Form Dir-38 - City Income Tax Return For Individuals - 2016
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2016
Attach W-2’s to the back of this page
Account Number:
DIR-38
City of Dublin, Income Tax Division
City Income Tax Return For Individuals
Check the appropriate box if:
Primary Social Security Number
REFUND
(An amount must be placed in
First name and Middle Initial
Last Name
Line 6B for this return to be
considered a valid refund request)
Spouse's Social Security Number
AMENDED
tax year
If a joint return, spouse's first name and initial
Last Name
□
□
Did you change residence
Yes
No
Filing Status:
during 2016?
Home Address (number and street)
Single
If YES, enter date of move __________
□
□
Should your account be inactivated?
Yes
No
Married-Filing Jointly
If YES, explain ________________________
Married-Filing Separately
□
□
City
Did you file a City return in 2015?
Yes
No
Zip Code
State
Attach all forms and applicable Federal schedules and/or documentation to the back of this return.
Occupation or nature of business
Employer(s) and address where work performed
TAXABLE WAGES
Part A
(+)
Trade Name
(+)
City of Employment #1
ADJUSTMENTS
City of Employment #2
(-)
City of Employment #3
(=)
NET WAGES (enter in Column B below)
City of Residence
TAX CALCULATION
Part B
A Declaration of Estimated City Tax (form DID-1) is REQUIRED for all individuals whose tax is not fully withheld.
TAX
Column B
Column C
Column D
Column E
Column F
Column G
Column A
RATE
LESS TAX WITHHELD (W-2)
CITY
INCOME FROM WAGES,
INCOME FROM NET
TOTAL NET
TAX DUE
NET TAX DUE
PAID BY A PARTNERSHIP OR
SALARIES, COMMISSIONS, ETC.
PROFITS, RENTS AND
TAXABLE INCOME
PAID DIRECTLY TO CITY WHERE
(SEE NET WAGES)
INCOME WAS EARNED
OTHER TAXABLE INCOME
DUBLIN (UFR)
2.0%
UFR = Universal Filing Requirement - residents must file a return.
1
1. TOTAL NET TAX DUE (TOTAL OF COLUMN G)
..................................................................................................................................................
2
2a
2. LESS CREDITS FOR:
OVERPAYMENT FROM PRIOR YEAR RETURN ONLY .......
ESTIMATED TAX PAYMENTS ...….
2b
3
3. BALANCE DUE (LINE 1 LESS LINE 2).
If Line 2 is greater than Line 1, enter amount (in brackets) here and carry to Line 6.
........................................
4. PENALTY: 15% $
+ INTEREST 5% $
+ LATE CHARGE $
......................................
4
(see instructions)
(see instructions)
(see instructions)
5. TOTAL AMOUNT DUE (ADD LINES 3 AND 4). NOTE: NO PAYMENT IS DUE IF AMOUNT IS $10.00 or less ……...............................................
5
6
6. OVERPAYMENT CLAIMED (IF LINE 2 EXCEEDS LINE 1) .............................................................................................
6A
A. Enter the amount from Line 6 you want
CREDITED
to your next year tax estimate ....................
6B
B. Enter the amount from Line 6 you want
REFUNDED (must be greater than $10.00)
(COMPLETE
Part C
INCOME FROM SOURCES OTHER THAN WAGES, SALARIES, COMMISSIONS, ETC.
REVERSE SIDE OF
FORM FIRST)
Column H
Column J
Column I
Column K
CITY
INCOME (OR LOSS) FROM
OTHER INCOME FROM
TOTAL OTHER INCOME
INSERT APPLICABLE CITIES
RENTAL INCOME (OR LOSS) FROM
BELOW
PART E OR SCHEDULE Y
(OR LOSS)
PART F (SECTION 1)
PART F (SECTION 2)
Do you want to allow another person to discuss this matter with the City of Dublin?
(see instructions)
Yes
NO
Complete the following
Third
(
)
Party
Print/Designee’s
Phone
►
No.
SSN
Designee
Name
The undersigned declares that this return (and accompanying schedules) is a true, correct and complete return for the
Signature
MAILING INFORMATION
taxable period stated, and that the figures used are the same as used for federal income tax purposes and
understands that this information may be released to the tax administration of the city of residence and the I.R.S.
Sign
Your
No Payment Enclosed/Refund Request:
►
Date
Here
Signature
Mail to: City of Dublin Tax Division
Spouse’s
PO Box 800
If a joint return
Dublin, Ohio 43017
Signature ►
Both must sign
Date
Paid
Payment Enclosed:
Make payable to: City of Dublin
Preparer’s
Signature
Date
PTIN
Mail to: City of Dublin Tax Division
►
Phone No. (
)
Use Only
PO Box 9062
Dublin, Ohio 43016-0962
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