Form D1-I DAYTON Individual/Joint Filing DECLARATION OF ESTIMATED TAX 
 
 Tax year              ending DECEMBER or                        
 
 1. Total Estimated Income subject to Dayton tax                       $   
 
 2. Dayton tax due @ 2.5%                                              $   
 
 3. Estimated tax withheld by employer (not to exceed 2.5%)            $   
 
 4. Total estimated tax due          (line 2 - line 3)                 $   
 
 5. Credit from prior year tax return                                  $   
 
 6. Net estimated tax due  (line 4 – line 5)                           $   
 
 D1 filing is due by April 15 and quarterly estimated payments are due June 15, September 15 of the year the income is earned and 
 January 15 after the year the income is earned. 
 Make Checks Payable to The City of Dayton, and mail to City of Dayton, PO Box 643700, Cincinnati, OH 45264-3700. 
 
 Signature                                   Date               Phone#      
 
 Name                                        Account # or SS#              
 
 Spouse’s Name                               Account # or SS#                                 
 
 Address                                     City, State, Zip                                
                                                            22.5% of Line 6 Paid $                                  
                                                                cut here 
 QUARTERLY ESTIMATED TAX PAYMENTS 
 You are required to make estimated quarterly income tax payments for the current tax year if you expect to owe $200.00 or more 
 when you file your next Dayton tax return. If 90% of your final tax is not paid on time, in four (4) scheduled quarterly estimated 
 payments (April, June, September, and January), you will be assessed an additional underpayment penalty when you file your next 
 return. 
 
 IMPORTANT REMINDERS:              Failure to file a D1 estimated tax return and pay an amount equal to at least 90% of the tax due on 
 your annual return in scheduled quarterly installments can result in an additional underpayment penalty being assessed at the time your 
 annual return is filed. A $25.00 non-filing penalty will also be applied. Income tax payments are due quarterly, not when the return is 
 filed. More tax information is available at www.daytonohio.gov, including tax forms and important changes in the revised City of 
 Dayton income tax ordinance. 
 
 PENALTIES: Dayton Income Tax Ordinance: 36.109(C)(3): Where the taxpayer has failed to file a city income tax return by the 
 due date or the date resulting from extension, twenty-five dollars ($25) per month or fraction thereof that the Dayton city income tax is 
 not filed, with the penalty not to exceed one hundred fifty dollars ($150). The penalty in this section 36.109(C) shall be imposed 
 regardless of cause.  
  
 Dayton Income Tax Ordinance: 36.111: Any person shall be guilty of a separate misdemeanor of the first degree if he shall: Fail, 
 neglect or refuse to make any return or declaration required by this chapter; or Knowingly make an incomplete, false or fraudulent 
 return; or Willfully fail, neglect or refuse to pay the tax, penalties or interest imposed by this chapter; or Attempt to do  anything 
 whatever to avoid the payment of the whole or any part of the tax, penalties or interest imposed by this chapter. 
 
                                                                                                                    (Rev 12/2017) 

               nd 
 DAYTON DCM 2 ESTIMATED INDIVIDUAL TAX PAYMENT 
 Tax year      ending DECEMBER or                        
 
 2nd estimated tax payment due June 15, of the year the income is earned.  
 Estimated full year TAX DUE (from declaration) $     
                Check here if amended 
 
 Name                          Account # or SS#                             
 
 Spouses name                  Account # or SS#                                    
 
 Address                       City, State, Zip                                    
                                                      22.5% due June 15, Paid $                                                                                          
  
 Make Checks Payable to the City Of Dayton, and Mail to City of Dayton, PO Box 643700, Cincinnati, Oh 45264-3700. 
 In the event your check is returned unpaid for insufficient funds or uncollected funds, we may electronically debit your account for the principal amount of the check 
 
                                                    cut here 

               rd 
 DAYTON DCM 3 ESTIMATED INDIVIDUAL TAX PAYMENT 
 Tax year      ending DECEMBER or                      
 
 3rd estimated tax payment due September 15, of the year the income is earned.  
 Estimated full year TAX DUE (from declaration) $    
                Check here if amended 
 
 Name                          Account # or SS#                                  
 
 Spouses name                  Account # or SS#                                        
 
 Address                       City, State, Zip                                        
                                                     22.5% due September 15, Paid $                                                                                       
 
 Make Checks Payable to the City Of Dayton, and Mail to City of Dayton, PO Box 643700, Cincinnati, Oh 45264-3700. 
 In the event your check is returned unpaid for insufficient funds or uncollected funds, we may electronically debit your account for the principal amount of the check 
 
                                                    cut here 

               th 
 DAYTON DCM 4 ESTIMATED INDIVIDUAL TAX PAYMENT 
 Tax year      ending DECEMBER or                       
 
 4th estimated tax payment due January 15, following the year the income is earned.  
 Estimated full year TAX DUE (from declaration) $    
                Check here if amended 
 
 Name                          Account # or SS#                              
 
 Spouses name                  Account # or SS#                                     
 
 Address                       City, State, Zip                                       
                                                      22.5% due January 15, Paid $                                                                                        
  
 Make Checks Payable to the City Of Dayton, and Mail to City of Dayton, PO Box 643700, Cincinnati, Oh 45264-3700 
 In the event your check is returned unpaid for insufficient funds or uncollected funds, we may electronically debit your account for the principal amount of the check 
                                                                                                                                                                          (Rev 12/2017)