Ohio Ohio Individual Income Tax Return Bundle

Ohio Individual Income Tax Return Bundle
Form IT 1040
2022 Ohio IT 1040

Do not staple or paper clip.

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Department of
Taxation

Individual Income Tax Return

22000102

Use only black ink/UPPERCASE letters. Use whole dollars only.

AMENDED RETURN - Check here and include Ohio IT RE.
Primary taxpayer's SSN (required)

If deceased

NOL CARRYBACK - Check here and include Schedule IT NOL.

If deceased

Spouse’s SSN (if filing jointly)

M.I.

School district #

Last name

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First name

Sequence No. 1

Spouse's first name (if filing jointly)

M.I. Last name

Address line 1 (number and street) or P.O. Box

Address line 2 (apartment number, suite number, etc.)

State

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

Foreign postal code

Residency Status – Check only one for primary
Resident

Part-year
resident

Check only one for spouse (if filing jointly)
Part-year
Resident
resident

Nonresident 

Indicate state

Filing Status –	Check one (as reported on federal income tax return)
Single, head of household or qualifying widow(er)
Married filing jointly

Nonresident 

Indicate state

Ohio Nonresident Statement – See instructions for required criteria

Do not staple or paper clip.

Ohio county (first four letters)

ZIP code

City

Spouse’s SSN

Married filing separately

Primary meets the five criteria for irrebuttable presumption as nonresident.

Federal extension filers - check here.

Spouse meets the five criteria for irrebuttable presumption as nonresident.

If someone can claim you (or your spouse if filing jointly) as a
dependent, check here.

1.	Federal adjusted gross income (federal 1040 or 1040-SR, line 11). Place a "-" in the box
if negative...........................................................................................................................................	

.....1.

	2a.	Additions – Ohio Schedule of Adjustments, line 10 (include schedule).....................................................2a.
2b.	Deductions
– Ohio Schedule of Adjustments, line 39 (include schedule)..................................................2b.
	
3.	Ohio adjusted gross income (line 1 plus line 2a minus line 2b). Place a "-" in the box if negative...

.....3.

4.	Exemption amount (include Schedule of Dependents if applicable)..........................................................4.
Number of exemptions including you and your spouse/dependents, if applicable:

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5.	Ohio income tax base (line 3 minus line 4; if negative, enter zero)...............................................................5.

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6.	Taxable business income – Ohio Schedule IT BUS, line 13 (include schedule)..........................................6.
7.	Taxable nonbusiness income (line 5 minus line 6; if negative, enter zero)....................................................7.

Do not write in this area; for department use only.
MM-DD-YY

Code

2022 IT 1040 – page 1 of 2

2022 Ohio IT 1040

SSN

Individual Income Tax Return

22000202

Sequence No. 2

	7a.	Amount from line 7 on page 1 .....................................................................................................................7a.
	
	8a.	Nonbusiness income tax liability on line 7a (see instructions for tax tables)...........................................................8a.
	
	8b.	Business income tax liability – Ohio Schedule IT BUS, line 14 (include schedule)...............................................8b.

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	8c. Income tax liability before credits (line 8a plus line 8b)...........................................................................................8c.
	 9.	Ohio nonrefundable credits – Ohio Schedule of Credits, line 35 (include schedule)...............................................9.
	10.	Tax liability after nonrefundable credits (line 8c minus line 9; if negative, enter zero).............................................10.

	11.	Interest penalty on underpayment of estimated tax (include Ohio IT/SD 2210)..................................................... 11.
12.	Unpaid use tax (see instructions).............................................................................................................................12.
	13.	Total Ohio tax liability before withholding or estimated payments (add lines 10, 11 and 12)................................13.
	 4.	Ohio income tax withheld – Schedule of Ohio Withholding, part A, line 1 (include schedule and
1
		 income statements)...............................................................................................................................................14.
	15.	Estimated and extension payments (from Ohio IT 1040ES and IT 40P), and credit carryforward
from last year's return..............................................................................................................................................15.

	16.	Refundable credits – Ohio Schedule of Credits, line 41 (include schedule)..........................................................16.
	17.	Amended return only – amount previously paid with original and/or amended return..........................................17.

