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CITY OF XENIA, OHIO
Income Tax Division
APPLICATION FOR EXTENSION OF TIME TO FILE A CITY OF XENIA TAX RETURN
If you have a timely filed Federal Extension to file, DO NOT COMPLETE THIS FORM. Instead
attach a copy of your timely filed Federal Extension to your tax return when filed to avoid late filing
penalties.
An extension to file is not an extension to pay. Estimated taxes due must be paid by the return
filing deadline to avoid non-payment penalty (15% of tax due) and monthly interest.
Attach a copy of this timely filed Xenia extension (or your timely filed Federal extension) to your
return to avoid late filing penalties.
For Calendar Year Ending December 31, __________ (REQUIRED)
Social Security Number(s):________________________________ _____________________________
Your SSN
Your Spouse’s SSN (if applicable)
Name(s):__________________________________________
________________________________
Your Name
Your Spouse’s Name (if applicable)
Current Address:_______________________________________________________________________
City, State Zip:_______________________________________________________________________
Since an extension to file is not an extension to pay, you should pay your estimated Xenia taxes due when you file your extension request.
Estimated Total Xenia City Taxable Income
A. $______________________
$0.00
Estimated Tax Due @ 2.25% (Line A times .0225)
B. $______________________
Credits -- Estimated Payments made previously, City Income Tax
C. $______________________
Withholding Credits, and/or Prior Year Overpayments
Note: Maximum credit for taxes withheld for another city are 1.5% of the
city’s taxable gross.
$0.00
Net Tax Due – Estimated Amount (Line B – Line C)
D. $______________________
Payment Made with this Application for Extension to File
E. $______________________
___________________________________
_________________________________
Signature
Your Spouse’s Signature (if applicable)
___________________________________
Date Signed
NO XENIA EXTENSION WILL BE GRANTED IF RECEIVED AFTER THE DUE DATE*
th
*April 15
or deadline for filing a Federal return for a calendar year filer
FOR OFFICE USE ONLY: Account Number______________________ Entered__________________________
2.25%