DW1 MT-DAY JEDD                                                                                                                                                   
   Employer’s return of employee income tax withheld.                                                                                          JEDD
MT-DAY JEDD payroll this period                 $___________                                                                                    
MT-DAY JEDD payroll tax (@ 1.75% )              $___________                                                                                    
Total MT-DAY JEDD tax withheld                  $___________         Is this an amended return?                                                 
                                                                                                                                              I certify that the information and statements contained herein  
Prior period adjustment                         $___________                    NO                                                             are true and correct.   (DECLARATION SIGNATURE IS REQUIRED) 
(If adjusted, provide explanation on back of this form)                        YES                                                            (Signed) ____________________________ 
Amount remitted                                 $___________                   Additional Withholding 
                                                                     Is this a Final return?                                                   (Print Name / Title)_______________________ 
Number of employee’s                              ___________                  NO                                                             Date ___________Phone #               ______________ 
                                                                                                                                               Federal tax ID# _________________________ 
ACCOUNT NUMBER                   ______________                                YES                                                            Returns are due 15 days after the end of the withholding period (for 
 
NAME AND ADDRESS                                                       For the tax period ending                                               Monthly)  and  the  last  day  of  the  month  after  the  end  of  the 
                                                                       _____________________                                                   withholding period (for Quarterly). 
                                                                       YOU MUST STATE THE MONTH AND YEAR ENDING THIS PAYMENT IS FOR                                                 
                                                                                                                                                         Make Check or money order payable to 
_______________________________                                                Filing Monthly  
                                                                                                                                                         City of Dayton and Mail only to: 
_______________________________                                                Filing Quarterly*                                                                                   
_______________________________                                                 *Quarterly cannot exceed $600.00. 
                                                                                                                                                                    City of Dayton 
                                                                       
                                                                                                                                                                 P. O. Box 643700 
                                                                                                                                                   Cincinnati, Ohio 45264-3700 
                                                                      
                                                                     ________                                                         ________  
                                                                                                                     CUT HERE                   
                                                                                                                                                
NEW TAX FORM                                                                                                                                    
Please fill in your account information, then 
                                                                                                                                                
copy this form for future use.                                                  IMPORTANT 
Your account number should be the same as                                                                                                      DO NOT ALTER         any pre-printed payment coupon 
your Federal Tax ID#, plus the suffix –1.                              WITHOLDING                                                              with  a  bar-code  at  the  bottom.  Your  payment  will 
                                                                                                                                               only be processed electronically to the account and 
The  City  of  Dayton  Finance  Department                                                          NOTICE!                                    specific tax period encoded on that line, regardless 
administers  the  Municipal  Income  Tax  for  the                                                                                             of any comments you write on the form. 
Miami  Township-Dayton  Joint  Economic                                                                                                         
                                                                                                                                                
Development District.                                                 
                                                                                                                                               DO  NOT  INCLUDE  CITY  OF  DAYTON  INCOME 
                                                                      
                                                                                                                                               TAX ON THIS FORM 
For additional information call 937-333-3500 or                                                                                                 
E-mail        taxquestions@daytonohio.gov  or  visit                                                                                           DO  NOT  USE  THIS  FORM  TO  SUBMIT  PAYMENT  OF  ANY 
www.daytonohio.gov for more tax forms.                                                                                                         PRIOR  BALANCE  DUE  THAT  HAS  ALREADY  BEEN 
1. Each employer within or doing business within the Miami                                                                                     REPORTED. 
   Township-Dayton  Joint  Economic  Development  District,                                                                                     
   who employs one or more persons is required to withhold                                                                                     Dayton Income Tax Ordinance: 36.111 VIOLATIONS AND 
                                                                                                                                               PENALTIES.  
   the  tax  from  all  Employee  compensation  and  remit  the                                                                                Any person shall be guilty of a separate misdemeanor of the 
   amount to the City of Dayton. 
                                                                      
2. A  fully  completed  return  of  withholding  taxes  withheld                                                                               first degree if he shall: 
   (Form DW1) and payment is due on the 15  day (Monthly)th                                                                                       Fail, neglect or refuse to make any return or declaration 
   or last  day of the month  (Quarterly)  after the end of the                                                                                    required by this chapter; or 
   withholding  period.  Certifying  declaration  signature  is                                                                                   Knowingly make an incomplete, false or fraudulent 
   required.                                                                                                                                       return; or 
3. Every  employer,  resident  or  non-resident,  required  to                                                                                    Willfully fail, neglect or refuse to pay the tax, penalties or 
   withhold the tax at the source, is liable for payment of such                                                                                   interest imposed by this chapter; or 
   tax  whether  or  not  actually  withheld  from  his  or  her                                                                                  Attempt to do anything whatever to avoid the payment 
   employees income.                                                                                                                               of the whole or any part of the tax, penalties or interest 
4. Employers are to file MONTHLY if tax withheld exceeded                                                                                          imposed by this chapter. 
   $600.00  for  the  previous  quarter  or  $2,399.00  for  the      
                                                                                                                                                  The failure of any employer, taxpayer or person to 
   previous calendar year.                                            
                                                                                                                                                   receive or procure a city income tax return, declaration 
5. Delinquent  payments  are  subject  to  interest  and  penalty                                                                                  or other required form shall not excuse such employer, 
   charges as provided by ordinance.                                                                                                               taxpayer or person from making any information return 
6. Failure  to  receive  or  procure  forms  shall  not  excuse  the                                                                               or city income tax return or declaration, from filing such 
   employer from filing a return and remitting the tax due on                                                                                      return or from paying city income tax. 
   schedule.                                                                                                                                    
7. Do  not  report  names  of  employees  with  this  form.  See                                                                                
   DW3 year end reconciliation for instructions on individuals        
   W2 reported information. 
                                                                      
DW1 MT JEDD REVISED 9-2016