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D-1 DECLARATION OF

ESTIMATED INCOME TAX

FOR CALENDAR YEAR

OR _______ MONTHS ENDING _______ 20____

FOR OFFICIAL USE ONLY

To Legally Constitute Filing A Declaration, The Form Must Be Signed, Dated And Accompanied By payment. The Safest And Easiest Way To Declare Is

To estimate This Year’s Taxes Based On Last Year’s Taxable Income. Mail To: Cincinnati Income Tax Bureau 805 Central Ave. Suite 600, Cincinnati

OH. 45202-5799, on or before APRIL 30,

or within 4 months after your tax period begins.

YOUR SOCIAL SECURITY NUMBER

SPOUSE’S SOCIAL SECURITY NUMBER

ACCT #

SSN

FED ID#

YOUR LAST NAME

YOUR FIRST NAME

M.I.

SPOUSE’S LAST NAME

SPOUSE’S FIRST NAME

M.I.

STREET ADDRESS

CITY

STATE

ZIPCODE

FED ID#

INTEREST AND PENALTIES MUST BE ASSESSED FOR FAILURE TO FILE AND MAKE TIMELY PAYMENTS

1. ESTIMATED

TAXABLE INCOME $

X 2.1% = ESTIMATED TAX…

2. LESS ALLOWABLE CREDITS, IF ANY

CINCINNATI TAX TO BE WITHHELD BY YOUR EMPLOYER………………………………………….

INCOME TAX NOT OVER 2.1% PAYABLE ANOTHER CITY BY CINCINNATI RESIDENT………….

3. BALANCE OF

ESTIMATED TAX…………………………………………………………………………………

4. DEDUCT OVERPAYMENT OF LAST YEAR’S

The undersigned declares this to be true, correct and complete

TAX IF YOU REQUESTED TRANSFER ON

declaration of estimated Cincinnati income tax for the year

YOUR

RETURN………………………..

_________

5. BALANCE OF

ESTIMATED

_____________________________

TAX PAYMENT…………………………….

SIGNATURE

DATE

___________________________

6. AMOUNT TO BE PAID WITH YOUR

DECLARTION AT TIME OF FILING

Title, if signing for a business

¼ OF LINE 3 MINUS LINE 4 ………………

EXPLANATION OF NEW TAXPAYER OR OF CHANGE OF TAX STATUS

DATES

AT THE PRESENT TIME

DATE BEGAN

PRIOR TO PRESENT TIME

FROM ______TO

BUSINESS LOCATION OR

PLACE OF RESIDENCY

___________________________________________

____________________________________________________________________

TYPE BUSINESS OR

OCCUPATION, ETC.

___________________________________________

____________________________________________________________________

EMPLOYER’S NAME

___________________________________________

____________________________________________________________________

BUSINESS CONDUCTED

OR WORK DONE IN (CITY)__________________________________________

____________________________________________________________________

GENERAL INFORMATION & INSTRUCTIONS

DECLARATION AND RETURN PAYMENT CALENDAR

APRIL 30,

JULY 31,

OCT. 31,

JAN. 31,

___

APRIL 30,

. PAY

FILE DECLARATION

MAKE 2

QUARTERLY

MAKE 3

QUARTERLY

MAKE 4

QUARTERLY

FILE RETURN

WITH ¼ PAYMENT

PAYMENT

ANY BALANCE DUE.

Within four months after beginning a new business or taking a new job, etc. everyone whose entire tax liability will not be withheld by an employer must file a

declaration. If filing your first declaration, or if your tax status has changed during the past year offer appropriate additional explanation above or by attachment.

Please notify the tax office promptly of any later changes. If your form is blank or your name address and account number has been imprinted and the information

shown is not correct, please make necessary changes in the boxes above.

The three months prior to the declaration due date should provide a reasonably accurate basis from which most taxpayers-wage earners in particular-can estimate the

current year’s income. An original estimate can and should be amended if subsequent events indicate it to be grossly in error. If impractical to base this year’s estimate

as suggested, refer to last year’s actual taxable income as indicated on your return. An estimate based on an amount equal to or greater than the last full year’s taxable

income is insurance against any penalty on underestimating for Cincinnati purposes.

Make your own income and estimated tax entries on lines 1 thru 3. If you overpaid last year’s tax and requested transfer of same towards this year’s estimated tax, enter

the amount on line 4. Then deduct it from line 3 and enter the difference on line 5.

Line 5 represents the net amount of your estimated tax payable this year either in full with the filing of this declaration on in installments as indicated by the payment

calendar. Enter on line 6 the amount of remittance accompanying your declaration – and don’t forget to make records for your own reference.