	18.	 Total Ohio tax payments (add lines 14, 15, 16 and 17).........................................................................................18.
	19.	Amended return only – overpayment previously requested on original and/or amended return...........................19.
	 0.	Line 18 minus line 19. Place a "-" in the box if negative..................................................................................	
2
	
If line 20 is MORE THAN line 13, skip to line 24. OTHERWISE, continue to line 21.

.......20.

	21.	Tax due (line 13 minus line 20). If line 20 is negative, ignore the "-" and add line 20 to line 13..............................21.
	 2.	Interest due on late payment of tax (see instructions).............................................................................................................22.
2
	
23.	TOTAL AMOUNT DUE (line 21 plus line 22). Include Ohio IT 40P (if original return) or
		 IT 40XP (if amended return) and make check payable to “Ohio Treasurer of State”.............. AMOUNT DUE	23.
	24.	Overpayment (line 20 minus line 13).......................................................................................................................24.
	
	 5.	 Original return only – portion of line 24 carried forward to next year’s tax liability..................................................25.
2
	26.	 Original return only – portion of line 24 you wish to donate:
		a. Wildlife Species	
b. Military Injury Relief	
c. Ohio History Fund
			
d. Nature Preserves/Scenic Rivers	

e. Breast/Cervical Cancer	

f. Wishes for Sick Children

Total.....26g.

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	27.	 REFUND (line 24 minus lines 25 and 26g)..............................................................................YOUR REFUND27.

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Sign Here (required): I have read this return. Under penalties of perjury, I declare that, to the best of my knowledge
and belief, the return and all enclosures are true, correct and complete.

Primary signature	
Spouse’s signature 		

	

NO Payment Included – Mail to:
Ohio Department of Taxation
P.O. Box 2679
Columbus, OH 43270-2679

Phone number

Date
		
Check here to authorize your preparer to discuss this return with the Department.

Preparer's printed name

Phone number
Preparer's TIN (PTIN)

P

If your refund is $1.00 or less, no refund will be issued.
If you owe $1.00 or less, no payment is necessary.

	

Payment Included – Mail to:
Ohio Department of Taxation
P.O. Box 2057
Columbus, OH 43270-2057
2022 IT 1040 – page 2 of 2

2022 Ohio Schedule
of Adjustments

Use only black ink. Use whole dollars only.
Primary taxpayer’s SSN

22000302
Sequence No. 3

Additions

(Only add the following amounts if they are not included on Ohio IT 1040, line 1)
	 1.	 Non-Ohio state or local government interest and dividends.....................................................................................1.

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	 2.	 Ohio pass-through entity taxes excluded from federal adjusted gross income........................................................2.
	 3.	 Ohio 529 plan funds used for non-qualified expenses.............................................................................................3.
	 4.	 Losses from sale or disposition of Ohio public obligations.......................................................................................4.
	
	 5.	 Nonmedical withdrawals from a medical savings account.......................................................................................5.
	
	6. 	Reimbursement of expenses previously deducted on an Ohio income tax return...................................................6.
Federal

	 7.	 Internal Revenue Code 168(k) and 179 depreciation expense addback.................................................................7.
	 8.	 Exempt federal interest and dividends subject to state taxation..............................................................................8.
	 9.	 Federal conformity additions....................................................................................................................................9.
10.	 Total additions (add lines 1 through 9 ONLY). Enter here and on Ohio IT 1040, line 2a........................... 10.

Deductions

	

(Only deduct the following amounts if they are included on Ohio IT 1040, line 1)

	
11.		Business income deduction – Ohio Schedule IT BUS, line 11............................................................................... 11.

	

12.		Employee compensation earned in Ohio by residents of neighboring states........................................................... 12.

13.		Taxable refunds, credits, or offsets of state and local income taxes (federal 1040, Schedule 1, line 1)................13.
14.		Taxable Social Security benefits (federal 1040 and 1040-SR, line 6b)..................................................................14.
15.		Certain railroad benefits.........................................................................................................................................15.
16.		Interest income from Ohio public obligations and purchase obligations; gains from the
			disposition of Ohio public obligations; or income from a transfer agreement.........................................................16.
17.		Amounts contributed to an Ohio county's individual development account program.............................................17.
18.		Amounts contributed to a STABLE account: Ohio's ABLE plan.............................................................................18.
19.		Income earned in Ohio by a qualifying out-of-state business or employee for disaster
work conducted during a disaster response period................................................................................................19.
Federal

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20.		Federal interest and dividends exempt from state taxation....................................................................................20.
			
