All City returns must include a copy of page 1 of IRS Form 
1040,  along  with  a  copy  of  all  W-2’s  and  1099’s.  If  you 
complete the “income other than wages” section of the return, 
you  must  provide  copies  of  the  federal  schedules  relating                                                                                                                                             15
to  this  income.                  A  return  is  not  considered  filed  until  all                                                                                          Extensions
necessary information is received.                                                                                                                                            If you need an extension to file,15you may request it directly 
                                                                                                                                                                              with the City of Midddletown or15attach a copy of15your federal 
                                                                                                                                                                              extension to your city return.  An15extension to file is not an 
                                                                                                                                                                                                                               15
                                                                                                                                                                              extension to pay; if you expect to owe us tax, you have to 
                                        18                                                                                                                                    pay that by April 18th as well. Late payments15are subject 
                                                                                                                                                                              to penalty and interest.                         15

                                                                                                                                                                              Questions?
                                                                                                                                                                              Call us at (513) 425-7862 or visit us at the City Building, One 
                                                                                                                                                                              Donham Plaza, Middletown OH 45042. We are located on 
                                                                                                                                                                              business, under Middletown Income Tax, then to download the second floor. Our hours are 8:00AM to 5:00PM, Monday 
                                                                                                                                                                              forms.through Friday. You can e-mail us at itax@cityofmiddletown.
                                                                                                                                                                              business, under Middletown Income Tax, then to download 
                                                                                                                                                                              org. You may also download forms from the website: 
                                                                                                                                                                              forms.business, under Middletown Income Tax, then to download 
SENIORS – If you turned 65 prior to 12/31/15 and have no                                                                                                                      www.cityofmiddletown.org go to Business, Income Tax, Tax 
                                                                                                                                                                              forms.
income other than pension, dividend, or interest, you do not                                                                                                                  business,Forms.under Middletown Income Tax, then to download  
need to file. However, your account will stay active until we SENIORS – If you turned 65 prior to 12/31/15 and have no 
are notified. Contact  our office if you have questions.income other than pension, dividend, or interest, you do not SENIORS – If you turned 65 prior to 12/31/15 and have no 
needSENIORSincometo file.other–However,Ifthanyoupension,turnedyour65dividend,accountprior to willor12stayinterest,/31/active21 andyouuntilhavedo notweno 
areincomeneednotified.to file.otherHowever,Contact than pension,ouryourofficedividend,accountif youwillorhaveinterest,stayquestions.activeyouuntildo notwe 
needare notified.to file. However,Contact  ouryourofficeaccountif youwillhavestayquestions.active until we 
are notified. Contact  our office if you have questions.

                                                                                                                                                                              14.
                                                                                                                                                                              15.
                                                                                                                                                                              16.

                                                                                                                                                                              17.
                                                                                                                                                                              18.
                                                                                                                                                                              19.
                                                                                                                                                                              20.
                                                                                                                                                                              21.
8. Vacation pay                                                                                                                                                               22.
9. Uniform, automobile and travel allowances
10. Reimbursement in excess of deductible expenses                                                                                                                            23.
11. Cost of group term life insurance over $50,000                                                                                                                            24.
12. Prizes and gifts connected to employment to the same extent
taxable for the Feds                                                                                                                                                          25.
13. Profit sharing

                                                                                                                                                                              14. 1099-C Cancellation of Debt
                                                                                                                                                                              15. Third party sick pay
                                                                                                                                                                              16. Election Poll work
8. Annuity distributions                                                                                                                                                      17. Income from non-qualified pension plans, unless deferred
9. Alimony received                                                                                                                                                                  from wage

    You must include a copy of all W-2’s, 1099’s, and page 1 of your 1040

               E.   If you had losses in the last five years, please refer to the Ohio Revised Code 718 for specific instructions.

You must provide a copy of all federal schedules relating to other income (ex. Schedule C, Schedule D, Schedule 4797, Schedule E, Schedule K1).
                                     A return is not considered filed until we have received all necessary schedules.

                                                                                                       2.0% of Column 2
                                                                                            $200.00                               $200.00
                                  $2,000.00                  $20.00                               $40.00                          $20.00
                                                                                                                                  $220.00

                                                                    20162022                      2

                                                                       DecemberJanuary15.15.

     APRIL 18TH*15                   JUNE 15                 SEPT 15                        JANDEC1515             APRIL 15TH

                                     April 1815th

Sign your completed return at the bottom and mail in the envelope provided. The return and tax due must be postmarked or paid by April 18.15If you 
are unable to pay the tax in full by April 18, send15the tax return so that you can avoid a late filing penalty of $25-$150. You may request a pay plan 
for a balance due, but we will access penalties and interest for paying late.

     You must include a copy of all W-2’s, 1099’s, and page 1 of your 1040
Form: IR Instructions, rev 12/22                                                                                                               S:3871