Form D-1 - Quarterly Payment Of Estimated Net Profit Tax - 2004 Page 2

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D-1
QUARTERLY PAYMENT OF ESTIMATED NET PROFIT TAX
CINCINNATI INCOME TAX BUREAU
2004
P O BOX 640770
CINCINNATI OH 45264-0770
FOR OFFICIAL USE ONLY
ACCOUNT #:
FED ID#:
Enter your name and address here
SSN#:
TAX RATE:
QUARTER ENDING: DECEMBER 31, 2004
DUE DATE: JANUARY 31, 2005
AMOUNT DUE: $
DATE
PHONE (
)_________________SIGNATURE______________________TITLE____________
------------------------------------------------------------------------------------------------------------------------------------------------

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