CITY OF BLUE ASH
                                        INDIVIDUAL DECLARATION OF ESTIMATED INCOME TAX
FOR OFFICIAL USE ONLY                                                  FOR CALENDAR YEAR ______________  
A legally filed declaration must be signed, dated and accompanied by payment.  The safest and easiest way to declare is to estimate this year's taxes
based on last year's taxable income.  Mail To: City of Blue Ash, Income Tax Office, 4343 Cooper Road, Blue Ash, OH 45242
by April 15, ____________ .

Name(s)                                                                                                              Blue Ash Tax Acct #
                                                                                                             Primary Social Security #
Address                                                                                                    Spouse's Social Security #

City/State/Zip

 Please make corrections as necessary if your account information is preprinted above.

TAX DECLARATION

1.            Total Estimated Income Subject to Tax  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.            Blue Ash Income Tax Declared (Multiply Line 1 by 1.25%) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
3.            Estimated Taxes Withheld from Wages  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.            Tax Due after Withholding (Line 2 less Line 3)   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 
5. * Quarterly Tax Due, if Line   is4Greater than $200 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  .  . . .
6.            Less Credits (from Previous Year Return) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7.            Amount Paid this Quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 The undersigned declares this to be a true, correct and complete Declaration of Estimated Blue Ash Income Tax.

              SIGNATURE                                                        SPOUSE'S SIGNATURE                                                              DATE

INSTRUCTIONS
Line 1.       Base your estimated income on the amount subject to tax in the preceding full year, or by annualizing income if the preceding tax year
              was not a full 12-month period.
Line 2.       Multiply line 1 by 1.25% (or .0125) for the total tax declared.
Line 3.       Estimate the amount of Blue Ash and other allowable municipal taxes (up to 1.25%)  to be withheld from your wages by your employer.
Line 4.       Line 2 less Line 3. Estimated annual tax due.
Line 5.       If Line 4 is $200 or greater, you are required to make quarterly estimated payments to avoid penalties and interest.  90% of the estimated
              tax due must be paid by December 15th of the applicable tax year.  The following schedule shows the minimum amount due per quarter.
              22.5% of the liability must be paid by April 15th (4th month)                          67.5% of the liability must be paid by September 15th (9th month)
              45% of the liability must be paid by June 15th (6th month)                             90 % of the liability must be paid by-DQ  15th (1 VW mth                                      QH[W 7<)
              For ease of calculation, 25% (or 1/4) of the total liability may be paid.
Line 6.       Enter the amount of tax you overpaid on last year's tax return that was not refunded to you. If you file an extension, please be
              aware that overpayments from prior years are not credited to your next year's liability until you file the prior year's return.
Line 7.       Line 5 less Line 6.
        * Subsequent payments are equal to the quarterly tax due (Line 5) less any overpayment still available from prior year.  Failure to remit timely
              payments may results in the charge of penalties and interest.  Once an estimate is filed, statements will be sent for subsequent quarters.

 PAYMENT SCHEDULE FOR CALENDAR YEAR FILERS (FISCAL YEAR FILERS)

            APRIL 15TH                  JUNE 15TH                  SEPTEMBER 15TH                                -$18$5< 15TH                                                  APRIL 15,            
        (or 15th of 4th month)     (or 15th of 6th month)        (or 15th of 9th month)                        (15th of 1 VW mth        Q[W \U)                     (or 15th of 4th month)
        Declaration w/1st Pmt      2nd Quarterly Pmt                 3rd Quarterly Pmt                             4th Quarterly Pmt                                Balance Due w/Filing

By the 15th day of the 4th month after beginning a new business or taking a new job, everyone whose entire tax liability will not be
withheld by an employer must file a Declaration.

01-2018