Form R-I - Individual Income Tax Return - 2012

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PAYMENT DUE
2012 CITY OF DAYTON
PLEASE REMIT TO:
INDIVIDUAL
CITY OF DAYTON
Is this Dayton Tax Return:
Single
Joint Filing
PO BOX 643700
INCOME TAX RETURN
TAX ID # OR SS #
CINCINNATI, OH 45264-3700
TAX ID # OR SS #
RETURN WITH PAYMENT DUE BY APRIL 15, 2013
Your phone #
90% of Estimated Tax Liability due by January 31, 2013
TAXPAYER NAME, ADDRESS & ACCOUNT NUMBER
Your Email address
Are you a Dayton resident?
Yes
No
Did you file a Dayton Return last year?
Yes
No
Did you file on a different Tax ID# last year?
Yes
No
If so, please list Tax ID#
Did You Move during this tax year?
Yes
No
Old address
Date Moved in
or Date Moved Out
All supporting W-2’s and Federal Schedules must be submitted with this return
If you moved more than once during the year, attach
Please Complete Work Sheet On Reverse Side Before Completing Section A
list to tax return showing addresses and dates
SECTION A
TOTAL TAXABLE INCOME
1.
Wages, Salaries, Tips, and Other Employee Compensation-Use highest wage figure on W-2.
See Section A on back of return. (Part year residents must pro-rate their income based on
time lived in Dayton.) ....................................................................................................................................................................... $
2.
Other Taxable Income or Deductions from Reverse Side............................................................................................................... $
3.
Taxable Income (Add Lines 1 through 2)......................................................................................................................................... $
4.
Dayton Tax Due @ 2.25% of Line 3 .............................................................................................................................................. $
5.
Payments and Credits:
A.
Dayton Tax Withheld ............................................................................... $
B.
Other City Tax Withheld .......................................................................... $
C.
Estimated Taxes Paid/Prior Year Credit.................................................. $
OFFICE USE ONLY
D.
Other Credits /Partnership Payments..................................................... $
6.
Total Payments and Credits (Add Lines 5A through 5D) ................................................................................................................ $
7.
Balance of Tax Due (Line 4 minus Line 6) .................................................................................................................................. $
8.
Penalty $
Interest $
.................................................... Total Penalty/Interest $
9.
Amount Due: Make Checks Payable to City of Dayton............................................................................................................. $
10. If Overpayment: Credit to Estimated Taxes $
or Refund $
If your refund is $1.00 or less, no refund will be issued. If you owe $1.00 or less, no payment is necessary.
SECTION B
DECLARATION OF ESTIMATED TAX FOR TAX YEAR 2013
11. Estimated Income Subject To Tax $___________ @ 2.25% =......................................................................................................... $
12. Estimated Tax Withheld By Your Employer(s) ................................................................................................................................. $
13. Total Estimated Tax Due (Line 11 minus Line 12) ........................................................................................................................... $
14. Credit From Prior Tax Year............................................................................................................................................................... $
15. Net Estimated Tax Due (Line 13 minus Line 14) ............................................................................................................................. $
16. Estimated Tax Amount Due is 22.5% of Line 15 (First Payment)................................................................................................... $
17. TOTAL AMOUNT DUE (Line 9 plus Line 16) AMOUNT ENCLOSED: ........................................................................................ $
SECTION C
VISA AND MASTER CARD PAYMENTS
READ BEFORE SIGNING: The undersigned declare this return and attached schedules
Due to privacy issues and possible identity theft, Visa and Master Card
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
payments will be accepted only by telephone 24 hours a day by calling
of the Dayton city tax ordinances represented by this return. I understand that if I
(937) 333-3500. Select “Option 2” to connect to the tax system, and then press
am under withheld in the following tax year (by $100.00 or 10% of tax due) I will
“Option 1” to make a payment. To speak to a customer service representative
be charged an underpayment penalty if I fail to make required estimated tax
during normal business hours, select “Option 2” and then “Option 7.”
payments. If this return was prepared by a tax professional, may we contact
them directly?
Yes
No
X
Tax Preparer Signature
Taxpayer Signature
Date
Tax Preparer Phone #
Spouse Signature
Date
FORM R-I

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