City of Lakewood – Division of Municipal Income Tax 
                                                         12805 Detroit Ave., Suite 1 
                                                          Lakewood, OH 44107  
                                         Telephone: (216) 529-6620     Fax: (216) 529-6099 
                                                          www.lakewoodoh.gov  
                                                                            
        Form L-ES(b) - Declaration of Estimated Tax for Businesses 
                                                                            
                                             Tax Year: ___________ 
                                                                            
Per Lakewood Ordinance §128.1303 and 128.1304, entities owing two hundred dollars ($200.00) or more of estimated tax 
are required to file a declared estimate of income tax on or before the April filing deadline, or within four (4) months of 
the date the entity becomes subject to tax for the first time. 
 
                       _________                                 ____  ___________________________________________  
FEIN/FEID                                    Business Name 

__________________________________________     _________________         _   ____       ______________ 
Present Address                                          Suite. #          City                    State          Zip Code 
  
ESTIMATED TAX CALCULATION 
 
1. a. Total taxable income for current tax year                             $____________ 
 
       Prorated Income (use this calculation if conducted business in Lakewood part of the year) 
       b. Annual income Line 1a / 12 months = $______________ 
       c. Monthly income Line 1b x _______ months in Lakewood = $____________ 
       Enter the applicable amount on Line 1 from Line 1a or Line 1c                          1. ___________________ 
                                                                                                   (Line 1a or Line 1c) 
2. Multiply Line 1 by 1.5% (or .015). This is your estimated income tax for the  
    entire year. If this amount is less than $200 – STOP, no estimate required.               2. ___________________         
 
3. Multiply Line 2 by 25% or 0.25.                                                            3. ___________________ 
 
4. Estimated income tax payments are     BILLED quarterly on the following dates:             4. ___________________ 
       March 1st       May 15th          August 15th             December 15 th
       Due April 15 th Due June 15  th   Due September 15  th    Due January 15 th

    Circle the dates that already passed as of the date you are completing this form and 
    enter the number of the dates circled above on Line 4. 
 
5. Multiply Line 3 by Line 4. Enter the amount on Line 5. This is the amount due with      5. ____________________          
       this form. 
 
I hereby declare the information supplied above to be true, correct, and complete. 
 
Signature____________________________________________________ Date _______________________________ 
 
Print Name __________________________________________________Title _______________________________ 
 
                  Mail completed form to the above Lakewood address or fax to: (216) 529-6099 

              INSTRUCTIONS FOR FORM DECLARATION OF ESTIMATED TAX 
                                                           
Per Lakewood Ordinance §128.1303 and 128.1304, entities owing two hundred dollars ($200.00) or more of 
estimated tax are required to file a declared estimate of income tax on or before the April filing deadline, or  
within four (4) months of the date the entity becomes subject to tax for the first time. 
 
 1. a. Enter the amount of total taxable income for the year.  
 
    UTILIZE THE  FOLLOWING LINES  ONLY IF  THE BUSINESS BECAME  OPERATIONAL  IN 
    LAKEWOOD DURING THE CURRENT YEAR 
    b. Calculate the monthly income. Divide Line 1a by 12 months. 
    c. Calculate the total income for the time the business was operational in Lakewood.  Multiply Line 1b  
    by the months operational in Lakewood.  
 
    Enter the applicable amount on Line 1 from Line 1a or Line 1c. 
 
 2. Multiply Line 1 by 1.5% or .015. Enter the amount on Line 2. This is the estimated income tax for the 
    entire year.  If this  amount is less than $200,      STOP, as  no estimated tax declaration is required  per 
    Lakewood Ordinance §128.1303. 
     
 3. Multiply Line 2 by 25% or .25. Enter the amount on Line 3. 
     
 4. Estimated income tax is billed by the City on a quarterly basis once a declaration of estimated tax has 
    been filed with  our office. To ensure  the  declared estimate is entered  into  the billing cycle  at the 
    appropriate time, circle the dates that have already passed as of the date you are completing this form. 
    Enter the number of dates circled on Line 4. 
     
 5. Multiply Line 3 by Line 4. Enter the amount on Line 5. This is the amount due with this form. If the 
    amount is zero, there is no payment due at this time and upon submitting this form to our office, the 
    declared estimate will be entered into the billing cycle for the remaining quarters. 
 
In all cases where the business is required to file an estimated tax declaration, the FEIN/FEID, business name, 
and address must be provided.  
 
This declaration form is not valid and will not  be processed  without the  date and  business  representative’s 
signature.