Form R-I - City Of Dayton Individual Income Tax Return
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1
2FORM R-I
PLEASE REMIT TO:
CITY OF DAYTON
CITY OF DAYTON
INDIVIDUAL
Is this Dayton Tax Return:
Single
Joint Filing
PO BOX 1830
DAYTON, OH 45401-1830
INCOME TAX RETURN
TAX ID # OR SS #
TAX ID # OR SS #
Your phone #
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
list to tax return showing addresses and dates
Please Complete Work Sheet On Reverse Side Before Completing Section A
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 .............................................................................................................................................. $
Payments and Credits:
5.
A.
Dayton Tax Withheld ............................................................................... $
B.
Other City Tax Withheld .......................................................................... $
C.
Estimated Taxes Paid/Prior Year Credit.................................................. $
OFFICE USE ONLY
Other Credits /Partnership Payments..................................................... $
D.
Total Payments and Credits (Add Lines 5A through 5D) ................................................................................................................ $
6.
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 $
SECTION B
DECLARATION OF ESTIMATED TAX FOR TAX YEAR 2008
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
i [
to be a true and complete return for the taxable year stated and that the figures used
Account #
Exp. Date
Amount Authorized $
herein are the same as used for Federal Tax purpose, adjusted to the requirements
3 Digit Credit Card Verification Code
(From back of card) Required to Process
of the Dayton city tax ordinances represented by this return. I understand that if I
am under withheld in the following tax year (by $100.00 or 10% of tax due) I will
Card Holder Name (print)
be charged an underpayment penalty if I fail to make required estimated tax
payments. If this return was prepared by a tax professional, may we contact
Signature
Date
them directly?
Yes
No
X
Tax Preparer Signature
Taxpayer Signature
Date
Tax Preparer Phone #
Spouse Signature
Date
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