Form Br - Blue Ash Income Tax Return - 2001
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1
2Form BR
File With
Fiscal Years Fill In Dates
BUSINESS
BLUE ASH
Beginning _____________
2001 — BLUE ASH INCOME TAX RETURN — 2001
INCOME TAX DIVISION
DUE ON OR BEFORE APRIL 30, 2002.
Ending ________________
4343 Cooper Road
LATE FILING OF THIS RETURN SUBJECTS YOU TO INTEREST AND A MINIMUM $25.00 PENALTY
Blue Ash, Ohio 45242-5699
FILING REQUIRED EVEN IF NO TAX DUE
And File Within 4 Months of
Tax Office Phone: (513) 745-8516
Ending Date
A WRITTEN EXTENSION REQUEST MUST BE RECEIVED BY DUE DATE. A FEDERAL EXTENSION DOES NOT AUTOMATICALLY APPLY TO BLUE ASH.
TAXPAYER’S NAME, ADDRESS
ACCOUNT NO.
PRINCIPAL BUSINESS ACTIVITY: ___________________________________________
CORPORATION • S CORPORATION • PARTNERSHIP • SOLE PROPRIETOR •
FEDERAL I.D. # ___________________________________________________________
PHONE # ________________________________________________________________
IF MOVED DURING CURRENT YEAR PLEASE GIVE DATE OF MOVE
INTO BLUE ASH ___________________ OUT OF BLUE ASH _____________________
INCOME 1.
TOTAL INCOME FROM PAGE 2 (ATTACH COPIES OF FEDERAL RETURNS & SCHEDULES) .................................$________________
2a. ITEMS NOT DEDUCTIBLE (FROM LINE M SCHEDULE X FROM PAGE 2) ............. ADD $ ______________
ADJUST- b. ITEMS NOT TAXABLE (FROM LINE Z SCHEDULE X ON PAGE 2)...........................DEDUCT $ ______________
MENTS
c. DIFFERENCE BETWEEN LINES 2a AND 2b TO BE ADDED TO OR SUBTRACTED FROM LINE 1....... (+ OR -)
$ _______________
TO
3a. ADJUSTED NET INCOME (LINE 1 PLUS OR MINUS LINE 2c IF SCHEDULE X IS USED)......................................
$ _______________
INCOME
b. AMOUNT OF LINE 3a ALLOCABLE _________% (FROM STEP 5 SCHEDULE Y)...................................................
$ _______________
c. LESS ALLOCABLE LOSS PER PREVIOUS INCOME TAX RETURN (ATTACH SCHEDULE).................................
$ _______________
4.
AMOUNT SUBJECT TO BLUE ASH EARNINGS TAX (LINE 3b LESS LINE 3c).......................................................
$ _______________
TAX
5.
TAX: 1% OF LINE 4......................................................................................................................................................
$________________
6.
CREDITS:
a. PAYMENTS AND CREDITS ON 2001 DECLARATION OF ESTIMATED TAX...................
$ _______________
b. PRIOR YEAR OVERPAYMENT............................................................................................
$ _______________
c. TOTAL CREDITS ALLOWABLE.............................................................................................................................
$ _____________
7. BALANCE OF TAX DUE (LINE 5 LESS LINE 6c)
MAKE REMITTANCE PAYABLE TO BLUE ASH INCOME TAX DIVISION AND ATTACH WHEN FILING....... ...... ..... ....2001 TAX DUE
$
8. OVERPAYMENT TO BE REFUNDED $__________________ OR CREDITED $________________ TO NEXT YEAR’S ESTIMATE
(if Line 6c is greater than Line 5)
No taxes or refunds of less than $1.00 shall be collected or refunded.
By Law, all Refunds & Credits in excess of $10.00 are being reported to I.R.S.
DECLARATION OF ESTIMATED TAX FOR YEAR 2002
9.
TOTAL INCOME SUBJECT TO TAX $__________________ MULTIPLY BY TAX RATE OF 1% FOR GROSS TAX OF.............. $________________
10. LESS OVERPAYMENT FROM PRIOR YEAR................................................................................................ .....................................$________________
11.
AMOUNT PAID WITH THIS DECLARATION (NOT LESS THAN ¼ OF LINE 9 LESS LINE 10) ................... .. . ................ ........
$
12. TOTAL OF THIS PAYMENT (LINE 7 PLUS LINE 11) ..................................................................................... ...............................
$
MAKE CHECKK PAYABLE TO BLUE ASH INCOME TAX DIVISION
FOR TAX OFFICE USE ONLY
Tax $_______________
Penalty $_____________
Interest $______________
Late ___________ months
TOTAL DUE (Tax & Assessments) ............................. .............................$_____________
I certify that I have examined this return (including accompanying schedules and statements) and to the best of my knowledge and belief it is true, correct
and complete. If prepared by a person other than taxpayer, the declaration is based on all information of which preparer has any knowledge.
May we discuss
___________________________________________________________
____________________________________________________
this return with
the preparer
Signature of Person Preparing if Other Than Taxpayer
Date
Signature of Taxpayer
Date
shown to the
left?
___________________________________________________________
____________________________________________________
Yes
No
•
•
Address
Telephone Number
Title, if Signing for a Business
(BLUE ASH SUGGESTS THAT YOU MAKE A PHOTOCOPY OF BOTH SIDES OF THIS RETURN AND RETAIN FOR YOUR RECORDS)
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