Form R-I - City Of Dayton, Ohio Income Tax Return Form Individual Or Joint Filing 2006

FORM R-I CITY OF DAYTON, OHIO INCOME TAX RETURN

INDIVIDUAL OR JOINT FILING

TAX YEAR

2006

RETURN with PAYMENT DUE by APRIL 15

Is this Dayton Tax Return: ____Single _____Joint Filing

Taxpayer Name

ACCOUNT # OR SS #

Spouse Name

ACCOUNT # OR SS #

Your Address

Your phone #

City/State/Zip

Your Email address

Are you a Dayton resident? Yes_____ or No_____

Did you file a Dayton Return last year? Yes ___ or No ____

If so, please list Tax ID#_________________________

Did you file on a different Tax ID# last year?_________

Did You Move in during this tax year? Yes ___ No ___

Old address

Date in ________ or Out _________

City/State/Zip

If you moved more than once during the year, attach list to tax return showing addresses and dates

(For Office Use Only)*

Retired and Taxpayers with NO TAXABLE INCOME please check box and complete section D on reverse side of this form

*Date Received

All supporting W2s and Federal Schedules must be submitted .

Please Complete Work Sheet On Reverse Side Before Completing Section A

SECTION A

TOTAL TAXABLE INCOME

SECTION A

1

Wages, Salaries, Tips, and Other Employee Compensation

2

Other Taxable Income or Deductions from Reverse Side

3

Taxable Income (Add Lines 1 through 3)

4

Dayton Tax Due @ 2.25% of Line 3

5

Tax Credits:

Please Attach

Please Attach

A. Dayton Tax Withheld

Check and Wage

Check and Wage

B. Other City Tax Withheld

Statements (W-

Statements (W-

C. Estimated Taxes Paid/Prior Year Credit

2's) Here

2's) Here

D. Other Credits /Partnership Payments

D. Other Credits /Partnership Payments

6

Total Credits (Add Lines 5A through 5D)

Total Credits (Add Lines 5A through 5D)

7

Balance of Tax Due (Line 4 minus Line 6)

8

Penalty

and/or Interest

9

Amount Due:

Make Checks Payable to City of Dayton

10

If Overpayment: Credit to estimated taxes

Refund

SECTION B

DECLARATION OF ESTIMATED TAX FOR TAX YEAR 2007

SECTION B

11

Estimated Income Subject To Tax____________ @ 2.25%=

12

Estimated Tax Withheld By Your Employer(s)

13

Total Estimated Tax Due (Line 11 minus Line 12)

14

Credit From Prior Tax Year

15

Net Estimated Tax Due (Line 13 minus Line 14)

16

Estimated Tax Amount Due is 22.5% of Line 15 (First Payment)

17

TOTAL AMOUNT DUE (Line 9 plus Line 16) AMOUNT ENCLOSED

SECTION C

SECTION C

VISA AND MASTER CARD PAYMENTS

Account #___________________ Exp. Date______________

Amount Authorized $

3 Digit Credit Card Verification Code_______________(From back of card)

Required to Process

Card Holder Name (print) _____________________________ Signature _______________________Date __________

READ BEFORE SIGNING: The undersigned declare this return and attached schedules to be a true and complete return for the taxable year stated and that the figures used herein are the same as used for Federal Tax

purpose, adjusted to the requirements of the Dayton city tax ordinances represented by this return. I understand that if I am under withheld in the following tax year (by $100.00 or 10% of tax due) I will be charged Penalties

and Interest if I fail to make required estimated tax payments. If this return was prepared by a tax professional, may we contact them directly? [ ] Yes

[ ] No

Tax Preparer Signature

Taxpayer Signature

Date

Tax Preparer Phone #

Spouse Signature

Date