YEAR                                                                                FOR TAX OFFICE USE ONLY
                    FILE WITH                                                                                                                           AMOUNT PAID                                                                 DATE
CITY OF STRUTHERS INCOME TAX                                                                                                                                                            CASH
             6 ELM STREET                                                                                                                                                               CHECK NO
                                                                                    or          Fiscal Period
          STRUTHERS, OHIO 44471                                                                                                                         AUDITED                                             DATE OF
                                                                                                                                                        BY                                                  AUDIT
PHONE: (330) 755-2181  FAX: (330) 755-2916
          Web: www.cityofstruthers.com                                                              to                                                DUE DATE: APRIL 15 OR THE IRS DUE DATE
TAX RETURNS NOT FILED BY THE DUE DATE WILL BE ASSESSED A LATE FILE PENALTY OF $25 PER                                                       ATTACH:           ALL  W-2  FORMS,  1099M  FORMS,  SUBSTANTIATING 
MONTH (MAXIMUM $150), LATE PAYMENT/ESTIMATE PENALTY OF 15% OF THE UNPAID TAX BALANCE                                                        FEDERAL SCHEDULES(I.E. A,C,E,F), AND FEDERAL 1040,1040A, 1040EZ,
                                                                                                                                            1120 OR 1120A, 1120S.
AND INTEREST OF 0.5% PER MONTH (6% PER ANNUM).                                                DATE OF BIRTH                                 EXTENSIONS:               EXTENSION  REQUESTS  MUST  BE  FILED  BY  THE  DUE 
RETIRED             UNEMPLOYED                      UNDER 18                    TAXPAYER:                                                   DATE.  FEDERAL  EXTENSIONS  WILL  BE  HONORED  IF  ATTACHED  TO  THE 
PLEASE MAKE ANY NAME OR ADDRESS CHANGES BELOW.                                  SPOUSE:                                                     RETURN  AND POSTMARKED BY THE EXTENDED IRS DUE DATE.
                                                                                                                                            TAXPAYERS CITY WHERE EMPLOYED
                                                                                                                                            SPOUSES CITY WHERE EMPLOYED
                                                                                                                                              SOCIAL SECURITY NO. (SELF)                                  SOCIAL SECURITY NO. (SPOUSE)

