Ohio I-File

Report Year 2009

Income Tax IT-1040 Tax Return

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Filing Information
Primary Social Security Number: 288-72-9347
Primary First Name: JEANENE
Primary Last Name: MILLS
Address: 1000 Kings Highland Dr S Apt 207, Columbus, OH 43229
Primary Resident Status: Resident
Filing Status: Single or Head of Household
Date Filed: 01/26/2010
Confirmation Number: 1002611200
IT 1040 Filing Information
001 Federal Adjusted Gross Income $31,643.00
002 Ohio Schedule A Adjustments $0.00
003 Ohio Adjusted Gross Income $31,643.00
004 Exemption Deduction $3,100.00
005 Ohio Taxable Income $28,543.00
006 Ohio Income Tax Before Credits $687.00
007 Credits from Schedule B $0.00
008 Ohio Tax Less Schedule B Credits $687.00
009 Exemption Credit $40.00
010 Ohio Tax Less Exemption Credit $647.00
011 Amount from line 10 $647.00
012 Joint Filing Credit $0.00
013 Ohio Tax Less Joint Filing Credit $647.00
014 Summary of Schedule C, D and E Credits $0.00
015 Manufacturing Equipment Grant $0.00
016 Ohio Income Tax $647.00
017 Ohio Use Tax Amount $0.00
018 Total Ohio Tax $647.00
019 Ohio Tax Withheld $1,756.00
020A Ohio IT 1040ES Estimated Payments $0.00
020B Ohio IT 40P Extension Payments $0.00
020C Amount of Last Year's Credit Carryover $0.00
020D Total Ohio Installment Payments $0.00
021A Refundable Business Jobs Credit $0.00
021B Refundable Pass-through Entity Credit $0.00
021C Historical Building Rehabilitation Credit $0.00
021D Motion Picture Investment Credit $0.00

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022 Total Payments $1,756.00
023 Amount Overpaid $1,109.00
024 Amount to be Credited to Next Year's Estimated Tax Liability $0.00
025A Military Donation $0.00
025B Scenic River Donation $0.00
025C Wildlife Donation $0.00
026 Refund Amount $1,109.00
027 Tax Before Interest $0.00
028 Interest Penalty on Underpayment of Estimated Tax $0.00
029 Interest and Penalty $0.00
030 Amount You Owe $0.00
Schedule A Additions
031 Non-Ohio Interest and Dividends $0.00
032 Pass-through Entity Addback and Adjustment $0.00
033A Federal Interest and Dividends $0.00
033B Reimbursement of College Tuition Expenses $0.00
033C Losses from Ohio Public Obligations $0.00
033D Withdrawals from Ohio Medical Savings Account $0.00
033E Reimbursements Previously Deducted $0.00
033F Non-education Expenditures $0.00
033G Adjustment for IRC Sections 168(K) and 179 Depreciation Expense $0.00
034 Total Schedule A Additions $0.00
Schedule A Deductions
035 Federal Interest and Dividends $0.00
036 Reciprocity, Military Nonresident, Civilian Nonresident Spouse Income $0.00
037 Military Pay for Ohio Residents $0.00
038 State and Local Overpayment $0.00
039 Disability and Survivorship Benefits $0.00
040 Social Security Benefits / Railroad Benefits $0.00
041 Contributions to College Savings Accounts $0.00
042 National Guard Credit $0.00
043 Total Health Care and Insurance Deduction $0.00
044 Funds in Medical Savings Accounts $0.00
045A Wage and Salary Expense $0.00
045B Interest from Ohio Public Obligations $0.00
045C Reimbursements from Federal Itemized Deductions $0.00
045D Repayment of Income $0.00
045E Qualified Organ Donor Expenses & Individual Development Account $0.00
045F Adjustment for IRC sections 168(K) and 179 Depreciation Expense $0.00
045G Military Retirement Income $0.00
046 Total Schedule A Deductions $0.00
047 Net Adjustments (Additions - Deductions) $0.00
Schedule A Deductions - Insurance & Medical Cost Worksheet
047A Unreimbursed Health Care Exp. & Unreimbursed Long-term Care Ins. Exp $0.00
047B Unremibursed Long-term Care & Health Insurance Expenses $0.00

