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Due by April 15th or APPLICATION FOR EXTENSION OF TIME TO FILE For taxable
3½ months from fiscal year end year ending:
City ______________________
File with:
Taxpayer Name(s) ____________________________________________ Account Number _______________________________ Vandalia Tax Office
PO Box 727
Address ____________________________________________________ SSN(s) or FID # ________________________________ Vandalia, OH 45377
City _______________________________________________________ State ______________ Zip Code _________________ FAX: (937) 415-2361
TAX RATE
ESTIMATED TOTAL (2% Vandalia; 2% Brookville; 1% Butler Twp LESS: OVERPAYMENT AND/OR
TAXABLE INCOME JEDZ) ESTIMATED TAX DUE PRIOR PAYMENTS NET TAX DUE
An extension of __________ days for filing the City income tax return for the year shown above is requested.
By signing below, I declare that the extension requested herein for filing the income tax return for Vandalia, Brookville and/or the Butler Township JEDZ is necessary, that I am authorized to sign this request, and that the
estimated tax amounts shown above are true and complete to the best of my knowledge.
Signature of Taxpayer _____________________________________________________________ Date _____________________________ Title (if officer of corporation) ___________________________________
TAXABLE ITEMS
• Wages, salaries and other compensation • Employer provided educational assistance and/or reimbursement (taxable to
• Commissions, fees and other earned income the same extent as for federal taxation)
• Sick pay; Vacation pay; Holiday pay • Royalties, if not derived from intangible property
• Bonuses, stipends and tips • Employer paid premiums for group term life insurance (taxable to the same
• Employer supplemental unemployment benefits (SUB pay) extent as for federal taxation)
• Director fees • Compensation paid in goods or services or property usage (taxed at fair market
• Strike pay value) or excess employee discounts
• Employee contributions to retirement plans and tax deferred annuity plans • Prizes and gifts if connected with employment
(including Sec. 401(k), 403(b), 457, etc.) • Income from guaranteed annual wage contracts
• Amounts attributable to non-qualified deferred compensation plans • Income from jury duty
• Income from wage continuation plans (including retirement incentive plans, • Executor fees
severancepay and golden parachute payments) • Union steward fees
• Pre-retirement distributions from retirement plans • Net profits of businesses, professions, sole proprietorships, joint ventures,
• Income from partnerships, estates or trusts partnerships, corporations, LLCs, etc.
• Contributions made on behalf of employees to tax deferred annuity programs • Ordinary gains as reported on Federal Form 4797
• Uniform, automobile, moving and travel allowances • Income received as a result of a covenant not to compete
• Reimbursements in excess of deductible expenses • Profit sharing
• Employee contributions to costs of fringe benefits • Stock options
• Net rental income • Gambling and lottery winnings
• Net farm income
NON-TAXABLE ITEMS
• Interest income • Active duty military pay (including National Guard and Reserves when on
• Dividends active duty)
• Capital gains • Educational scholarships unless subject to federal taxation
• Social Security • Housing allowances for the clergy to the extent that the allowance is used to
• Income from federally qualified retirement or pension plans provide a home
• Earnings of persons under 18 years of age • Health and welfare benefits distributed by governmental, charitable, religious
• State unemployment benefits or educational organizations
• Worker’s compensation • Proceeds of sickness, accident, liability, or life insurance policies
• Court ordered child support • Compensatory insurance proceeds derived from property damage or personal
• Alimony injury settlements
• Annuity distributions • Disability payments received from private industry or local, state or federal
• Prizes or gifts not connected with employment governments or from charitable, religious or educational organizations
• Patent and copyright income • Compensation for serving as a precinct election official under $1,000
• Royalties derived from intangible income
This list is for informational purposes only. It may not be all-inclusive and is subject to revision without notice.
For items not listed, contact the Income Tax Office for clarification at (937) 415-2240.