                                                                                                                                              FED. I.D. NO.                                               PHONE NO.
                                                                                                                                                                                                          (                       ) -
          1. WAGES, SALARIES, TIPS & ALL OTHER EMPLOYEE COMPENSATION (Enclose W-2 Forms and/or 1099 MISC. Forms)                                                                                          (1)                    $
          (Total Compensation Before Any Payroll Deductions - Include Sub Pay, Deferred Compensation) Do Not Include Interest Income.
          2. OTHER INCOME (List Type ___________________________________________)                                                                                                                         (2)                    $
          (Include Income From Tips, Commissions, And Other Miscellaneous Income.)
          3. PROFIT AND LOSS (LOSSES MAY NOT BE USED TO OFFSET SALARIES, WAGES, COMMISSIONS OR OTHER PERSONAL
          SERVICE COMPENSATION)
          A.  BUSINESS OR PROFESSION . . . . . . . . . . . . . . . . . . . . . . .  LOSS ($_______________)                                   PROFIT $_______________
             (Attach Schedule C. Form 1120, 1120A, 1065 of 1120S)
          B.  RENTS, PARTNERSHIPS  . . . . . . . . . . . . . . . . . . . . . . . . . .  LOSS ($_______________)                               PROFIT $_______________
  INCOME     (Attach Schedule E)
          C. NET TAXABLE INCOME (Add Lines A,B) NOT LESS THAN ZERO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                        (3C)                   $
          4. NON TAXABLE INCOME   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (4)                    $
          A. NOLCF (from 2017 at 50%)   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     (4A)                   $
          5. TAXABLE INCOME (Line 1 Plus Line 2 Plus Line 3C as adjusted by Line 4 and 4A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                    (5)                    $
          6. CITY TAX DUE 2% Of Line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  (6)                    $
          7. CREDITS
          A. STRUTHERS INCOME TAX WITHHELD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  (7A)                      $
          B. CREDIT FOR TAX PAID TO OTHER CITIES (Not to Exceed 2% per W-2 per city)                                                                              (7B)    $
          C. OVERPAYMENT FROM PRIOR YEAR                                                                                                                          (7C)    $
          D. ESTIMATED TAX PAYMENTS                                                                                                                               (7D)    $
          E. TOTAL CREDITS (Add Lines A, B, C, D)                                                                                                                                                         (7E)                   $
                                                                                                                                                          A. Tax due under $10.00 not required
  CREDITS 8. BALANCE TAX DUE IF LINE 6 IS GREATER THAN LINE 7E (Payment in Full Must Accompany Return)                                                    B. Tax overpaid under $10.00 not returned (8)                          $
          9. PENALTY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (9) $
          10. TOTAL AMOUNT DUE PAYABLE TO CITY OF STRUTHERS (LINE 8 PLUS LINE 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (10) TOTAL DUE                                                                        $
          11. OVER PAYMENT CLAIMED (If Line 7E Exceeds Line 6 Enter Difference Here) . . . . . . . . . . . . . . . . . . . . . . . . . (11) $
          AMOUNT TO BE CREDITED TO NEXT YEAR ESTIMATE     $                                                                         OR REFUNDED                 $
                         DECLARATION OF ESTIMATED TAX FOR YEAR
1.  ESTIMATED TOTAL TAXABLE INCOME FOR YEAR  (Gross Income) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   (1)                                                $
2. ESTIMATED TAX DUE 2%  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    (2)              $
3. LESS CREDIT FOR TAX PAID TO ANOTHER CITY (2% Of Wage On Which Other City Tax is Paid) _________________________________ (3)                                                                                                   $
                                                                                                                                                                (NAME OF CITY)
4.  LESS STRUTHERS CITY TAX TO BE WITHHELD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   (4)                                 $
5.  BALANCE OF ESTIMATED STRUTHERS CITY TAX DECLARED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  (5)                                                $
6.  LESS CREDITS (A) OVERPAYMENT ON PREVIOUS YEAR’S RETURN . . . . . . . . . . . . . . . . .  (6A)                                        $
                    (B) PREVIOUS PAYMENT IF THIS IS AN AMENDED DECLARATION . . . . . . (6B)                                               $
                    (C) OTHER (Specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  (6c)   $
                    (D) TOTAL CREDITS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  (6D)                    $
7.  NET TAX DUE (Line 5 Less Line 6D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     (7)                $
8.  AMOUNT PAID WITH THIS ESTIMATE (Not Less Than 1/4 Of Line 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    (8)                                          $
9.  BALANCE OF ESTIMATED TAX DUE (Line 7 Less Line 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    (9)                                   $
          BALANCE PAYABLE IN EQUAL INSTALLMENTS FOR EACH CALENDAR QUARTER
I CERTIFY THAT I HAVE EXAMINED THIS RETURN (INCLUDING ACCOMPANYING SCHEDULES.  FORMS AND STATEMENTS) AND BELIEVE IT IS TRUE.  CORRECT AND COMPLETE.
X                                                                                                                       X
SIGNATURE OF PERSON PREPARING, IF OTHER THAN TAXPAYER                                 DATE                              SIGNATURE OF TAXPAYER OR AGENT

NAME OF FIRM OR EMPLOYER                                                                                                TITLE                                                                                                       DATE
                                                                                                                        X
ADDRESS                                                                               PHONE                             SPOUSE SIGNATURE IF JOINT RETURN                                                                            DATE

IF YOU MOVED DURING THIS CALENDAR YEAR, PLEASE ANSWER

 MOVED INTO          STRUTHERS, OHIO                              ON                                                           FROM

 MOVED FROM          STRUTHERS, OHIO                              ON                                                           TO

                                              (ATTACH FEDERAL FORMS AND SCHEDULES)