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047C Line 1 - Line 2 (not less than zero) $0.00
047D 7.5% of Federal Adjusted Gross Income Amount $2,373.00
047E Line 3 minus Line 4 (not less than zero) $0.00
047F Total Health Care and Insurance Deduction $0.00
Schedule A Deductions - Medical Savings Account Worksheet
047G Medical Savings Account Primary Contributions $0.00
047H Medical Savings Account Spouse Contributions $0.00
047I Medical Savings Account Earnings $0.00
047J Medical Savings Account Subtotal $0.00
047K Medical Savings Account Withdrawals $0.00
047L Funds in Medical Savings Accounts $0.00
047M Withdrawals from Ohio Medical Savings Account $0.00
047N Lump Sum Distributions $0.00
047O Miscellaneous Federal Tax Adjustments $0.00
Schedule B Credits
048 Retirement Income Credit $0.00
049 Senior Citizen Credit $0.00
050 Lump Sum Distribution Credit (not available on I-file) $0.00
051 Child and Dependent Care Credit $0.00
052 Lump Sum Retirement Credit (not available on I-file) $0.00
053 Credit if Ohio taxable income is $10,000 or less $0.00
054 Displaced Worker Training Credit $0.00
055 Ohio Political Contributions Credit $0.00
056 Ohio Adoption Credit Amount $0.00
057 Total Credits $0.00
Schedule B Credits - Retirement Income Credit Worksheet
057A Ohio Adjusted Gross Income $31,643.00
057B Retirement Income Amount $0.00
057C Retirement Income Credit $0.00
Schedule B Credits - Child and Dependent Care Credit Worksheet
057D Ohio Adjusted Gross Income $31,643.00
057E Federal Child and Dependent Care Credit $0.00
057F Eligible Percentage based on Ohio Adjusted Gross 0.0%
057G Child and Dependent Care Credit $0.00
Schedule B Credits - Displaced Worker Training Credit Worksheet
057H Amount of Displaced Worker Training Credit for Primary $0.00
057I Half of Displaced Worker Training Expenses $0.00
057J Lesser of $500 or half of Displaced Worker Training Expenses $0.00
057K Amount of Displaced Worker Training Credit Claimed Last Year $0.00
057L Amount of Displaced Worker Training Credit for Primary SSN $0.00
057M Amount of Displaced Worker Training Expenses for Spouse $0.00
057N Half of Displaced Worker Training Expenses $0.00
057O Lesser of $500 or half of Displaced Worker Training Expenses $0.00
057P Amount of Displaced Worker Training Credit Claimed Last Year - Spouse $0.00
057Q Amount of Displaced Worker Training Credit for Spouse SSN $0.00

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057R Displaced Worker Training Credit $0.00
Schedule C - Ohio Resident Credit
058 Portion of Ohio Adjusted Gross subjected to tax by Other States $0.00
059 Ohio Adjusted Gross Income $31,643.00
060A Percentage of Income in Other States 0.0%
060B Schedule C Credit Before Limit $0.00
061 2009 Income Tax Less Other State Tax Payments $0.00
062 Ohio Resident Tax Credit Amount $0.00
Schedule D - Nonresident / Part-Year Resident Credit
063 Portion of Ohio Adjusted Gross not earned in Ohio $0.00
064 Ohio Adjusted Gross Income $31,643.00
065A Percentage of Income Outside Ohio 0.0%
065B Nonresident/Part-year Resident Credit $0.00
Schedule E - Non Refundable Business Credits
066 Schedule E Total Credit $0.00
067 Schedule C Total Credit $0.00
068 Schedule D Total Credit $0.00
069 Summary Credits Total $0.00
Schedule I - Billing Interest and Penalty Amounts
070 Previous Tax Year's Ohio Income Tax $0.00
071 Billing Interest $0.00
072 Billing Filing Penalty $0.00
073 Balance Due $0.00
W2 Summary

SSN FEIN Gross Wages Federal Withholding Ohio Withholding Ohio Withholding Acct

288729347 410760000 $31643.00 $2553.00 $1756.00 51330789

K1 Summary
PTE Withholding PTE Percent of
SSN FEIN PTE Business Name Amount Ownership
Other Income Summary

SSN Income Amount Income Source

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