1. Total equity capital.................................................................................................................................2. Apportionment factor

a. Total Ohio gross receipts .................................... ÷b. Total gross receipts ............................................ =

3. Total Ohio equity capital (line 1 x line 2c) ..............................................................................................4. Total tax liability (line 3 times the tax rate from computation, but not less than the minimum tax) ........5. Total nonrefundable credits (from schedule A, line 5) ...........................................................................6. Tax due after nonrefundable credits (line 4 minus line 5, but not less than the minimum tax) ..............7. Estimated payments made in tax year 2019 .........................................................................................8. Total refundable credits (from schedule B, line 5) .................................................................................9. Tax due (line 6 minus lines 7 and 8)......................................................................................................

10. Interest Penalty Total interest and penalty 11. Balance due (line 9 plus line 10) ........................................................................................................... 12. Refund (overpayment) .......................................................................................................................... Schedule A (Nonrefundable Credits)1. Job retention tax credit ..........................................................................................................................2. New markets tax credit..........................................................................................................................3.Creditforqualifiedresearchexpenses..................................................................................................4. Ohio historic preservation credit............................................................................................................5. Total nonrefundable credits (enter total here and on line 5 above) .......................................................

Schedule B (Refundable Credits) 1. Ohio historic preservation credit ......................................................................................................................2. Job retention or job creation credit ........................................................................................................3. Losses on loans made under the Ohio venture capital program........................................................... 4. Motion picture production credit ............................................................................................................5. Total refundable credits (enter total here and on line 8 above) .............................................................

2019 Financial Institutions Tax ReportBased upon calendar year 2018

FIT 10Rev. 1/19

Whole numbers only

00

00000000000000000000

1.

2c.

3.4.5.6.7.8.9.

10.11.12.

1.2.3.4.5.

1.2.3.4.5.

(carry to six decimals).

Company name

Address (if address change, check box)

City, state, ZIP code

Federal employer I.D. number

FIT account number

Ohio charter or license number

Ifthisisanamendedreport,checkthebox(iftheamendedreportreflectsarefund,attachformFITREF)

NorthAmericanIndustryClassificationSystem(NAICSCode)

00

0000

0000

I declare under penalties of perjury that this report, including any accompanying schedules and statements, has been examined by me and to the best of my knowledge and belief is a true, correct and complete return and report.

Signatureofofficerormanagingagent Title

Preparer’s name (please print) Date

Contact person for tax records (please print) Title

E-mail address Phone number

Mail to: Ohio Dept. of Taxation, P.O. Box 2476, Columbus, OH 43216-2476

Processing Code

Check Amount

Date Received

00

0000

0000

DO NOT FILE

THIS FORM.

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nic fil

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ts.