	
21. 	Deduction of prior year 168(k) and 179 depreciation addbacks.............................................................................21.
22.		Refund or reimbursements from the federal 1040, Schedule 1, line 8z for federal
itemized deductions claimed on a prior year return................................................................................................22.

2022 Schedule of Adjustments – page 1 of 2

2022 Ohio Schedule
of Adjustments

22000402

Primary taxpayer’s SSN

Sequence No. 4

23.		Repayment of income reported in a prior year.......................................................................................................23.
24.		Wage expense not deducted based on the federal work opportunity tax credit.....................................................24.
25. Federal conformity deductions................................................................................................................................. 25.

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Uniformed Services

26. Military pay received by Ohio residents while stationed outside Ohio..................................................................... 26.
27.		 Compensation earned by nonresident military servicemembers and their civilian spouses.................................... 27.
28.		Uniformed services retirement income...................................................................................................................28.

29.		Military injury relief fund grants and veteran’s disability severance payments................................................................. 29.
30.	 Certain Ohio National Guard reimbursements and benefits...................................................................................30.
	
Education
31.	 Amounts contributed to Ohio CollegeAdvantage: Ohio’s 529 Plan........................................................................31.

32.		Pell/Ohio College Opportunity taxable grant amounts used to pay room and board.............................................32.
33.		Ohio educator expenses in excess of federal deduction........................................................................................33.
Medical

34.		Disability benefits...................................................................................................................................................34.
35.  Survivor benefits.....................................................................................................................................................35.
36.		Unreimbursed medical and health care expenses (see instructions for worksheet; include a copy)...................36.
37.		Medical savings account contributions/earnings (see instructions for worksheet; include a copy)......................37.
38.		Qualified organ donor expenses............................................................................................................................38.

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39.	 Total deductions (add lines 11 through 38 ONLY). Enter here and on Ohio IT 1040, line 2b..............................39.

2022 Schedule of Adjustments – page 2 of 2

2022 Ohio Schedule IT BUS
Business Income

Use only black ink/UPPERCASE letters.
Primary taxpayer’s SSN

22260102
Sequence No. 5

Enter all business income that you (and your spouse, if filing jointly) received during the tax year on this schedule. Enter only those amounts that are
included in your federal adjusted gross income. Only one IT BUS should be used for each return filed. See R.C. 5747.01(B). Use whole dollars only.
Part 1 – Business Income From IRS Schedules

	
	
	
	
	
	
	

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Note: Do not include amounts listed on the IRS schedules below that are nonbusiness income.
See R.C. 5747.01(C). If the amount on a line is negative, place a “-“ in the box provided.
1.	Schedule B – Interest and Ordinary Dividends.........................................................................................................1.
2.	Schedule C – Net Profit or Loss From Business (Sole Proprietorship)....................................................... 	

....2.

3.	Schedule D – Capital Gains and Losses..................................................................................................... 	

....3.

4.	Schedule E – Supplemental Income and Loss........................................................................................... 	

....4.

	 5.	Guaranteed payments or compensation from a pass-through entity to a 20% or greater direct

		 or indirect owner.......................................................................................................................................................5.
	 6.	Schedule F – Net Profit or Loss From Farming........................................................................................... 	

.... 6.

	7.	Other business income or loss not reported above (e.g. form 4797 amounts)........................................... 	

....7.

	 8.	Total business income (add lines 1 through 7)............................................................................................ 	

....8.

Part 2 – Business Income Deduction

	 9.	Enter the lesser of line 8 above or Ohio IT 1040, line 1. If negative, enter zero;
stop here and do not complete Part 3......................................................................................................................9.
	10.	Enter
$250,000 if filing status is single or married filing jointly; OR
	
	 	 Enter $125,000 if filing status is married filing separately.......................................................................................10.

	11.	Enter the lesser of line 9 or line 10. Enter here and on Ohio Schedule of Adjustments, line 11.................................... 11.
Part 3 – Taxable Business Income

	Note: If Ohio IT 1040, line 5 is zero, do not complete Part 3.
		12.	Line 9 minus line 11.................................................................................................................................................12.
	13.	Taxable business income (enter the lesser of line 12 above or Ohio IT 1040, line 5). .Enter here and
		 on Ohio IT 1040, line 6............................................................................................................................................13.
	

