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Form BR File With BUSINESS ACCOUNT
CITY OF MIDDLETOWN - CITY OF MIDDLETOWN -
INCOME TAX DIVISION TAXABLE PERIOD BEGINNING ____________________ AND ENDING _________________
P.O. BOX 428739
FEDERAL ID
(513) 425-7862 ISCAL YEAR DUE ON 15
MIDDLETOWN, OHIO 45042 TH DAY OF THE 4TH MONTH AFTER YEAR END
www.cityofmiddletown.org EXTENSION REQUESTS MUST BE ATTACHED TO YOUR RETURN.
TAXPAYERS NAME AND ADDRESS (MAKE ADDRESS CORRECTIONS)
CONSOLIDATED RETURN AMENDED RETURN
SHOULD YOUR ACCOUNT BE INACTIVATED? YES NO
IF YES, PLEASE EXPLAIN: __________________________________________
FILING STATUS (CHECK ONE)
CORPORATION S-CORPORATION
PARTNERSHIP LLC
FIDUCIARY (TRUSTS AND ESTATES)
BUSINESS TELEPHONE: __________________________________________
EMAIL: ___________________________________________________________
OFFICE USE ONLY
1. Adjusted Federal Taxable Income (attach copy of Federal return) . . . . . . . . . . . . . . . . . 1. Adjusted Federal Taxable Income (attach copy of Federal return) . . . . . . . . . . . . . . . . . 1 $ ______________1 $ ______________ 1 ______________1 ______________
2.2. AdjustmentsAdjustments(from(fromLineLineN,M,ScheduleScheduleX)X) ..................................................................... . 22$$____________________________ 22____________________________
3. 3. TaxableTaxableincomeincomebeforebeforeapportionmentapportionment(Line(Line11plus/minusplus/minusLineLine2)2)................................ 33$$____________________________ 33____________________________
4. 4. ApportionmentPre-Allocated NOLpercentage . . . . . . ._________% . . . . . . . . . . .(from. . . .Line. . . .5,. .Schedule. . . . . . . .Y). . . . . . . . . . . . . . . . . 4 $ ______________ 44 ____________________________
5. Apportionment percentage _________% (from Line 5, Schedule Y) 5 $ ______________ 5 ______________
5. Middletown taxable income (Line 3 multiplied by Line 4) . . . . . . . . . . . . . . . . . . . . . . . 5 $ ______________ 5 ______________
6. Middletown taxable income (Line 3 multiplied by Line 5) . . . . . . . . . . . . . . . . . . . . . . . 6 $ ______________ 6 ______________
6. Net loss carryforward (limited to 5 years)(Refer to ORC 718 for instructions).... . ... . . . . . . ......... . ... . .. . . . 6 $ ______________ 6 ______________
7. Taxable income after NOLS 7 $ ______________ 7 ______________
8. 7. IncomeNet losssubjectcarryforwardto Middletown(limited toincome5 years)tax.(Line. . . .5. .minus. . . . .Line. . . .6). ............................... . . . 78$$____________________________ 78____________________________
9.8. MiddletownIncome subjecttax isto1.75%Middletown(.0175)incomeof Linetax7. .(Line. . . . .6.minus. . . . . .Line. . . .8). ................................ . . 89$$____________________________ 89____________________________
10. 9. TaxMiddletowncredits: tax is 2.0% (.02) of Line 9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 $ ______________ 10 ______________
11. A. Tax Estimatedcredits: Payments ................... . ... . .. . . 9A $ ______________ 9A11A___________________11B_____
B. A. PriorEstimated Year PaymentsOverpayments 11A $__________............... . .B... .Prior. . . .Year9B Overpayments $ ______________11B $__________ Total tax credits (Lines 11A9B11C______________and_____________11B) 11C $___________
12. C. BalanceTotal taxDuecredits (if Line(Lines10 is9Agreaterand 9B)than..........................Line 11C) Line.10...minus. . . . .Line. 9C11C$ ______________. . . . . . . . . . . . 12 $ ______________ 9C12___________________________
10. Balance Due (if Line 8 is greater than Line 9C) Line 8 minus Line 9C . . . . . . . . . . . . . . .10 $ ______________ 10 ______________
NO TAX DUE OR REFUNDED IF LESS THAN $10.01
