Form Br - Business - City Of Middletown - 2016
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1
2BUSINESS
ACCOUNT
Form BR
File With
CITY OF MIDDLETOWN
2016 - CITY OF MIDDLETOWN - 2016
INCOME TAX DIVISION
TAXABLE PERIOD BEGINNING ____________________ AND ENDING _________________
P.O. BOX 428739
FEDERAL ID
CALENDAR YEAR TAXPAYERS FILE ON OR BEFORE APRIL 18, 2017
MIDDLETOWN, OHIO 45042
TH
TH
FISCAL YEAR DUE ON 15
DAY OF THE 4
MONTH AFTER YEAR END
(513) 425-7862
EXTENSION REQUESTS MUST BE ATTACHED TO YOUR RETURN.
TAXPAYERS NAME AND ADDRESS (MAKE ADDRESS CORRECTIONS)
CONSOLIDATED RETURN
AMENDED RETURN
SHOULD YOUR ACCOUNT BE INACTIVATED?
YES
NO
IF YES, PLEASE EXPLAIN: __________________________________________
FILING STATUS (CHECK ONE)
CORPORATION
S-CORPORATION
PARTNERSHIP
LLC
FIDUCIARY (TRUSTS AND ESTATES)
BUSINESS TELEPHONE:
__________________________________________
EMAIL: ___________________________________________________________
OFFICE USE ONLY
1. Adjusted Federal Taxable Income (attach copy of Federal return) . . . . . . . . . . . . . . . . .
1 $ ______________
1 ______________
2. Adjustments (from Line N, Schedule X)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 $ ______________
2 ______________
3. Taxable income before apportionment (Line 1 plus/minus Line 2) . . . . . . . . . . . . . . . .
3 $ ______________
3 ______________
4. Apportionment percentage _________% (from Line 5, Schedule Y)
4 ______________
5. Middletown taxable income (Line 3 multiplied by Line 4) . . . . . . . . . . . . . . . . . . . . . . .
5 $ ______________
5 ______________
6. Net loss carryforward (limited to 5 years)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 $ ______________
6 ______________
7. Income subject to Middletown income tax (Line 5 minus Line 6) . . . . . . . . . . . . . . . . . .
7 $ ______________
7 ______________
8. Middletown tax is 1.75% (.0175) of Line 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 $ ______________
8 ______________
9. Tax credits:
9A ______________
A. Estimated Payments
. . . . . . . . . . . . . . . . . . . . . . . . . . . . 9A $ ______________
9B ______________
B. Prior Year Overpayments
. . . . . . . . . . . . . . . . . . . . . . . . 9B $ ______________
C. Total tax credits (Lines 9A and 9B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9C $ ______________
9C ______________
10. Balance Due (if Line 8 is greater than Line 9C) Line 8 minus Line 9C . . . . . . . . . . . . . . .10 $ ______________
10 ______________
NO TAX DUE OR REFUNDED IF LESS THAN $10.01
11. Overpayment (if Line 8 is less than Line 9C) Line 9C minus Line 8. . . . . . . . . . . . . . . . 11 $ ______________
11 ______________
A. REFUND amount
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11A $ ______________
11A ______________
B. CREDIT amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11B $ ______________
11B ______________
DECLARATION OF ESTIMATED TAX FOR 2016
2017
12. Total estimated income subject to tax (to avoid penalty, no less than Line 7) . . . . . . . . . 12 $ ______________
12 ______________
13. Estimated tax due (multiply Line 12 by 1.75% [.0175] )
13 $ ______________
13 ______________
If less than $200, estimated payments are not required
14. First quarter tax due before credits (at least 25% of Line 13) . . . . . . . . . . . . . . . . . . .
14 $ ______________
14 ______________
.
15. Prior year tax credit from Line 11B above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 $ ______________
15 ______________
16. Net estimated first quarter tax due with this return (Line 14 minus Line 15.)
(If negative, enter zero)*. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 $ ______________
16 ______________
17. TOTAL TAX DUE (Lines 10 and 16) Make check payable to Middletown Income Tax Division 17 $ ______________
17 ______________
*First quarter estimated tax payment should be paid with this return. Subsequent estimated payments
th
th
th
th
are due by the 15
day of the 6
, 9
and 12
months after the beginning of the taxable year.
The undersigned declares that this return (and accompanying schedule) is a true, correct and complete return
FOR OFFICE USE ONLY - PENALTY & INTEREST
of the taxable period stated and that the figures used herein are the same as used for Federal Tax purposes.
FAILURE TO PAY ESTIMATE BY DEC 15
FAILURE TO PAY ESTIMATE BY JAN 31
$ ___________________
Signature of Taxpayer or Agent ______________________________________________________________
FAILURE TO PAY TAX DUE BY APRIL 18
FAILURE TO PAY TAX DUE BY APRIL 15
___________________
Title ____________________________________________________ Date __________________________
________________________________________________________________________________________
FAILURE TO FILE BY APRIL 18
FAILURE TO FILE BY APRIL 15
___________________
Name & address of person or firm preparing this return
TOTAL PENALTY & INTEREST ___________________
Telephone number of the preparer _______________________________________________________________________________
May we discuss this return with the taxpreparer?
Yes No
GRAND TOTAL
$ ___________________
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