Form  D1-X            City of Dayton, Ohio Individual Income Tax Return Request For Extension 
 For tax year              ending December or                                             
 Taxes are due and payable by the due dates. An extension is to file the return, NOT TO PAY TAXES OWED. If a 
 payment is required with this form, you must file a D-1 estimate for next year and make quarterly estimated 
 tax payments. 

 Are you a Dayton resident? Yes  No           Will you be filing the Return:  Single      or Joint Filing    ? 
 
 Name                                                          Your Tax ID#, Account # , or SS#                     
 Spouse Name                                                   Spouse Tax ID#,  Account #, or SS#                                  
 Your Address                                                  Your telephone #                                    
 City/State/Zip                                                       Your E-mail address                         
 Did you file a Dayton Return last year? Yes  or No    . Did you file on a different Tax ID# last year? Yes      or No         
 1 ESTIMATED DAYTON Income subject to tax                                                   1     $              
 2 ESTIMATED DAYTON Tax Due @ 2.5%                                                          2     $              
   Tax Credits 
 A Dayton Tax withheld                                 A     $ 
 B Other City Tax withheld                             B     $ 
 C Credits from prior tax years                        C     $ 
 D Estimated quarterlypayments made                    D     $ 
 3 Total credits available                                                                    3   $
 4 Balance of Dayton Tax Due (Line 2 Minus Line 3)                                            4   $
 
 An extension of                days until                       for filing a Dayton return is herebyrequested. 
 
 READ BEFORE SIGNING: The undersigned declare this extension is necessary and adjusted to the requirements of the Dayton city tax 
 ordinances represented by this request. I understand that if I have not paid 90% of my final tax liability in the tax year the extension is 
 requested for and/or under withheld in the following year (by $200.00 or 10% of tax due) I will be charged Penalties and Interest if I fail to 
 make required estimated tax payments. 
   Tax Preparer Signature                              Taxpayer Signature                                 Date                 
 
   Tax Preparer Telephone #                            Spouse Signature                                   Date                
  A copy of this request must be submitted when you file your return. 
  Submit completed form with copy of your Federal Extension Request (if applicable) to: 
  Mail Extension with BALANCE DUE      To:             City of Dayton PO Box 643700               Cincinnati, OH 45264-3700 
  Mail Extension with ZERO BALANCE DUE To: City of Dayton             PO Box 1830             Westerville, OH 43086-1830 
  If you should have any questions please E-mail us or Call:          taxquestions@daytonohio.gov  (937) 333-3500 (Phone) 
                                                                                                             (937) 333-4280 (Fax) 
 
  A request for a period of 120 days or less need not be filed if no balance is expected to be due. However, Federal form 4868 or 7004 must 
  be attached when you file your return. Form D1X must be filed for extension in excess of 120 days. You are considered to have "reasonable 
  cause" for the extended period only if at least 90% of your actual tax liability is paid before the regular due date of your return through 
  withholding or estimated quarterly tax payments. (Refer to tax instructions on Federal IRS extension forms 4868 and 7004). 

  Any taxpayer that has requested an extension for filing a federal income tax return shall be granted an extension for the filing of the city 
  income tax return for the same taxable year by filing a copy of the taxpayer's federal extension request for such taxable year with the Tax 
  Administrator. Any taxpayer not required to file a federal income tax return may make a written request for an extension to file a city 
  income tax return. The request for extension must be filed on or before the original due date for the city income tax return, as set forth in 
  Section 36.104(A). If the request is granted, the extended due date of the city income tax return shall be the fifteenth (15th) day of the 
  tenth (10th) month after the last day of the taxable year to which the return relates. 

  As provided in Ohio Revised Code Section 718.05 and in the rules and regulations, a taxpayer who receives an extension for filing the 
  federal income tax return will receive an extension for filing the city income tax return for the same taxable year by complying with Ohio 
  Revised Code Section 718.05(G), but such taxpayer must pay any city income tax owed by the un-extended due date for filing the city 
  Income tax return, as provided in Section 36.104(F). 
 
                                                                                                                              (Rev 1/2018)