Form It 1100 - Application For Extension Of Time To File - 2000
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1CITY OF XENIA, OHIO
Income Tax Division
APPLICATION FOR EXTENSION OF TIME TO FILE
For Calendar Year Ending December 31,
or
For Fiscal Year Beginning
,
Ending
,
Account No.
File this form IN DUPLICATE with the Division of
Taxation, on or before the due date of the return.
Name
Address
See instructions on reverse side.
City
State
Zip
Fed. I D No.
Estimated Total Taxable Income
$
Estimated Tax Due @1.75%
$
Less Amount Paid on Current
Estimate and/or Any Overpay-
ment Credits
$
Net Tax Due - Tentative Amount
$
Payment With This Return
$
An extension of
days* until
,
for filing City Income Tax Return for the year stated
G
above is hereby requested for the following reason (or
see attached Federal extension):
This application must be accompanied by a remittance of the net tax due, if any.
I declare that the extension requested herein for filing of the Xenia City Income Tax Return for the taxable year
stated is necessary for the reason given above and that I am authorized to sign this request. Please mail
G
G
duplicate to
taxpayer
agent signing this request
. (Please check one.)
(if to be returned to agent, include address)
APPROVED
Signature (see instructions)
NOT APPROVED
By
Title
Date
Date
*
Extensions in excess of 4 months for individuals or 6
months for corporations MUST have federal extension
Input
by
attached.
NO EXTENSION WILL BE GRANTED IF RECEIVED AFTER THE DUE DATE
IT 1100 6/2000
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