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                                                                                                                      IT RE
                                                                                                                      Rev. 10/15

                                                         15270101

                2015 Ohio IT RE – Reason and Explanation of Corrections
                                        Note: For amended individual return only
                          Please attach documentation to support any adjustments to line items. Refer to the
                instructions to identify required documentation for complete processing of the amended return.
Taxpayer Social Security no. (required) 

First name                                 M.I.       Last name

Reason(s):
  Net operating loss carryback (IMPORTANT: Be sure to complete      Ohio Schedule of Credits, manufacturing equipment grant 
  and attach Ohio IT NOL, Net Operating Loss Carryback              increased
  Schedule [available at tax.ohio.gov] and check the box on the     Ohio Schedule of Credits, manufacturing equipment grant 
  front of the IT 1040 indicating that you are amending for a NOL.) decreased
  Federal adjusted gross income decreased                           Ohio Schedule of Credits, refundable credit(s) increased
  Federal adjusted gross income increased                           Ohio Schedule of Credits, refundable credit(s) decreased
  Filing status changed                                             Ohio IT/SD 2210 interest penalty amount increased
  Residency status changed                                           Ohio IT/SD 2210 interest penalty amount decreased
  Exemptions increased (attach Schedule J)                          Ohio sales and use tax increased
  Exemptions decreased (attach Schedule J)                          Ohio sales and use tax decreased
  Ohio Schedule A, additions to income                              Ohio withholding increased
  Ohio Schedule A, deductions from income                           Ohio  withholding decreased
  Ohio Schedule of Credits, nonrefundable credit(s) increased       Estimated and/or Ohio IT 40P amount or previous year 
  Ohio Schedule of Credits, nonrefundable credit(s) decreased       carryforward overpayment increased
  Ohio Schedule of Credits, nonresident credit increased            Estimated and/or Ohio IT 40P amount or previous year 
  Ohio Schedule of Credits, nonresident credit decreased            carryforward overpayment decreased
  Ohio Schedule of Credits, resident credit increased               Amount paid with original ﬁ ling did not equal amount reported as 
                                                                    paid with the original ﬁ ling
  Ohio Schedule of Credits, resident credit decreased
Detailed explanation of adjusted items (attach additional sheet(s) if necessary):

E-mail address (optional)                                           Telephone number (optional)

                                           Federal Privacy Act Notice
                Because we require you to provide us with a Social Security number, the   Federal Privacy Act of 
                1974 requires us to inform you that providing us with your Social Security number is mandatory. 
                Ohio Revised Code sections 5703.05, 5703.057 and 5747.08 authorize us to request this informa-
                tion. We need your Social Security number in order to administer this tax.

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Do not use staples. Use only black ink and UPPERCASE letters.

2015 Universal IT 1040
Rev. 11/15
Individual Income Tax Return

Note: For taxable year 2015 and forward, this form encompasses the IT 1040, IT 1040EZ and amended IT 1040X.

Are you ﬁ ling this as an amended return? Yes No If yes, attach Ohio IT RE, 2015 Reason and Explanation of Corrections
Is this a Net Operating Loss (NOL) carryback? Yes No If yes, attach Schedule IT NOL
Taxpayer Social Security no. (required)  If deceased Spouse’s Social Security no. (if ﬁ ling jointly)  If deceased Enter school district # for
this return (see instructions).
check box check box SD#
First name M.I. Last name

Spouse's ﬁ rst name (only if married ﬁ ling jointly) M.I. Last name

Mailing address (for faster processing, use a street address)

City State ZIP code Ohio county (ﬁ rst four letters)

Home address (if different from mailing address) – do NOT show city or state ZIP code Ohio county (ﬁ rst four letters)

Foreign country (if the mailing address is outside the U.S.) Foreign postal code

Ohio Residency Status – Check applicable box Filing Status – Check one (as reported on federal income tax return,
Full-year Part-year Nonresident with limited exceptions – see instructions)
resident resident Indicate state
Single, head of household or qualifying widow(er)
Check applicable box for spouse (only if married ﬁ ling jointly)
Full-year Part-year Nonresident Married ﬁ ling jointly Married ﬁ ling separately
 Yes No
resident resident Indicate state
Yes No Did you ﬁ le federal extension form 4868? ....................................
Ohio Political Party Fund Yes No
Do you want $1 to go to this fund? ............................................ Is someone else claiming you or your spouse (if joint return) as
a dependent? If yes, enter "0" on line 4 ........................................
If joint return, does your spouse want $1 to go to this fund? .....
Note: Checking “Yes” will not increase your tax or decrease your refund.
If the amount on a line is negative, place a negative sign ("–") in the box provided.
1. Federal adjusted gross income (from IRS forms 1040, line 37; 1040A, line 21;
1040EZ, line 4; 1040NR, line 36; or 1040NR-EZ, line 10) ..................................................... ....1. , , , . 00

00
2a. Additions to federal adjusted gross income (attach Ohio Schedule A, line 11) ...........................2a. , , , .

2b. Deductions from federal adjusted gross income (attach Ohio Schedule A, line 35) ....................2b. , , , . 00

3. Ohio adjusted gross income (line 1 plus line 2a minus line 2b) ........................................ ....3. , , , . 00
00
4. Personal and dependent exemption deduction (if claiming dependent(s), attach Schedule J) .....4. , .