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	14.	Business income tax liability – multiply line 13 by 3% (.03). Enter here and on Ohio IT 1040, line 8b.......................14.

Do not write in this area; for department use only.

2022 Schedule IT BUS – page 1 of 2

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2022 Ohio Schedule IT BUS
Business Income

Primary taxpayer’s SSN

22260202
Sequence No. 6

Part 4 – Business Sources
List all sources of business income, with Ohio sources listed first. Also separately list your ownership percentage and/or your spouse’s ownership percentage (if filing jointly). If necessary, complete additional copies of this page and include with your return.

Business name

	2. FEIN / SSN

	

Business name

	3. FEIN / SSN

	

Business name

	4. FEIN / SSN

	

Business name

	5. FEIN / SSN

Business name

	 6. FEIN / SSN

	

Business name

	7. FEIN / SSN

	

Primary ownership

.

Spouse’s ownership

%

.

%

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	1. FEIN / SSN

Business name

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	8. FEIN / SSN

Business name

Primary ownership

.

Spouse’s ownership

%

Primary ownership

.

%

%

%

%

%

.

%

.

%

Spouse’s ownership

%

Primary ownership

.

.

Spouse’s ownership

Primary ownership

.

%

Spouse’s ownership

Primary ownership

.

.

Spouse’s ownership

Primary ownership

.

%

Spouse’s ownership

Primary ownership

.

.

.

%

Spouse’s ownership

%

.

%

2022 Schedule IT BUS – page 2 of 2

hio

Department of
Taxation

2022 Ohio Schedule of Credits
Use only black ink. Use whole dollars only.
Primary taxpayer’s SSN

22280102

Sequence No. 7

Many of these credits must be calculated using a worksheet and/or be supported by additional required documentation. See the instructions for
worksheets and information on supporting documentation.

		

Nonrefundable Credits

1.	 Tax liability before credits (from Ohio IT 1040, line 8c)............................................................................................. 1.

	

2.	 Retirement income credit (include 1099-R forms).................................................................................................. 2.

	

3.	 Lump sum retirement credit (include a copy of the worksheet and 1099-R forms)........................................... 3.

	

4.	 Senior citizen credit (must be 65 or older to claim this credit)................................................................................ 4.

	

5.	 Lump sum distribution credit (include a copy of the worksheet and 1099-R forms).......................................... 5.

	

6.	 Child care & dependent care credit (include a copy of the worksheet)............................................................... 6.

	

7. 	Displaced worker training credit (include a copy of the worksheet and all required documentation)................. 7.

	

8.	 Campaign contribution credit for Ohio statewide office or General Assembly........................................................ 8.

	

9.	 Income-based exemption credit.............................................................................................................................. 9.

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	 10.	 Total (add lines 2 through 9)................................................................................................................................. 10.

	 11.	 Tax less credits (line 1 minus line 10; if negative, enter zero)............................................................................... 11.
	
	 12.	 Joint filing credit (see instructions for table).               % times line 11, up to $650............................................................... 12.
	 13.	 Earned income credit............................................................................................................................................ 13.
	 14.	 Home school expenses credit (include copies of all required documentation)............................................... 14.
	 15.	 Scholarship donation credit (include copies of all required documentation)................................................... 15.
	 16.	 Nonchartered, nonpublic school tuition credit (include copies of all required documentation)....................... 16.
	 17.	 Vocational job credit (include a copy of the credit certificate).......................................................................... 17.
	 18.	 Ohio adoption credit.............................................................................................................................................. 18.
	 19.	 Nonrefundable job retention credit (include a copy of the credit certificate).................................................... 19.
	 20.	 Credit for eligible new employees in an enterprise zone (include a copy of the credit certificate).................. 20.
   21. Grape production credit......................................................................................................................................... 21.

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	 22.	 InvestOhio credit (include a copy of the credit certificate)............................................................................... 22.

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	 23.	 Lead abatement credit (include a copy of the credit certificate)...................................................................... 23.
	 24.	 Opportunity zone investment credit (include a copy of the credit certificate).................................................. 24.

Do not write in this area; for department use only.
	

