Form R-I-2005 - Income Tax Return - Individual Or Joint Filing printable pdf download

Form R-I CITY OF DAYTON, OHIO INCOME TAX RETURN - INDIVIDUAL or JOINT FILING

2005

RETURN with PAYMENT DUE by APRIL 15

TAX YEAR

Are you a Dayton resident? Yes _____ or No ________ Is this Dayton Return: _____Single or _____ Joint Filing

Your Name

ACCOUNT # or SS#

Spouse Name

Your Address

Your phone #

City/State/Zip

Your Email address

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, show all addresses and dates on back of tax form.

(For Office Use Only)

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

All supporting W2s and Federal Schedules must be submitted .

Please Complete Work Sheet On Reverse Side Before Completing Section A and Section B

SECTION A

Total W-2 Wages

1 A. TOTAL TAXABLE WAGES

B. Less 2106 Expenses

(Limited to 2% exclusion of adjusted gross income from Federal Schedule A)

C. Total Net Taxable Wages (Lines 1A-1B)

2 OTHER INCOME

Date Stamp

(Both Income and Losses MUST be reported and documented)

A. Profit (or loss) From Any Business

B. Profit (or loss) From Rental Property

C. Other Income

D. Total (Lines 2A+2B+2C) if this amount is negative enter ZERO

3 TOTAL TAXABLE INCOME (Lines 1C + 2D)

Amount pro-rated to Dayton (non residents)

4 Dayton Tax Due @ 2.25%

5 TAX CREDITS:

(Please

A. Dayton Tax Withheld

B. Other City Tax Withheld

attach

C. Estimated Payments/Credit From Prior Years

check here)

D. Total Credits Available (Lines 5A+5B+5C)

6 BALANCE OF TAX DUE (Line 4 - Line 5D)

7 Penalty ____________ and/or Interest ______________

8 AMOUNT DUE (MAKE CHECKS PAYABLE TO CITY OF DAYTON)

Refund

If Overpayment:

Credit to tax year

SECTION B

MANDATORY DECLARATION OF ESTIMATED TAX FOR TAX YEAR______

10 Estimated Income Subject To Tax (A)____________ @ 2.25%

10 ( B )

11 Estimated Tax Withheld By Your Employer(s)

12 Total Estimated Tax Due (Line 10 - 11)

13 Credit From Prior Tax Year

14 Net Estimated Tax Due (for current full year)

ESTIMATED TAX AMOUNT DUE FOR CURRENT TAX YEAR IS 22.5% OF LINE 14

Return Received

TOTAL AMOUNT DUE (LN 8)__________(LN 15)__________ AMOUNT ENCLOSED

SECTION C

VISA AND MASTER CARD PAYMENTS

VISA AND

Account # ________________________ Exp. Date ____________ Amount Authorized $

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

Form R-I-2005 - Income Tax Return - Individual Or Joint Filing

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