FORM BR file with:                                                         CITY OF BROOKVILLE                                                                                   CHECK ONE: 
Income Tax Office                                                                                                                                                                    Corporation 
P.O. Box 727                                                  2022 BUSINESS INCOME TAX RETURN                                                                                        Partnership 
333 J.E. Bohanan Memorial Dr.                                                                                                                                                        Other ______________ 
Vandalia, OH 45377                                                     FILING REQUIRED EVEN IF NO TAX DUE                                                                        
Phone: (937) 415-2240; Fax: (937) 415-2361                      DUE ON OR BEFORE APRIL 18, 2023 OR WITHIN        
Toll free: (866) 898-5891                                         3½ MONTHS FROM END OF FISCAL YEAR                                  FEDERAL ID NO.   _______________________________                                     
                                                                BEGINNING __________ AND ENDING __________ 
Email: tax@vandaliaohio.org                                                                                                           
www.vandaliaohio.org                                                                                                                 Nature of Business   _______________________________ 
                                                                                                                                      
LIST NAME AND ADDRESS BELOW.                                                                                                         Old Address   ____________________________________ 
                                                                                                                                      
                                                                                                                                     Date Moved  (in) ______________   (out) ______________                               
                                                                                                                                     DID YOU FILE A CITY INCOME TAX RETURN THE 
                                                                                                                                     PREVIOUS YEAR?             Yes           No  
                                                                                                                                      
                                                                                                                                     Email address  ____________________________________ 

SECTION A 

1.  Income per attached Federal Return ………………………………………………………………………………………………...                                                 1. 
2.  Adjustment from Schedule X ……………………………………………………………………………………………………….                                                        2. 
3.  Adjusted Federal Taxable Income (Line 1 +/ -Line 2)       ……………………………………………………………………………...                                 3. 
4.  Total Unutilized Pre-apportioned Losses from tax years beginning on or after 1/1/17 (subject to 50% limitation) ……………….    4. 
5.  Pre-apportioned Losses from tax years beginning on or after 1/1/17 utilized in tax year 2022 (see instructions) ………………...  5. 
6.  Income/Loss Subject to Apportionment (Line 3  -Line 5 if applicable) …………………………………………………………….                              6. 
7.  Amount Allocable to Brookville (If Schedule Y is used __________% of Line 6) MUNICIPAL TAXABLE INCOME ………..                7. 
8.  TAX DUE (2% x Line 7) ……………………………………………………………………………………………………………                                                            8. 
9.  TAX CREDITS 
      9-A.  Estimated Tax Paid …………………………………………………………………………………………………………..                                                      9- A.
      9-B.  Credit from Prior Year ……………………………………………………………………………………………………….                                                    9- B.
      9-C.  Total Credits Available ………………………………………………………………………………………………………                                                    9- C.
10.  BALANCE OF TAX DUE (Line 8  -Line 9-C)                   …………………………………………………………………………………..                                10. 
11.  Penalty $________________  Interest $________________  Late Fee $________________ …………………………………..                         11. 
12.  TOTAL AMOUNT DUE (Make check payable to City of Vandalia) 
      (No payment due if $10.00 or less) ………………………………………………………………………………………………...                                               12. 
13.  If overpayment ($10.01 minimum), please indicate below: 
      13-A.  CREDIT TO NEXT YEAR        ………………………………………………………………………………………………...                                                13- A.
      13-B.  REFUND   …………………………………………………………………………………………………………………...                                                           13- B.

Reviewed by _____________  Check No. __________________  Cash __________________  Amt. Received _________________              
 
SECTION      B  -Declaration of Estimated Tax for 2023 
 
14.  Income Subject to Tax x Tax Rate (2%) ………………………………………………………………………………………………….                                              14. 
15.  Quarterly Amount Due (1/4 of Line 14)  …………………………………………………………………………………………..                                               15. 
16.  Credit from Line 13-A    ($10.01 minimum) ………………………………………………………………………………………..                                             16. 
17.  Amount of Estimated Tax Due with this Return (Line 15  -Line 16)  ……………………………………………………………..                               17. 
18.  Total Payment Due (Line 12 + Line 17) …………………………………………………………………………………………..                                                18. 

