions on page Tel 3 before completing this 
                                                                 part. Enter your total number of W-2 forms. If you have more than nine 
                                                                 W-2s, you cannot TeleFile.
                                                             
                                                                       Round all dollar amounts to the nearest dollar (do not include cents).
                                                                           Employer I.D. number             State wages, tips, etc.           Ohio income tax with-     Indicate whether your                     
                                                                        9. (box b, not box 15)          10. (box 16)                  11.     held (box 17, not box 2) 12. W-2 or spouse's W-2

                                                            1st W-2                                                           00                               00      F Yours F Spouse's
                                                            2nd W-2                                                           00                               00      F Yours F Spouse's
                                                            3rd W-2                                                           00                               00      F Yours F Spouse's
                                                            4th W-2                                                           00                               00      F Yours F Spouse's
                                                            5th W-2                                                           00                               00      F Yours F Spouse's
                                                            6th W-2                                                           00                               00      F Yours F Spouse's
                                                            7th W-2                                                           00                               00      F Yours F Spouse's
                                                            8th W-2                                                           00                               00      F Yours F Spouse's
                                    Provide W-2 Information 9th W-2                                                           00                               00      F Yours F Spouse's

                                                                        Be sure that you entered on line 9 the employer I.D. number appearing in box (b) of your W-2. Do not 
                                                                        enter the I.D. number appearing in box 15.  Also, be sure that you entered on line 11 the amount of your 
                                                                 !      Ohio income tax withheld appearing in box 17 of your W-2. Do not enter the amount of the federal income 
                                                             CAUTION    tax withheld appearing in box 2. If box 15 on any of your W-2 forms shows a state other than OHIO or 
                                                                        OH, you cannot TeleFile.
                                                                                                                     - Tel 5 -



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                                                                                                                                                                                               Retain for your records. 
         2013 Ohio Income Tax TeleFile Worksheet (cont'd.)                                                                                                                                       DO NOT MAIL!

                                                                                    13. Tax Refund or Tax Due – Your refund can be deposited directly into your checking or savings account. You may pay your 
                                                                                        tax due by credit card (see page 7) or by electronic check and have the amount transferred (direct debit) from your checking 
                                                                                        or savings account. If you want to use this convenient option, you must complete the following information so you will have 
                                                                                        it ready when TeleFile asks you to enter this information.
                                                                                                                                                                   Date you want your payment 
                                                                                        Type of AccountCheck the box below to designate either                  withdrawn from your account
                                                                                        checking or savings.
                                                                                        Checking         Routing number                                             MM D D                     2 0 1 4

                                                                                        Savings          Account number
                                                                                        Bank Routing NumberThe fi rst two digits of the routing number must 
                                                                                        begin with 01 through 12, or 21 through 32.                                                                                                     20
                                                                                        All routing numbers must be nine digits. In this example the routing number 
                                                                                        is 044036036.
                                                                                        Account Number     The account number can be up to 17 digits. Omit 
                                                                                        hyphens, spaces and special symbols. Enter the number from left to right 
                                                      Tax Refund or Tax Due             and leave any unused boxes blank. In this example the account number is 
                                                                                        40404059.

                                                                                        CAUTION! Donot use a deposit slip to verify the number because the deposit slip may contain numbers other than your routing 
                                                                                                 or account number. 
                                                                                        Payment Date If you owe tax, you may fi le now and schedule an electronic funds withdrawal (electronic check) from your 
                                                                                        checking or savings account through April 15, 2014. After April 15th, your payment will be electronically transferred within 
                                                                                        24 hours of the fi ling date.

TeleFile                                                                            14. Now You're Ready to TeleFile. Call 1-800-697-0440 (phone lines are busiest between 6 p.m. and 10 p.m.). TeleFile will 
                                                                                        ask you to enter lines 1-12 to compute your return. TeleFile will tell you the dollar amounts that you need to enter on the 
                                                                                        lines below. TeleFile will then ask you to enter the information from line 13 if you choose the direct deposit or direct debit 
                                                                                        option. 
                                                                                     
                                                                                        a) Your Ohio taxable income ............................................................................................................ $
                                                                                     
                                                                                        b) Your Ohio income tax for 2013 ..................................................................................................... $
                                                                                     
                                                                                        c)  Your Ohio earned income credit for 2013 ....................................................................................... $
                                                                                     
                                                                                        d) Your unpaid  Ohio use taxfor 2013 ................................................................................................ $
                                                                                     
                                                                                        e) Your total tax for 2013 ................................................................................................................... $
                                                                                     
                                                                                        f)  Amount of your tax refund before donations ............................................................................... $

                                                                                           1) Military Injury Relief Fund ....................................................................$
                                                                                           2) Natural areas/endangered species ......................................................$
                                                                                           3) Ohio Historical Society.........................................................................$
                                                      Now You're Ready To TeleFile!        4)  Wildlife species/endangered wildlife ....................................................$
                                                                                        g) Amount of your tax refund after donations .................................................................................. $ 
                                                                                     
                                                                                        h)  Amount you owe (see payment options on page 7) ..................................................................... $

                                                                                        i) Sign your return and receive your fi ling confi rmation number. TeleFile will now ask you to sign your return by entering
                                                                                           your ZIP code. Upon agreement, TeleFile will then assign you a 10-digit fi ling confi rmation number. Do not hang up until 
                                                                                           you have signed your return and received this number. If you hang up before signing your return, your return will 
                                                                                           not be processed. Enter the fi ling confi rmation number in the designated boxes below. It is your proof of fi ling. If you 
                                                                                           have a balance due and pay by electronic check, you will also receive a separate 15-digit electronic check confi rmation 
                                                                                           number. Enter this number in the designated boxes below.

                                              rmation Number!                              Filing confi rmation number               Electronic check confi rmation number (if applicable)             Date you fi led

                                                                                                                                                                                                     MM D D                               1 4

                                                                                      IMPORTANT: If at anytime during your TeleFile transaction you are disconnected without receiving your confi rmation 
         Don't Forget To Write Down          Your Confi
                                                                                     number(s), call again and resubmit your information. 
                                                                                                                                         - Tel 6 -






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