13. Overpayment (if Line 10 is less than Line 11C) Line 11C minus Line 10. . . . . . . . . . . . . . .13 $ ______________ 13 _____________
11. OverpaymentA. REFUND amount(if Line.8. .is. .less. . .than. . . .Line. . . .9C). . . .Line. . . .9C. .minus. . . . 13A Line$8......______________. ... . .. . . . 11 $ ______________ 1113A___________________________
A. B. CREDITREFUND amountamount . ....................... . . . . . . . . . ....... ...........11A. . . .$.______________. . . . . 13B $ ______________ 11A13B___________________________
B. CREDIT amount ...................... . ... . .. . . 11B $ ______________ 11B ______________
14. 12. TotalTotalestimatedestimatedincomeincomesubjectsubjecttototaxtax(to(toavoidavoidpenalty,penalty,nonolesslessthanthanLineLine7)10). ................12. 12 $ ______________$ ______________ 1212____________________________
13.15.EstimatedEstimatedtaxtaxduedue(multiply(multiplyLineLine1412byby2.0%1.75%[.02][.0175])IfIfIflesslessless) thanthanthan$200,$200,$200,estimatedestimatedestimatedpaymentspaymentspaymentsarearearenotnotnotrequiredrequired required15 13$ ______________ $ ______________ 1315____________________________
14.16. FirstFirstquarterquartertaxtaxdueduebeforebeforecreditscredits(at(atleastleast25%25%ofofLineLine13)15)...................................... . . 1416 $$____________________________ 1416____________________________
15.17. PriorPrioryearyeartaxtaxcreditcreditfromfromLineLine11B13Baboveabove.................................................................... 15 $ ______________17 $ ______________ 1517____________________________
16. Net estimated first quarter tax due with this return (Line 14 minus Line 15.)
(If(Ifnegative,negative,enterenterzero)*.zero)*............................................................................................... 16 $18______________$ ______________ 1618____________________________
19.17. TOTALTOTALTAXTAXDUEDUE (Lines(Lines1210andand18)16) MakeMakecheckcheckpayablepayableto Middletownto MiddletownIncomeIncomeTaxTaxDivisionDivision1719$$____________________________ 1719____________________________
are due by the 15thday of the 6 , 9thandth12 monthsth after the beginning of the taxable year.
*First*Firstquarterquarterestimatedestimatedth taxtax paymentpaymentsth th shouldshouldthbebepaidpaidwithwiththisthisreturn. return. SubsequentSubsequentestimatedestimatedpaymentspayments
are due by the 15 day of the 6 , 9 and 12 months after the beginning of the taxable year.
The undersigned declares that this return (and accompanying schedule) is a true, correct and complete return FOR OFFICIAL USE ONLY - PENALTY & INTEREST
of the taxable period stated and that the figures used herein are the same as used for Federal Tax purposes. FAILURE TO PAY ESTIMATE BY DEC 15 $ _______________________
Signature of Taxpayer or Agent ______________________________________________________________ FAILURE TO PAY ESTIMATE BY JAN 31 $ ___________________
FAILURE TO FILE BY APRIL 18 $ _______________________
Title ____________________________________________________ Date __________________________ FAILURE TO PAY TAX DUE BY APRIL 18FAILURE TO PAY TAX DUE BY APRIL 15 ___________________
________________________________________________________________________________________ FAILURE TO FILE BY APRIL 15INTEREST $ __________________________________________
Name & address of person or firm preparing this return
Telephone number of the preparer _______________________________________________________________________________ TOTAL PENALTYPENALTY& INTEREST $ __________________________________________
May we discuss this return with the taxpreparer? Yes No TOTAL PENALTY & INTEREST $ _______________________$ ___________________
GRAND TOTAL $ _______________________