SECTION C 
Please refer to the website, www.vandaliaohio.org, to access the online payment center to pay by credit card or electronic check. 
Credit card payments are now accepted in person in the tax office as well. 
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, adjusted to the ordinance requirements for local tax purposes.  If an audit of the federal return is made which affects the tax liability shown on the return, an amended return is required to be filed within 90 days.  
If this return was prepared by a Tax Practitioner, may we contact your practitioner directly with questions regarding the preparation of this return?          Yes           No 

Signature of Person Preparing Return (If Other Than Taxpayer)                   Date                    Signature of Taxpayer                                                                   Date 

Phone Number                                                                                            Title 

ALL FEDERAL SCHEDULES AND OTHER SUPPORTING DOCUMENTS SHOULD BE ATTACHED TO THIS RETURN                                                
 
SCHEDULE X  -Reconciliation with Federal Income Tax Return 

                     ITEMS NOT DEDUCTIBLE                                    ADD                                            ITEMS NOT TAXABLE                                 DEDUCT 
                                                                                                      N. Capital Gains from sale, exchange or other disposition (including 
A. Capital Losses (including IRC 1221 & 1231 property) …………….        $                                IRC 1221 & 1231 property) ……………………………………………                           $ 
B. Expenses attributable to non-taxable income ……………………….            $                                O. Interest earned or accrued …………………………………………..                      $ 
C. City & State income taxes and other taxes based on income ……….    $                                P. Dividends ……………………………………………………………                                  $ 
D. Net Operating Loss deduction per federal return……………………           $                                Q. Other intangible income (please explain) …………………………..              $ 
E. Payments to Partners (including former partners) …………………..        $                                _______________________________________________________                
F. Amounts distributed or set aside for REIT & RIC investors ………..   $                                R. Federal Tax Credits (if expense reduction) …………………………              $ 
G. Amounts deducted for self-employment retirement, health and life 
insurance plans …………………………………………………………                               $                                S. Other income exempt from city tax (please explain) ……………….         $ 
H. Special Deduction (Line 29b from Form 1120) …………………….             $                                _______________________________________________________                
I. Rental activities by Partnership, S-Corp, LLC, Trusts ………………      $                                Z. Total of Lines N through S  ………………………………………….                      $ 
J. Other expenses not deductible (please explain) ……………………..         $                                                                                                       
______________________________________________________                                                                                                                       
M. Total of Lines A through J ………………………………………….                      $                                                                                                       

1.  INCOME PER ATTACHED FEDERAL RETURN                  ………………………………………………………………………………………………………………...                                                       $ 
2.  A.  ITEMS NOT DEDUCTIBLE (From Line M Schedule X above)         ……………………………………………………                           Add                                       
     B.  ITEMS NOT TAXABLE (From Line Z Schedule X above) …………………………………………………………                                   Deduct                                    
     C.  ENTER EXCESS OF LINE 2A OR 2B (Carry to Line 2 Page 1) ……………………………………………………………………………………………….                                                       $ 
SCHEDULE Y  -Business Apportionment Formula 
 Use this schedule if engaged in business in more than one locality, and you do not have books and records which will disclose with reasonable accuracy what portion of the net profits is 
 attributed to that part of the business done within the boundaries of Brookville. 
 A. Located Everywhere                                                                                                                                       
      Step 1.  Original cost 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 made and work or services performed …………………………………………………………………………………………..                                           $ 
 B. List city portion of the above 3 steps in spaces below and compute percentage for Brookville (B divided by A)                                            
  
                                        CITY OF BROOKVILLE 

                                $ 
 Step 1  
                                                                                   % 
                                $ 
 Step 2  
                                                                                   % 
                                $ 
 Step 3  
                                                                                   % 
 Average                                                                                  *Determine average percentage by dividing 
 Percentage*                                                                       %      total percentages by number of percentages 
                                                                                          used.       

*Enter average percentage on Line 7 Page 1. Multiply percentage by Income/Loss Subject to Apportionment on                                                    
  Line 6 Page 1 to calculate the Municipal Taxable Income.                                                                                                    

Are any employees leased in the year covered by this return?  (Check box)        Yes          No  
 
If yes, please provide Name _______________________________ Address ________________________________________ and Federal ID # of the leasing company ____________________________