City of Fairfield
                                                                                          Income Tax Division 
                                               APPLICATION FOR 
                                                                                          701 Wessel Dr 
                                           EXTENSION OF TIME TO FILE                      Fairfield, OH 45014 
                                           LOCAL INCOME TAX RETURN                        www.fairfield-city.org

                                           FOR CALENDAR YEAR 2023
                                                         OR 
                          FISCAL YEAR ____________________ TO ____________________ 

     THIS FORM NOT REQUIRED TO BE FILED IF YOU HAVE REQUESTED AN EXTENSION TO FILE YOUR 
                  FEDERAL RETURN. PLEASE PROVIDE COPY OF THE FEDERAL EXTENSION. 

General Information 

This application is to be filed only by taxpayers that have not requested or received an extension to file their federal return or 
by taxpayers that have a federal extension but are remitting an extension payment. 

Upon the filing of this request in a timely fashion, you will be granted a 6-month extension to file your City of Fairfield 
income tax return.  The extended due date shall be the fifteenth day of the tenth month after the last day of the taxable year.  
For calendar year taxpayers, this is October 15, 2024.

This extension does not extend the time to pay tax due.  A 15% penalty plus interest will be charged on any taxes remitted 
after the original due date of the return. 

Taxpayers that have requested or received a federal extension need not complete this form.  Instead, please send a copy of 
your federal extension to our office. 

For questions regarding the extension application, please call 513-867-5327.

Due Date 

This form and payment (if applicable) must be postmarked on or beforeApril 15, 2024 to be considered timely filed. 

Account Number     __________________________________  Federal Identification Number ________________________ 

Taxpayer  __________________________________________  Social Security Number  _____________________________ 

Spouse     __________________________________________   Social Security Number  _____________________________ 

Address   __________________________________________  City/State/Zip  _____________________________________ 

Signature__________________________________________
Payment of tax included with this application   $________________________ 

Make checks payable to: City of Fairfield Income Tax           To pay via credit card: Enter number, expiration date, 
                                                               CVV code, and amount authorized fully and accurately.
To file, please submit this form to:
City of Fairfield         Fax: 513-867-5333
Income Tax Division                                            Card Number: __________________________________
 701 Wessel Drive                                              CVV Code: ______________ Exp: __________________
Fairfield, Ohio  45014                                         Amount Authorized: $___________________________
                                                               Phone Number: ________________________________
Email: income.tax@fairfield-city.org
                                                               Cardholder Signature: ___________________________