5. Ohio income tax base (line 3 minus line 4; if less than -0-, enter -0-) ...........................................5. , , , . 00

6. Taxable business income (attach Ohio Schedule IT BUS, line 13) ...............................................6. , , . 00
7. Line 5 minus line 6 (if less than -0-, enter -0-) ...............................................................................7. , , , . 00
Enclose your federal income tax return
if line 1 of this return is -0- or negative.
Do not write in this area; for department use only.
/ /
Postmark date Code

2015 Universal IT 1040 – page 1 of 2

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                                                       2015 Universal IT 1040 
                         Rev. 11/15                  Individual Income Tax Return
                                                                                                                                                                       
   SSN

  7a. Amount from line 7 on page 1 .....................................................................................................7a. ,                  ,        ,                 . 00
 
                                                                                                                                                                                           00
  8a. Tax liability on line 7a (see instructions for tax tables) .............................................................................8a.              ,        ,                 .
                                                                                                                                                                                           00
  8b. Business income tax liability (attach Ohio Schedule IT BUS, line 14) ..................................................... 8b.                           ,        ,                 .
                                                                                                                                                                                           00
  8c. Tax liability before credits (line 8a plus line 8b) ....................................................................................... 8c.          ,        ,                 .
                                                                                                                                                                                           00
  9. Ohio nonrefundable credits/grants (attach Ohio Schedule of Credits, line 35) ......................................... 9.                                 ,        ,                 .
                                                                                                                                                                                           00
  10. Tax liability after nonrefundable credits/grants (line 8c minus line 9; if less than -0-, enter -0-) ...............10.                                  ,        ,                 .
 
   11. Interest penalty on underpayment of estimated tax (attach Ohio IT/SD 2210) ........................................11.                                  ,        ,                 .00
  12. Sales and use tax due on Internet, mail order or other out-of-state purchases (see instructions). 
     If you certify that no sales or use tax is due, check the box to the right ........................................                     ...12.            ,        ,                 .00
                                                                                                                                                                                           00
 13. Total Ohio tax liability before withholding or estimated payments (add lines 10, 11 and 12) ................13.                                           ,        ,                 .
                                                                                                                                                                                           00
  14. Ohio income tax withheld (W-2, box 17; W-2G, box 15; 1099-R, box 12) ................................................14.                                 ,        ,                 .
 15. Estimated and extension payments made (2015 Ohio IT 1040ES and/or IT 40P) and credit 
                                                                                                                                                                                           00
     carryforward from previous year return ......................................................................................................15.          ,        ,                 .
                                                                                                                                                                                           00
  16. Refundable credits (attach Ohio Schedule of Credits, line 41) .................................................................16.                       ,        ,                 .
                                                                                                                                                                                           00
 17. Amended return only – amount previously paid with original/amended return ......................................17.                                       ,        ,                 .
                                                                                                                                                                                           00
 18. Total Ohio tax payments (add lines 14, 15, 16 and 17) .........................................................................18.                        ,        ,                 .
                                                                                                                                                                                           00
 19. Amended return only – overpayment previously received on original/amended return .........................19.                                             ,        ,                 .
                                                                                                                                                                                           00
  20. Line 18 minus line 19 ...............................................................................................................................20. ,        ,                 .
 
            If line 20 is MORE THAN line 13, skip to line 24. OTHERWISE, continue to line 21.

                                                                                                                                                                                           00
  21. Tax liability (line 13 minus line 20) ............................................................................................................21.    ,        ,                 .
                                                                                                                                                                                           00
 22. Interest and penalty due on late ﬁ ling or late payment of tax (see instructions) ...........................................................22.          ,        ,                 .
 23. TOTAL AMOUNT DUE (line 21 plus line 22). Enclose Ohio IT 40P (if original return) or IT 40XP
                                                                                                                                                                                           00
     (if amended return) and make check payable to “Ohio Treasurer of State” .....................................23.                                          ,        ,                 .
                                                                                                                                                                                           00
  24. Overpayment (line 20 minus line 13) ........................................................................................................24.          ,        ,                 .
 
                                                                                                                                                                                           00
 25. Original return only – amount of line 24 to be credited toward 2016 income tax liability .........................25.                                     ,        ,                 .
  26. Amount of line 24 to be donated:
     a. Military injury relief       b. Ohio History Fund          c. State nature preserves
                           00                         00                              00
            ,            .               ,           .                    ,       .
     d. Breast / cervical cancer     e. Wishes for Sick Children   f. Wildlife species
                           00                         00                              00                                                                                                   00
            ,            .               ,           .                    ,       .          Total.......26g.                                                  ,        ,                 .
 27. YOUR REFUND (line 24 minus lines 25 and 26g) ...................................................................................27.                       ,        ,                 . 00

   Sign Here (required): I have read this return. Under penalties of perjury, I declare that, to                                            If your refund is $1.00 or less, no refund will be issued. 
   the best of my knowledge and belief, the return and all enclosures are true, correct and complete.                                       If you owe $1.00 or less, no payment is necessary.
                                                                                                                                            NO Payment Enclosed  –Mail to:
   Your signature                                                              Date (MM/DD/YYYY)                                                              Ohio Department of Taxation
                                                                                                                                                               P.O. Box 2679
   Spouse’s signature (see instructions)                                       Phone number                                                                   Columbus, OH  43270-2679
                                                                                                                                                               Payment Enclosed  –Mail to:
                                                                                                                                                               Ohio Department of Taxation
       Preparer’s   printed name (see instructions)  PTIN                       Phone number                                                                   P.O. Box 2057
       Do you authorize your preparer to contact us regarding this return?      Yes   No                                                                       Columbus, OH  43270-2057

                                                                                  2015 Universal IT 1040 – page 2 of 2

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