2022 Schedule of Credits – page 1 of 2

2022 Ohio Schedule of Credits
Primary taxpayer’s SSN

22280202
Sequence No. 8

	 25.	 Technology investment credit carryforward (include a copy of the credit certificate)....................................... 25.
	 26.	 Enterprise zone day care & training credits (include a copy of the credit certificate)...................................... 26.
	 27. Research & development credit (include a copy of the credit certificate)........................................................ 27.

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	 28.	 Nonrefundable Ohio historic preservation credit (include a copy of the credit certificate)............................... 28.
	 29.	 Total (add lines 12 through 28)............................................................................................................................. 29.
	 30. Tax less additional credits (line 11 minus line 29; if negative, enter zero)............................................................ 30.
Nonresident Credit

Dates of Ohio residency 	

to 	

Other state of residency

	31.	Nonresident Portion of Ohio adjusted gross income 		 Ohio IT NRC Section I, line 18 (include a copy).............. 31.
	
	 32.	 Ohio adjusted gross income (Ohio IT 1040, line 3)............ 32.

	33a.	 Divide line 31 by line 32 (four decimals; do not round;
if greater than 1, enter 1.0000)...................................................................................33a.

.

	 33. Nonresident credit (line 30 times line 33a)........................................................................................................... 33.
Resident Credit
	
	
	 34.	 Resident credit – Ohio IT RC, line 7 (include a copy)......................................................................................... 34.
	35.	Total nonrefundable credits (add lines 10, 29, 33 and 34; enter here and on Ohio IT 1040, line 9)................. 35.

Refundable Credits

	 36.	 Refundable Ohio historic preservation credit (include a copy of the credit certificate).................................... 36.
	

	 37.	 Refundable job creation credit & job retention credit (include a copy of the credit certificate)................................. 37.
	 38.	 Pass-through entity credit (include a copy of the Ohio IT K-1s)........................................................................ 38.
	 39.	 Motion picture & Broadway theatrical production credit (include a copy of the credit certificate).................... 39.
	
	 40.	 Venture capital credit (include a copy of the credit certificate)........................................................................ 40.

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	41.	Total refundable credits (add lines 36 through 40; enter here and on Ohio IT 1040, line 16)............................ 41.

2022 Schedule of Credits – page 2 of 2

2022 Ohio Schedule
of Dependents

22230102

Use only black ink/UPPERCASE letters.
Primary taxpayer's SSN

Sequence No. 9
Do not list the primary filer and/or spouse (if filing jointly) as dependents on this schedule. Use this schedule to claim dependents. If you have more
than 15 dependents, complete additional copies of this schedule and include them with your income tax return. Abbreviate the “Dependent’s relationship to
you” if necessary.
	1. Dependent’s SSN

Dependent's date of birth (MM-DD-YYYY)

-

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-

Dependent’s relationship to you

Dependent’s first name

	2. Dependent’s SSN

M.I. Dependent's last name

Dependent's date of birth (MM-DD-YYYY)

-

Dependent’s first name

	3. Dependent’s SSN

Dependent's date of birth (MM-DD-YYYY)

Dependent’s first name

-

Dependent's date of birth (MM-DD-YYYY)

Dependent’s first name

Dependent’s relationship to you

-

M.I. Dependent's last name

Dependent's date of birth (MM-DD-YYYY)

-

Dependent’s first name

Dependent’s relationship to you

-

M.I. Dependent's last name

Dependent's date of birth (MM-DD-YYYY)

-

Dependent’s relationship to you

-

M.I. Dependent's last name

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Dependent’s first name

Dependent’s relationship to you

M.I. Dependent's last name

-

	7. Dependent’s SSN

-

Dependent's date of birth (MM-DD-YYYY)

Dependent’s first name

	6. Dependent’s SSN

Dependent’s relationship to you

M.I. Dependent's last name

-

	5. Dependent’s SSN

-

M.I. Dependent's last name

-

	4. Dependent’s SSN

Dependent’s relationship to you

Do not write in this area; for department use only.

