City of Englewood, Income Tax Division 
Tax Year 20__ __
Form BR-1 City Income Tax Return For Business        OR 
Fiscal Year 20__ __
Business   Name  Beginning  _____ /_____ /_____ 
  Ending       _____ /_____ /_____ 
Address 
 Amended Return  Final Return 
Filing Status: DATE RECEIVED 
Address 
 C-Corporation TAX OFFICE USE ONLY: 
 S-Corporation 
City State Zip Code  Partnership PAYMENT AMOUNT __________________ 
 LLC CASH/CHECK/CC# ____________________ 
Federal ID# - Account Number - B  Fiduciary (Trusts/Estates)

SECTION A 
1. INCOME PER ATTACHED FEDERAL RETURN ………………………………………..…………………. ………………………….. 1 
2. ITEMS NOT DEDUCTIBLE (From Line M, Schedule X reverse page)……………………… … …….. .. 2 
3.      ITEMS NOT TAXABLE (From Line Z, Schedule X reverse page)…………………………………………. 3 
4. TAXABLE INCOME  (Line 1 + Line 2 - Line 3) …..……………………………………………………………………………………...  4 
 5. NET OPERATING LOSS FROM 2017 OR AFTER (Limited to 50%) …………………………………………………………….. 5 
6. TAXABLE INCOME AFTER NET OPERATING LOSS DEDUCTION …………………………………………...…………………. 6 
7. AMOUNT OF THE APPORTIONMENT FOR THE CITY OF ENGLEWOOD  (Schedule Y _________% x Line 4) ……................... 7 
8. TAX DUE  (Line 5 x 1.75%) ……………………………………………………………………………………………………………….. 8 
9. TAX CREDITS
     9A  Estimated Tax Paid ………………………………………………………………………………………. 9A 
     9B  Credit from Prior Year …………………………………………………………………………………….. 9B 
     9C  Total Credits Available (Line 9A + Line 9B) …………………………………………………………………………...………...  9C 
10. BALANCE OF TAX DUE (Line 8 - Line 9C) ……………………………………………………………………………………………. 10 
11. PENALTY $__________ INTEREST $________ LATE FEE $_________  ………………………………………………………… 11 
12. TOTAL AMOUNT DUE (Make Check Payable to the City of Englewood) (no payment if $10.00 or less) …………………….  12 
13. IF OVERPAYMENT: (Indicate Below Credit to Next Year and/or Refund)
     13A  CREDIT TO NEXT YEAR ……………………………………………………………………………….. 13A 
     13B  REFUND  (no refund if $10.00 or less) ….………………………………………………………...  13B 
SECTION   B — DECLARATION OF ESTIMATED TAX 
14. INCOME SUBJECT TO TAX x 1.75% ……………………………………………………………………………… 14 
15. QUARTERLY AMOUNT DUE  (1/4 of Line 14) ………………...…………………………………………………. 15 
16. CREDIT FROM 13A …………………………………………………………………………………………………. 16 
17. Line 15 - Line 16 (Amount of Estimated Tax being paid with this Return) ……………………………………………………………... 17 
Please attach copies of all appropriate Federal Return and Supporting Schedules. 18. TOTAL OF THIS PAYMENT (Line 12 + Line 17) ………………...………………………………………………………………………. 18 
 SIGNATURE   
 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, and 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 three months.   
Date 
Signature  
Sign 
Email 
Here Title 
 Date CONTACT INFORMATION 
Paid Preparer’s 
Preparer’s Signature  Phone Number City of Englewood 
Use Only Income Tax Department 
333 W National Rd 
Third  Do you want to allow another person to discuss this matter with the City of Englewood? (see instructions)    YES   (complete below)    NO Englewood, OH  45322 
Party Designee’s 937-836-5106
Designee Name Phone Number tax@englewood.oh.us 

                             ALL FEDERAL SCHEDULES LISTED BELOW AND OTHER SUPPORTING DOCUMENTS                                                           
                                                                MUST BE ATTACHED TO THIS RETURN. 

 SCHEDULE X        RECONCILIATION WITH FEDERAL INCOME TAX RETURN 

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

SCHEDULE   Y       BUSINESS APPORTIONMENT FORMULA 
Use this schedule if engaged in business in more than one city 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 the city or cities involved. 
                                                                                       A. LOCATED                 B. LOCATED IN      PERCENTAGE              
                                                                                       EVERYWHERE                 ENGLEWOOD             (B ÷ A)              
STEP 1.   ORIGINAL COST OF REAL & 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 AND OTHER COMPENSATION PAID………...                         $                        $                                   %     
STEP 4.   TOTAL PERCENTAGES………………………………………..                                        $                        $                                   %     
STEP 5.   AVERAGE PERCENTAGE (divide total percentages by number of percentages used).  Transfer to Line   for7 allocation …………………                              % 

 SCHEDULE Z        RECONCILIATION OF WITHHOLDING TAX 
A.   Total Wages Allocated to Englewood (From Schedule Y step 3 or Federal Return)…...                          $                     
B..  Total Wages Reported on Withholding Tax Reconciliation (W-3)………………………..                                    $                     
C.   If Lines A and B DO NOT MATCH, Provide a detailed explanation or a billing letter will be sent for the difference: 
      
                                                                ADDITIONAL REQUIRED INFORMATION 
Has Your Federal Tax Liability for any Prior Year been changed as a result of an examination by the IRS? ...                                     YES    NO    
          List Year(s) _____________________   Has an Amended Return been filed with Englewood?........                                          YES    NO    
Do You have Employees in Englewood? ..……………………………………………………………………………                                                                              YES    NO   N/A 
Do You use subcontract labor to perform work in Englewood?...…………………………………………………..                                                              YES      NO  N/A 
Are any employees leased in the year covered in this return? ……………………………………………………..                                                              YES     NO  N/A 
          If YES please provide the following information about the Leasing Company:                                                                  
                  Name ______________________________________________________ 
                  Address ____________________________________________________