Form Br - Addyston Income Tax Return - 2003
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22003 - ADDYSTON INCOME TAX RETURN - 2003
Form BR
File With
FISCAL YEAR DATE
Addyston Income
Tax Bureau
FILING REQUIRED EVEN IF NO TAX DUE
FROM__________________
235 Main Street
Addyston, Ohio 45001
TO_____________________
On or before April 30, 2004
TAXPAYER’S NAME, ADDRESS
PRINCIPAL BUSINESS ACTIVITY_______________________________
G
G
G
CORPORATION
PARTNERSHIP
SOLE PROPRIETOR
IF OTHER, EXPLAIN:_________________________________________
BUSINESS TELEPHONE :_____________________________________
FEDERAL ID#_______________________________________________
IF YOU MOVED DURING CURRENT YEAR PLEASE GIVE DATE.
A WRITTEN EXTENSION REQUEST MUST BE RECEIVED BY DUE DATE.
MOVED IN ____________________ MOVED OUT _______________
A FEDERAL EXTENSION DOES NOT AUTOMATICALLY APPLY TO ADDYSTON.
INCOME
1.
TOTAL INCOME FROM PAGE 2 OR ATTACHED COPIES OF FEDERAL RETURNS AND SCHEDULES . . . . . .
$ _______________
ADJUST-
MENTS
2a. ITEMS NOT DEDUCTIBLE (FROM LINE M SCHEDULE X (FROM PAGE 2) . . . .
ADD $ ___________________
TO
INCOME
b. ITEMS NOT TAXABLE (FROM LINE Z SCHEDULE X (FROM PAGE 2) .
.
. . DEDUCT $ ___________________
c. DIFFERENCE BETWEEN LINES 2a AND b TO BE ADDED TO OR SUBTRACTED FROM LINE 1 . . . . ( + OR - ) $ ______________
3a. ADJUSTED NET INCOME (LINE 1 PLUS OR MINUS LINE 2c IF SCHEDULE X IS USED) . . . . . . . . . .
$ ______________
b. AMOUNT OF LINE 3a ALLOCABLE ( ____% FROM LINE 5 SCHEDULE Y) . . . . . . . . . . . . . . . . .
$ ______________
4.
AMOUNT SUBJECT TO ADDYSTON INCOME TAX (LINE 3b) . . . . . . . . . . . . . . . . . . . . . .
$ ______________
5.
TAX: 1% LINE 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ______________
6.
CREDITS: PAYMENT & CREDITS ON 2003 DECLARATION OF ESTIMATED TAX . . . $ ____________________
7.
IF LINE 5 GREATER THAN LINE 6 PAYMENT OF BALANCE MUST ACCOMPANY THIS RETURN: 2003 TAX DUE . . . . . . $_____________
8.
OVERPAYMENT TO BE REFUNDED $ __________________
.
.
.
.
.
.
.
.
.
.
.
. OR CREDITED $ ______________
DECLARATION OF ESTIMATED TAX FOR YEAR 2004
9.
TOTAL INCOME SUBJECT TO TAX $ _________________: MULTIPLY BY TAX RATE OF 1% FOR GROSS TAX OF . . . . . . . $ ______________
10.
LESS EXPECTED TAX CREDITS
A.
OVERPAYMENT FROM PRIOR YEAR . . . . . . . . . . . . . . . . . . . . . . . . . $ _________________
B.
PAYMENT TO ANOTHER MUNICIPALITY (NOT TO EXCEED 1%) . . . . . . . . . . . . . . .
$ _________________
C.
TOTAL CREDITS . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
$ ______________
11. NET TAX DUE (LINE 9 LESS LINE 10C)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$ ______________
12. AMOUNT PAID WITH THIS DECLARATION (NOT LESS THAN 1/4 OF LINE 11) . . . . . . . . . . . . . . . . . . . . . .
$ ______________
13. BALANCE OF 2004 TAX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . $ ______________
I CERTIFY THAT I HAVE EXAMINED THIS RETURN (INCLUDING ACCOMPANYING SCHEDULES AND STATEMENTS) AND TO THE BEST OF MY
KNOWLEDGE AND BELIEF IT IS TRUE, CORRECT AND COMPLETE. IF PREPARED BY A PERSON OTHER THAN TAXPAYER, THE DECLARATION IS
BASED ON ALL INFORMATION OF WHICH PREPARER HAS ANY KNOWLEDGE.
_______________________________________________________________
______________________________________________________________
Signature of Person Preparing if Other Than Taxpayer
Date
Signature of Taxpayer or Agent
Date
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