2022 Schedule of Dependents – page 1 of 2

2022 Ohio Schedule
of Dependents

22230202

Primary taxpayer's SSN
Sequence No. 10
	8. Dependent’s SSN

Dependent's date of birth (MM-DD-YYYY)

-

M.I. Dependent's last name

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Dependent’s first name

Dependent’s relationship to you

	9. Dependent’s SSN

Dependent's date of birth (MM-DD-YYYY)

-

Dependent’s first name

	10. Dependent’s SSN

Dependent's date of birth (MM-DD-YYYY)

Dependent’s first name

-

Dependent's date of birth (MM-DD-YYYY)

Dependent’s first name

Dependent’s relationship to you

-

M.I. Dependent's last name

Dependent's date of birth (MM-DD-YYYY)

-

Dependent’s first name

Dependent’s relationship to you

-

M.I. Dependent's last name

Dependent's date of birth (MM-DD-YYYY)

-

Dependent’s relationship to you

-

M.I. Dependent's last name

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Dependent’s relationship to you

M.I. Dependent's last name

-

Dependent’s first name

-

Dependent's date of birth (MM-DD-YYYY)

Dependent’s first name

15. Dependent’s SSN

Dependent’s relationship to you

M.I. Dependent's last name

-

	14. Dependent’s SSN

-

Dependent's date of birth (MM-DD-YYYY)

Dependent’s first name

	13. Dependent’s SSN

Dependent’s relationship to you

M.I. Dependent's last name

-

	12. Dependent’s SSN

-

M.I. Dependent's last name

-

	11. Dependent’s SSN

Dependent’s relationship to you

2022 Schedule of Dependents – page 2 of 2

2022 Schedule of Ohio
Withholding

Use only black ink/UPPERCASE letters. Use whole dollars only.
Primary taxpayer’s SSN

22350102
Sequence No. 11

List your and your spouse’s (if filing jointly) W-2, 1099, and W-2G forms only if they have Ohio withholding. Enter “P” in the “P/S” box if the form is the
primary taxpayer’s and enter “S” if it is the spouse’s. If the Ohio ID number on a statement has 9 digits, enter only the first 8 digits. Complete additional
copies if necessary. Place state copies of your income statements after the last page of your return.

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Part A - Total Withholding
1. Total of all Ohio state tax withheld on pages 1 and 2 as well as any additional pages. Enter here
	 and on line 14 of your Ohio IT 1040...............................................................................................................1.
Part B - W-2s

Box b - EIN

Box 1 - Wages, tips, other compensation

Box 15 - Employer’s Ohio ID number

Box 16 - Ohio wages, tips, etc.

	2. P/S

Box b - EIN

Box 1 - Wages, tips, other compensation

	

Box 15 - Employer’s Ohio ID number

Box 16 - Ohio wages, tips, etc.

	3. P/S

Box b - EIN

Box 1 - Wages, tips, other compensation

	

Box 15 - Employer’s Ohio ID number

Box 16 - Ohio wages, tips, etc.

	4. P/S

Box b - EIN

Box 1 - Wages, tips, other compensation

	

Box 15 - Employer’s Ohio ID number

Box 16 - Ohio wages, tips, etc.

Box b - EIN

Box 1 - Wages, tips, other compensation

Box 15 - Employer’s Ohio ID number

Box 16 - Ohio wages, tips, etc.

	 6. P/S

Box b - EIN

Box 1 - Wages, tips, other compensation

	

Box 15 - Employer’s Ohio ID number

Box 16 - Ohio wages, tips, etc.

Box b - EIN

Box 1 - Wages, tips, other compensation

	1. P/S

	5. P/S

Box 15 - Employer’s Ohio ID number

Box 16 - Ohio wages, tips, etc.

Box 17 - Ohio income tax

Box 2 - Federal income tax withheld

Box 17 - Ohio income tax

Box 2 - Federal income tax withheld

Box 17 - Ohio income tax

Box 2 - Federal income tax withheld

Box 17 - Ohio income tax

Box 2 - Federal income tax withheld

Box 17 - Ohio income tax

Box 2 - Federal income tax withheld

Box 17 - Ohio income tax

Box 2 - Federal income tax withheld

Box 17 - Ohio income tax

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	7. P/S

Box 2 - Federal income tax withheld

	

2022 Schedule of Withholding – page 1 of 2

2022 Schedule of Ohio
Withholding

Primary taxpayer’s SSN
Part C - 1099-Rs
	1. P/S Payer’s TIN

22350202
Sequence No. 12

Box 1 - Gross distribution

Box 4 - Federal income tax withheld

	2. P/S

Payer’s TIN

Box 1 - Gross distribution

	

