Form R - Xenia City Income Tax - 2004 Page 2
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SCHEDULE W
INCOME OTHER THAN WAGES
List all income below as reported to the IRS on each of the following schedules:
CORPORATIONS
INDIVIDUALS & SOLE PROPRIETORS
PARTNERSHIPS & FIDUCIARIES
Column 1
Column 2
Column 3
SCHEDULE C .................
FORM #4797....................
FORM #1120 ...................
FORM 1099-MISC ...........
FORM #1120S .................
FORM #1065 & K-1’s.......
SCHEDULE E .................
FORM #1041 ...................
OTHER.............................
MISC. INCOME
SCHEDULE F..................
(From Line 21
(or Form #4835)
of Form 1040)...................
TOTAL OF COLUMNS 1 AND 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$___________________
Enter the figure in Column 3 (above) on
Enter the Total of Columns 1 and 2 (above) on Line 2 (Page 1) of Form R. ATTACH 1040.
Line 2 (Page 1) of Form R
ALL FEDERAL SCHEDULES LISTED ABOVE MUST BE ATTACHED TO THIS RETURN
(Include individual partnership distribution Form #1065 K-1)
SCHEDULE X
RECONCILIATION WITH FEDERAL INCOME TAX RETURN
(Partnerships & Corps only)
ITEMS NOT DEDUCTIBLE
ITEMS NOT TAXABLE
A.
Capital losses deducted. DO NOT include . . . . . . . . .$______________
N.
Capital gains from sale, exchange . . . . . . . . . . . . . .$_______________
ordinary loss from Federal Form 4797
or other disposition of capital or other
B.
Expenses attributable to non-taxable in- . . . . . . . . . . ______________
assets (from Federal Schedule D).
come. (MUST BE 5% OF LINE Z)
DO NOT include ordinary gain from
C.
Taxes based on income . . . . . . . . . . . . . . . . . . . . . ______________
Federal form 4797.
D.
Net operating loss deduction per Federal . . . . . . . . . . ______________
O. Interest & Dividend income . . . . . . . . . . . . . . . . . . . _______________
Return.
P.
Federal Tax Credit to the extent corresponding . . . . . ._______________
E.
Payments to partners . . . . . . . . . . . . . . . . . . . . . . . . ______________
operating expenses have been reduced
F.
Dividends, distributions, or amounts set aside for,
. . ______________
Q. Not previously deducted IRC Section 179 expense . . ._______________
credited to, or distributed to REIT or RIC investors
R.
Partnership, S corp, LLC charitable contributions . . . . ._______________
G. Qualified self-employed retirement health and life . . . .______________
S.
Other deductions
. . . . . . . . . . . . . . . . . . . . . . _______________
insurance plans for owners of non-C corp entities
T.
TOTAL DEDUCTIONS . . . . . . . . . . . . . . . . . . . . . . $_______________
TOTAL ADDITIONS (From Line I) . . . . . . . . . . . . . . _______________
H. Rental activities by partnership, S corp or LLC, Trusts ______________
I.
TOTAL ADDITIONS . . . . . . . . . . . . . . . . . . . . . . . $_______________
TOTAL SCHEDULE X (Enter as Line 3 on Page 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $_______________
SCHEDULE Y
BUSINESS ALLOCATION FORMULA
The Business Allocation Formula is to be used by companies who have a place or places of business outside Xenia, and
ONLY IN THE ABSENCE OF BOOKS AND RECORDS
which will disclose, with reasonable accuracy, what portion of the net profits is attributed to that part of the business within the boundaries of Xenia. Businesses located
wholly within the Xenia city limits must include copies of tax returns paid to other cities in order to allocate less than 100% to Xenia.
A. LOCATED
B. LOCATED
C
PERCENTAG
EVERYWHERE
IN XENIA
E
$
(B / A)
$
Step 1. Average original cost of real and tangible personal property.. . . . .
$
$
Gross annual rentals multiplied by 8 . . . . . . . . . . . . . . . . . . . . .
$
$
Total step 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
%
$
$
Step 2. Gross receipts from sales and work or services . . . . . . . . .
%
$
$
Step 3. Total qualifying wages, salaries, commissions and other . . . . . . .
%
compensation of all employees
$
$
Step 4. Total percentages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
%
Step 5. AVERAGE PERCENTAGE (Divide total percentages by number of percentages used.)
Enter on Line 5, page 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
%
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