        SCHEDULE A   -  PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION - SOLE PROPRIETORSHIP - PARTNERSHIP - OR CORPORATION
1.  NET PROFIT (OR LOSS) FROM BUSINESS OR PROFESSION (ATTACH FEDERAL FORMS AND SCHEDULES) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ______________________
2.  A.  ITEMS NOT DEDUCTIBLE (Schedule X, Line M) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   Add  $ ______________________
 B.     ITEMS NOT TAXABLE (Schedule X, Line Z) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deduct  $ ______________________
 C.     ENTER EXCESS LINE 2A OR 2B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  $ ______________________
3.  A.  ADJUSTED NET INCOME (Line 1 Plus / Minus Line 2C) IF SCHEDULE X IS USED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   $ ______________________
 B.     AMOUNT ALLOCABLE TO STRUTHERS IF SCHEDULE Y STEP 5 IS USED ____________________ % OF LINE 3A . . . . . . . . . . . . . . . . . . . . . . .  $ ______________________
4.  TAXABLE BUSINESS INCOME: LINE 3A OR LINE 3B (Enter On Page 1 Line 5) . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  $ ______________________

                     SCHEDULE X - RECONCILIATION WITH FEDERAL INCOME TAX RETURN
        ITEMS NOT DEDUCTIBLE                                      ADD                                                          ITEMS NOT TAXABLE                                                                               ADD
a.  CAPITAL LOSSES (From Federal Schedule D) . . . . . . . . . . . . . . . $ _________________________                     n.  CAPITAL GAINS (Exclusive of Gains treated as Ordinary income for
                                                                                                                            Federal Income Tax purposes Attach Federal Schedule D) . . . . . . . . . . . . .  $ ___________________
b.   EXPENSES APPLICABLE TO NON-TAXABLE INCOME
 (Not less than 5% of line Z) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   _________________________    o.  INTEREST EARNED OR ACCRUED (Subject to Ohio intangible
                                                                                                                            Personal Property Tax and Obligations of the United States Govern-
                                                                                                                            ment) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    ___________________
c.  INCOME TAXES (Federal-State-Municipalities) . . . . . . . . . . . . . . .   _________________________

d.  PAYMENTS TO PARTNERS OR COMPENSATION OF
 OFFICERS, SUB CHAPTER S CORPORATION . . . . . . . . . . . . . .   _________________________                               p.  DIVIDENDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    ___________________
e.  SICK PAY EXCLUSIONS OMITTED IN LINE 1 ABOVE . . . . . . . . .   _________________________
                                                                                                                           q.  INCOME FROM PATENTS AND COPYRIGHTS . . . . . . . . . . . . . . . . . . . . . .   ___________________
f.  CONTRIBUTIONS in                            _________________________
                                                                                                                           r.  OTHER (Explain) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  ___________________
g.  LOSS CARRY FORWARD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  _________________________
h.  OTHER (EXPLAIN) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  _________________________  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ___________________

m.  TOTAL ADDITIONS (ENTER ON LINE 2A ABOVE) . . . . . . . . . . . . $ _________________________                           z.  TOTAL DEDUCTIONS (ENTER ON LINE 2B ABOVE) . . . . . . . . . . . . . . . . . $ ___________________

SCHEDULE Y  - BUSINESS ALLOCATION FORMULA
                                                                                                                            A.   Located                                                     B.   Located in       C. Percentage
                                                                                                                               Everywhere                                                       STRUTHERS               (B - A)
Step 1.  Average value of real and tangible personal property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  $ ___________________                       $ ___________________

       Gross annual rentals multiplied by 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  $ ___________________               $ ___________________

       Total step 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  $ ___________________ $ ___________________ __________________ %

Step 2.  Total wages, salaries, commissions and other compensation
       of all employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . . . . . . . . . . . .   $ ___________________   $ ___________________ __________________ %

Step 3.  Gross receipts from sales and work or services performed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  $ ___________________                           $ ___________________ __________________ %

Step 4.  Total percentages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  __________________ %

Step 5.  Average percentage (divide total percentages by number of percentages used enter Schedule A, Line 3B.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . __________________ %