Box 15 - Payer’s Ohio number

Box 4 - Federal income tax withheld

	3. P/S

Payer’s TIN

Box 1 - Gross distribution

	

Box 15 - Payer’s Ohio number

Box 4 - Federal income tax withheld

	4. P/S

Payer’s TIN

Box 1 - Gross distribution

	

Box 15 - Payer’s Ohio number

Box 4 - Federal income tax withheld

Box 7 Distribution code
Box 14 - Ohio tax withheld

FO
N R
O
T TA
FI X
LE Y
E
U A
N R
TI 2
L 02
JA 2
N O
U N
AR LY
Y
20
23

Box 15 - Payer’s Ohio number

Total
distribution

Total
distribution

Box 7 Distribution code

Box 14 - Ohio tax withheld

Total
distribution

Box 7 Distribution code

Box 14 - Ohio tax withheld

Total
distribution

Box 7 Distribution code

Box 14 - Ohio tax withheld

Part D - W-2Gs

Payer’s federal ID number

Box 1 - Reportable winnings

Box 13 - Ohio state ID number

Box 14 - Ohio state winnings

	 2. P/S

Payer’s federal ID number

Box 1 - Reportable winnings

	

Box 13 - Ohio state ID number

Box 14 - Ohio state winnings

	3. P/S

Payer’s federal ID number

Box 1 - Reportable winnings

	

Box 13 - Ohio state ID number

Box 14 - Ohio state winnings

	1. P/S

	 Part E - 1099-NECs
1. P/S Payer’s TIN

D

O

Box 6 - Payer’s Ohio number

2. P/S

Box 1 - Nonemployee compensation

Box 7 - State income

Payer’s TIN

Box 1 - Nonemployee compensation

Box 6 - Payer’s Ohio number

Box 7 - State income

Box 4 - Federal income tax withheld

Box 15 - Ohio income tax withheld

Box 4 - Federal income tax withheld

Box 15 - Ohio income tax withheld

Box 4 - Federal income tax withheld

Box 15 - Ohio income tax withheld

Box 4 - Federal income tax withheld

Box 5 - Ohio tax withheld

Box 4 - Federal income tax withheld

Box 5 - Ohio tax withheld

2022 Schedule of Withholding – page 2 of 2

O

D

FO
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O
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FI X
LE Y
E
U A
N R
TI 2
L 02
JA 2
N O
U N
AR LY
Y
20
23
10211411



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2022 Ohio IT 40P
Include the voucher below with your payment for your ORIGINAL 2022 Ohio income tax return.

Important

FO
N R
O
T TA
FI X
LE Y
E
U A
N R
TI 2
L 02
JA 2
N O
U N
AR LY
Y
20
23

•	 Make payment payable to: Ohio Treasurer of State
•	 Include the tax year and the last four digits of your SSN on the “Memo” line of your
payment.
•	 Do not send cash.
•	 Do not use this voucher to make a payment for an amended return. Use Ohio IT 40XP.
•	 Do not use this voucher to make a payment for a school district income tax return.
Use Ohio SD 40P for an original school district income tax return. Use Ohio SD 40XP
for an amended school district income tax return.

Electronic Payment Options

You can make your payment electronically even if you file by paper. To pay by electronic
check, credit card, or debit card, visit tax.ohio.gov/pay OR scan with your phone.

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
information. We need your Social Security number in order to administer this tax.

ORIGINAL PAYMENT



Cut on the dotted lines. Use only black ink.

OHIO IT 40P

Tax Year

2022

Original Income Tax Payment Voucher
First name	

Use UPPERCASE letters
to print the first three letters of

Last name



M.I. 	

Last name



Spouse’s first name (only if joint filing)	

M.I.	

•	 Do NOT send cash
•	 Do NOT fold, staple,
	 or paper clip

Taxpayer’s
last name

Spouse’s last name
(only if joint filing)

O

Address

D

City, State, ZIP code

Make payment payable to: Ohio Treasurer of State
Sending with return - Mail to: Ohio Department of Taxation,
P.O. Box 2057, Columbus, OH 43270-2057
Sending without return - Mail to: Ohio Department of Taxation,
P.O. Box 182131, Columbus, OH 43218-2131

402

Taxpayer’s SSN
Spouse’s SSN
(only if joint filing)

Amount of
Payment

$

,


,


.0

0