CITY OF MANSFIELD                                        FORM FR – B
       INCOME TAX DIVISION                                    INCOME TAX RETURN
       P.O. BOX 577                                             YEAR                                                  BUSINESS 
       MANSFIELD, OHIO 44901-0577                                     2022 
       Telephone (419) 755-9711                                      OR 
                 Fax (419) 755-9751 
       Make Checks and Money        Fiscal Period__________________to____________________                             Tax Return for 
       Orders Payable to:           CALENDAR YEAR TAXPAYERS FILE ON OR BEFORE APRIL 18, 2023                          ___Corporationn
       City of Mansfield            FISCAL and PARTIAL YEARS FILE WITHIN 105 DAYS AFTER THE CLOSE OF THE FISCAL YEAR. ___Partnerships 
                                                                                                                      ___Fiduciary 
       DID YOU FILE A CITY          Is this   a Final Return? n  Yes   No                                             ___Estates 
       RETURN LAST YEAR?                                                                                              ___Trusts 
                                                                                                                      CHECK ONE
       n  Yes             No?      

       Name: __________________________________________ 

       Address: ________________________________________ 
                                                                                              Federal Employer Identification Number 
       City:_______________  State: _______________    Zip Code:______ 
                                                                                             Has a return been previously filed with 
       Is this an address change    ___Yes  ___No                                            Mansfield Using this number?     
                                                                                              YES                       NO

       1.   Taxable Income from Federal Return (attach Copy of Federal Return)………………………………………………………………                           $ 
       2.   Adjustments (from line O, Schedule X) on following page..…………………………………..…………………………………………..                           $ 

       3.   Loss carry forward (Tax year 2017 is the first loss carry forward year allowed).…………………..………………….......              $ 
       4.   Taxable Income before allocation (Line 1 plus/minus line 2 less line 3) …………………………………………………………..                     $ 
       5.   Apportionment Percentage (From Schedule Y) _____________%

       6.   Mansfield Taxable Income (Multiply line 4 by line 5)…………………………………………………………………………………………..                             $ 
       7.   Mansfield Income Tax (Multiply line 5 by 2%)…………………………………………………………………………………………………….                                  $ 
       8.   Credits applied from 20___ to this year’s liability…………………………………………………………………             $ 
       9.  Estimates paid on this year s' liability…………………………………………………………………………………….                 $ 
       10.   Total Credits………………………………………………………………………………………………………………………………………………………….                                            $ 
       11.  Tax Due (Subtract line 10 from line  )……………………………………………………………………………………………………………….7                                   $ 
       12.  LATE FILING PENALTY - PLUS LATE PAYMENT PENALTY (see instructions)……………………………………………………..                             $ 
       13.   Interest (5% per annum if paid after due date)……………………………………………………………………………………….                                    $ 

       14.    Total Due (If less than $10.00-do not remit)……………………………………………………………………..               Pay This Amount             $ 
       15.   Overpayment (Line 10 greater than line  )7(must be more than $10.00)………………………..         $ 
             A.  Amount from line 14 to be refunded……………………………………………………………………………..                   $ 
             B.  Amount from line 14 to be credited to next year………………………………………………………….              $ 
          If this return was prepared by a tax practitioner, check here if we may contact him/her directly with questions regarding the preparation of this return. 
       The undersigned declares that this return (and accompanying schedules) is a true, correct and complete return for the taxable period 
       stated and that the figures used herein are the same as used for Federal Income Tax purposes. 

       SIGNATURE OF PERSON PREPARING, IF OTHER THAN TAXPAYER    DATE           SIGNATURE OF TAXPAYER OR AGENT                      DATE 

       ADDRESS OF FIRM OR EMPLOYER                              PHONE #        TITLE                                               PHONE # 

        SCHEDULE X – RECONCILIATION WITH FEDERAL INCOME TAX RETURN 
        ITEMS NOT DEDUCTIBLE                  ADD                       ITEMS NOT TAXABLE                        DEDUCT 
A  Capital Losses (Excluding Ordinary Loss)…. $                I  Capital Gains (Excluding Ordinary Gain)        $ 
B  Income Taxes Paid……………………………………..          $                J  Interest Earned or Accrued………………….             $ 
C  5% of Amount Deducted as 
             Intangible Income……………………….      $                K  Dividends……………………………………………..                   $ 
                                                               L  Income From Royalties,  
D  Guaranteed Payments to Partners……………       $                    Patents and Copyrights………………………               $ 
E  Amounts for Qualified Self-Employed 
    Retirement, Health & Life Insurance Plans                  M  Other (Explain)
    For owners of non-C Corporation Entities                   _______________________________       $      
    or self-employment tax……………………………         $                _______________________________      $ 
F  Other………………………………………………………..               $                _______________________________   $ 
G  TOTAL ADDITIONS…………………………………..             $                N  TOTAL DEDUCTIONS                               $  $ 

                                                 Combine lines G and N and enter net on front page Line 2  $ 

                       SCHEDULE Y – BUSINESS APPORTIONMENT FORMULA 
                                                               A  Located         B  Located in                  C  Percentage 
                                                               Everywhere         Mansfield                          (B / A) 
Step 1  Average Original Cost of real and tangible personal property  $           $ 
       Gross annual rentals paid multiplied by 8…………………………….   $                  $ 
       Total Step 1…………………………………………………………….……………..             $                  $                                          % 
Step 2  Gross receipts from sales made and/or work or services 
        Performed……………………………………………………………….……………..  $                              $                                          % 
Step 3  Wages, Salaries, Etc. Paid……………………………………………………..       $                  $                                       % 
Step 4  Total Percentages……………………………………………………………………                                                                          % 
Step 5  Average percentage (Divide total percentages by number of percentages used – carry to line 4 on front)…… 

                       SCHEDULE Z – PARTNER’S DISTRIBUTIVE SHARE OF NET INCOME 

                                                               2  Social Security 3  Amount                      4  EIN of Payer 
1  Name and address of each partner                                Number 

(a) 

(b) 

(c) 

(d) 

Carry forward to line 1 on front                                        TOTAL 

                                    ATTACH FEDERAL SCHEDULES