CITY OF BLUE ASH
                           BUSINESS DECLARATION OF ESTIMATED INCOME TAX
FOR OFFICIAL USE ONLY        FOR CALENDAR YEAR ______________   or  AMENDED RETURN TAX 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, ____________  or by the 15th day of the 4th month after the tax year begins.

FID#                                 Blue Ash Tax Acct #                                                       Filing Status (Check one)
Name(s)                                                                                                        □                                        C-Corporation
                                                                                                               □                                        S-Corporation
Address                                                                                                        □                                        LLC
                                                                                                               □                                        Partnership/Association
City/State/Zip                                                                                                 □                                        Fiduciary (Trust & Estates)

 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. * Quarterly Tax Due, if Line 2 is Greater than $200 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.             Less Credits (from Previous Year Return) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
5.             Amount Paid this Quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

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

               SIGNATURE                                   TITLE                           DATE                                                                                                                             PHONE NUMBER

 INSTRUCTIONS
Line 1. Base estimated income on the amount subject to tax in the preceding year, or on the preceding 3-month period annualized for the
        remainder of the year if the preceding tax year was not for a full 12-month period.
Line 2. Multiply Line 1 by 1.25% (or .0125) for the total tax declared.
Line 3. If Line 2 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 December 15th (12th month)
        For ease of calculation, 25% (or 1/4) of the total liability may be paid.
Line 4. If you overpaid last year's tax and requested the overpayment to be credited toward this year's estimated tax, enter the amount.
Line 5. Line 3 less Line 4.
               Make checks payable to the City of Blue Ash.

* Subsequent payments are equal to the quarterly tax due (Line 3) 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                  DECEMBER 15TH                                                                                                                               APRIL 15,            
(or 15th of 4th month)     (or 15th of 6th month)          (or 15th of 9th month)          (or 15th of 12th month)                                                                                                          (or 15th of 4th month)
Declaration w/1st Pmt      2nd Quarterly Pmt               3rd Quarterly Pmt               4th Quarterly Pmt                                                                                                                Balance Due w/Filing

Business filing for the first time should attach a Business Questionnaire Form.  This form is available on our website at www.blueash.com.

01-2016