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Form IT DA Fillable Affidavit for Non-Ohio Residency/Domicile for Taxable Year 2013
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)
For the current taxable year (2013) you have no intent to (: 2) Unchecked (: Yes) Unchecked (if within the U S ) and country (if not within the U S ) where I was domiciled (Reset Form) Reset Form (text) (text) (text) (text) (text) *Ohio Revised Code section 5747 24(A)(1) states that an individual has one contact period in this state if the individual is away overnight from his/her 1 I was not domiciled in Ohio at any time during taxable year 2013 I was domiciled in 182847 Columbus OH 43218 2847 The postmark date 2 I had at least one abode (place where I lived) outside of Ohio for the entire taxable year Name of city (or cities) state(s) 3 I had no more than 182 contact periods* in Ohio during the taxable year 45 days the due date for any report As such you must file 5747 08 authorize us to request this information We need your Social Security number in order to administer this tax a nonresident/nondomiciliary abode in Florida abode located outside this state and while away overnight from that abode spends at least some portion however minimal of each of two consecutive About This Affidavit? affidavit and for the notice affidavit and Ohio form IT 10 Please do not mail the affidavit Affidavit of Non Ohio Residency/Domicile for Taxable Year 2013 An individual has one contact period in this state if the and Jan 3) in Ohio and was away overnight (from sometime and notice together since there is a different address for the any income in Ohio you may want to consider filing both this are presumed to be a full year domiciliary Attn: Correspondence and Line Item Review P O Box Because we require you to provide us with a Social Security number the Federal Privacy Act of 1974 requires us to inform By filing Ohio form IT 10 you are indicating that you have no cause to question your nonfiling City state ZIP code click on Contact and electronically send us your question(s) Code Section 5747 24? correct and complete Current mailing address County days in this state Do I Need To File This Affidavit if I Have Not Earned or Due date: May 31 2014 See Ohio Revised Code section 5747 24 During the previous taxable year (2012) you filed an Ohio entire year (the law does not defi ne abode ) Even if you have no income that you earned or received in Federal Privacy Act Notice file an Ohio income tax return and you have (i) an abode Filing this affi davit does not exempt you from timely filing your Ohio income tax return for 2013 and paying any tax due First name flies from Toledo back to the individual s abode in Florida Florida has an abode in Florida for the entire year On Jan 2 following criteria: following the last day of the taxable year However R C For example: An individual who claims to be domiciled in For faster service you can visit our Web site at tax ohio gov for filing the year 2013 affidavit for the current taxable year (2013) you are claiming to be if all of the following circumstances are present: If I Timely File Ohio Form ITDA Do I Also Have To File If you meet either of the criteria set forth above but you do in Ohio (ii) a contact period in Ohio and/or (iii) nexus with income tax return as a resident or part year resident and individual does not have to spend the night in Ohio individual is away overnight from the individual s abode individual spent some portion of two consecutive days (Jan 2 IT DA IT DA Instructions Later on Jan 2 the individual drives to Michigan and spends located outside the state and while away overnight from M I Last name Social Security no M I Last name Spouse s Social Security no (only if joint affidavit) Mail to: Ohio Department of Taxation Attn: Correspondence and Line Item Review Michigan back to Ohio Late in the day on Jan 3 the individual must be no later than May 31 2014 Please do not attach must file this affidavit by the 15th day of the fourth month Name of city (or cities) state(s) (if within the U S ) and country (if not within the U S ) where I was domiciled no authority to extend beyond May 31 2014 the due date not file this affidavit by May 31 2014 under Ohio law you of each of two consecutive days in this state Note that the of the taxable year the individual flies from Florida to Toledo Ohio and Ohio Form IT 10 Information Notice of No Tax Due? Ohio income tax liability If you have not earned or received Ohio to the extent that the tax commissioner would have Ohio you must timely file this affidavit by May 31 2014 if on Jan 2 until sometime on Jan 3) from the individual s or you can call 1 800 282 1780 P O Box 182847 Columbus OH 43218 2847 Please do not attach to or enclose with your Ohio income tax return Please mail this affidavit to the Ohio Department of Taxation presumption of full year non Ohio residency the taxpayer Questions? Call us toll free at 1 800 282 1780 R C section 5747 24 requires that in order to preserve the Received Any Income in Ohio? residency Rev 11/13 section 5703 35 allows the tax commissioner to extend for shall shall not be filing a year 2013 Ohio individual income tax return Signature Date Spouse s fi rst name (only if joint affidavit) Spouse s signature (only if joint affidavit) Date tax return Taxation this affidavit and the affidavit is not false that abode spends at least some portion however minimal The individual has at least one abode outside Ohio for the The individual has no more than 182 contact periods in The individual has one contact period in Ohio because the The individual timely submits to the Ohio Department of the night in Michigan On Jan 3 the individual drives from The postmark date must be no later than May 31 2014 this affidavit to or enclose with your Ohio individual income This form is for use only by individuals who are claiming This portion of Ohio law provides for a bright line test under this tax return by May 31 2014 The tax commissioner has to be full year nonresidents for Ohio income tax purposes Under penalties of perjury I declare all of the following to be true: Under penalties of perjury I declare that to the best of my knowledge and belief the statements on this affidavit are true What Is a Contact Period in Ohio? What Is the Bright Line Test Under Ohio Revised What Is the Due Date for Filing This Affidavit? Where Do I Mail This Affidavit? which an individual is presumed to be a full year nonresident Who must file: Please see instructions Who Should File This Affidavit? Whom Do I Contact if I Have Additional Questions Why Should I File This Affidavit? You must file this yearly affidavit if you meet either of the you that providing us with your Social Security number is mandatory Ohio Revised Code sections 5703 05 5703 057 and you want to preserve the presumption of full year non Ohio