EXTENSION DUE BY 4/18/2023
    FORM           City of Brook Park, Ohio Income Tax return Application for Automatic Extension of Time To File 2022 Tax Return.  
 23 BPERT                                                                                            This is not an extension of time to pay your tax.
 8/ Last name,     and initial                                                                Your social security number                     Corporate / Company Name                                           Account #                                                FISCAL TAXPAYERS DUE 15TH OF THE 4TH 

    If a joint return, spouse’s               name and initial                                Spouse’s social security number                 Contact Person                                                     Federal   #                          MONTH AFTER YEAR END

    Home address (number, street, and apt. no.)                                               Account #                                       Business Address

    City, state, and ZIP code                                                                 Phone #                                         City, state, and ZIP code

    Extension granted   until 10/16/2   3     or copy   of Federal Extension            request   is submitted   to Brook Park Tax Dept. with For calendar   yr 2021 ; Request extension   of time to: ______________________________________________ 
    tax return. Declarations   of Estimated             Tax      for 202 3are due by 4/18/2 3. Schedule C,   E and   F    are not subject 
    to Uniform Net         Base.                                                                                                              For     year end: _______________________________________________________________________    
 CALENDARUnder penaltiesTAXPAYERSof perjury, IDUEdeclareDATEthat I4/1have examined this form, including accompanying schedules and            Request extension time to: _________________________________________________________________            
    statements, and to the best of my knowledge and belief, it is true, correct, and complete; and, if prepared by                            If no dates entered, 10/16/2 3will be used.              Payment     of $ _____________________________ 
    someone other than the taxpayer, that I am authorized to prepare this form.
                                                                                                                                              Enclosed for __________________ QTR,       ________________ Year 
    Your Signature                                                                                      Date                                        Signature                                                              Date