Form Ir-25 - City Income Tax Return For Individuals - 2016 Page 3

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Name(s) as shown on Page 1

Primary Social Security Number

Stop:

If your only source of income is from wages, do not complete the remainder of this page.

Return to Page 1.

Copies of your Federal

Schedules C, E and F may be attached to your city return in lieu of completing the schedules below.

Part E

SCHEDULE C

- INCOME FROM SELF-EMPLOYMENT

Profit or Loss from Business (Sole Proprietorship)

If you conducted business in more than one city, you must allocate income on Schedule Y.

Business Name:

Business Address:

Nature of Business:

Employer ID Number, if any:

Has City income tax been withheld from and remitted for all taxable employees

Date Business Started:

during the period covered by this return?

Date City Business Began:

YES

If NO, explain on an attached statement.

Cash

Accrual

Other

Accounting Method:

Section 1

INCOME

1. Total Receipts Less Allowances, Rebates and Returns..............................................................................................................

2. Less

or (B) Cost of Operations,

whichever is applicable................................................................

(A) Cost of Goods Sold

Enter Amount of Labor Costs included on Line 2 here

( attach 1099’s if issued)

3. Gross Profit, Subtract Line 2 from Line 1.....................................................................................................................................

4. Dividends

+ Interest

+ Royalties

= ............................................................

5. Rents Received (if connected with trade or business).................................................................................................................

6. Other Business Income ( attach schedule )................................................................................................................................

7. Gross Income. Add Lines 3 through 6........................................................................................................................................

Section 2

EXPENSES

8. Advertising & Promotion........................

14. Repairs.................................................................

9. Bad Debts..............................................

15. Salaries & Wages.................................................

10. Car & Truck Expenses...........................

16. Compensation of Officers.....................................

11. Depreciation, Amortization, Depletion....

17. Commissions ( attach 1099’s if issued).............

12. Interest on Business Indebtedness........

18. Taxes & Licenses.................................................

13. Rents (Paid to:

).......

19. Other:

Attach Schedule if over $5,000 ..........

20. Total Expenses. Add Lines 8 through 19 ...................................................................................................................................

21. Net Profit (or Loss) from Business or Profession. Subtract Line 20 from Line 7.........................................................................

Part F

RENTAL AND PARTNERSHIP INCOME

Section 1

INCOME OR LOSS FROM RENTAL REAL ESTATE

Part 1

Property A

Property B

Property C

Property D

1. Address of Property

(include No., Street, City

and State...................................

2. Rents Received ........................

3. Depreciation..............................

4. Repairs .....................................

5. Other Exp. (attach Sched.)........

6. Net Income (Loss).....................

7. Local Tax paid...........................

8. Local jurisdiction paid ...............

Residents only. Attach Schedule E

Section 2

PARTNERSHIP/OTHER INCOME

Federal Identification #

Income Taxable to

Your Share of City

Partnership/Source

(if applicable)

What City?

Taxable Income

Taxes Paid

The loss from an unincorporated business activity reported on this page may not be used to offset W-2 wages reported on Page 1. However, the loss from an unincorporated business

activity may be used to offset a gain from another unincorporated business activity if: both unincorporated activities are taxed by your city of residence.

NOTE: Remember to file your Declaration of Estimated Taxes (Form IR-21) for the current year. Phone (614) 645-7370.

Rev. 11/8/16

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