City of Fairfield 
                                                                                                                                    Income Tax Division         Phone: 513-867-5327
                                                                                             Business Tax Return
                                                                                                                                    701 Wessel Dr               Fax: 513-867-5333
                                                                                                  2023                              Fairfield, OH 45014  
                                                                                                                                    www.fairfield-city.org 

   Account Number: ______________________    FEIN:    __________________________                                                                Filing Status (Check one)
   Business Name                                                                  : ________________________________________________________       C-Corporation
                                                                                                                                                   S Corporation
   Mailing Address:    ________________________________________________________                                                                    LLC
   City/State/Zip    _____________________________________________________ ___:                          _                        __               Partnership/Association
                                                                                                                                                   Fiduciary
   Local Address (if different than above): ______________________________________________
                                                                                                                                                   Amended Return
   City/State/Zip: ____________________________________________________________________                                                            Refund
Did you file a City return last year?                                                        Is this a combined corporate return?               Should this account be inactivated?
                                                                              YES   NO       YES     NO                                                  YES                     NO
1.  ADJUSTED FEDERAL TAXABLE INCOME (Enclose Copy of Federal Return) From Form _______ Line _____                                                  1.
2.  ADJUSTMENTS (From Line L, Schedule X)                                                                                                          2.
3.  TAXABLE INCOME BEFORE APPORTIONMENT (Line 1 plus/minus Line 2)                                                                                 3.
                                                                                                                                                   4.
4.  APPORTIONMENT PERCENTAGE (From Step 5, Schedule Y) ___________ %
5.  FAIRFIELD TAXABLE INCOME (Multiply Line 3 by Line 4)                                                                                           5.
                                                                                                                                                   6.
6.  OTHER SEPARATELY STATED ITEMS.  (Net operating loss carryforward claimed)
                                                                                                                                                   7.
7.  AMOUNT SUBJECT TO FAIRFIELD INCOME TAX
                                                                                                                                                   8.
8.  FAIRFIELD INCOME TAX  (Line 7 multiplied 1.50%)
9 a. ESTIMATES MADE ON THIS YEAR'S LIABILITY                                                         9 a.
9 b. CREDITS APPLIED TO THIS YEAR'S LIABILITY                                                        9 b.
10. TOTAL PAYMENTS AND CREDITS (Add Lines 9a and 9b)                                                                                            10.
11. TAX DUE (Subtract Line 10 from Line 8)                                                                                                      11.
                                                                                                                                                     FEDERAL EXTENSION FILED
12. OVERPAYMENT (Line 10 greater then Line 8)                                                        12.                                                    If yes, attach copy
13. AMOUNT TO BE REFUNDED (Amounts less than $10.0 1will not                                         13.                                                    YES                  NO
be refunded )
14. CREDIT TO NEXT YEAR (Amounts less than $10.01 will not be                                        14.
credited)
                                                                              2024 DECLARATION OF ESTIMATED TAX DUE - Complete this seciton if 2023 tax due is $200.00 or greater

15. TOTAL ESTIMATED INCOME SUBJECT TO TAX                                                                                                       15.
16. FAIRFIELD ESTIMATED INCOME TAX DUE (Multiply Line 15 by 1.5%)                                                                               16.
17. FIRST QUARTER ESTIMATED TAX DUE BEFORE CREDITS (At least 25% of Line 16)                                                                    17.
18. LESS PRIOR YEAR CREDIT (Line 14) APPLIED TO FIRST QUARTERLY PAYMENT                                                                         18.
19. BALANCE OF FIRST QUARTER PAYMENT DUE (Line 17 minus Line 18)                                                                                19.
20. TOTAL AMOUNT DUE (Add Lines 11 and 19).                                                                                                     20.
    Make check or money order payable to City of Fairfield.
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, and if an audit of Federal return is made which affects tax liability shown on this return, an amended return will be filed 

Signature                                                                              Title Date    Preparer's Signature (other than taxpayer)                                    Date

E-Mail Address                                                                                       Address of Preparer (City, State, Zip)                                      Phone Number

If this return was prepared by a tax practitioner, may we contact them directly with any questions concerning the preparation of this return?                   YES                NO

                             BUSINESS INCOME TAX RETURN- FAIRFIELD  INCOME TAX DIVISION

Questions regarding Schedule X and Schedule Y: Refer to Ohio Revised  Code Section 718 for assistance. In preparing  your  FAIRFIELD 
Business Income Tax Return, you must arrive at "Adjusted Federal Taxable Income" as outlined in ORC 718.01. Refer to ORC 718.02 for 
instructions regarding Business Apportionment Formula.

SCHEDULE X - RECONCILIATION WITH FEDERAL INCOME TAX RETURN

           ITEMS NOT DEDUCTIBLE                                                                   ADD              ITEMS NOT TAXABLE                           DEDUCT

a.  Capital Losses and 1231losses...............................................................        n. Capital gains (Do not include ordinary
b.  Interest and/or other expenses incurred in the production of................                           gains from Federal Form 4797)..................
    non-taxable income (at least 5% of line z, not including line n)                                    o. Interest earned or accrued..........................
c.  Taxes on net income deducted to compute federal taxable income........                              p. Dividends (less Federal Exclusion)............
d.  Guaranteed payments to partners and retired partners...........................                     q. Other items not taxable (full explanation required)
e.  Net operating loss deduction per Federal Return....................................                    ______________________________
f.  Payments to Self-Employed Retirement Plans, health insurance, and                                      ______________________________
    life insurance payments to owners or owner-employees                                                   ______________________________
g.  Distribution to investors of REIT (Real Estate Investment Trusts)........                              ______________________________
h.  Other items not deductible (full explanation required)...........................                   r. Royalties (intangible)
    __________________________________________...........................                               z. TOTAL DEDUCTIONS..........................
    __________________________________________...........................
l.  Contributions in excess of Federal Limit................................................
m.  TOTAL ADDITIONS...........................................................................

SCHEDULE Y - BUSINESS APPORTIONMENT FORMULA
The business apportionment formula is to be used only in the absence                                    A. LOCATED  B. LOCATED IN                              C. PERCENTAGE
of books and records which will disclose within reasonable accuracy                                     EVERYWHERE   FAIRFIELD                                 (B/A)
that portion of the net profits  which is attributable to the City of
Fairfield .
STEP 1.    Average value of real and tangible personal property                                       $            $
           Gross annual rents multiplied by 8                                                         $            $
           TOTAL STEP1                                                                                $            $                                                 %
STEP 2.    Gross receipts from sales and work or services performed                                   $            $                                                 %
STEP 3.    Total wages, salaries, commissions, and other compensation of all employees                $            $                                                 %
STEP 4.    Total percentages                                                                                                                                         %
STEP 5.    AVERAGE PERCENTAGE(Divide total percentages by the number of percentages used - Enter on % line 6 on front of the return
                                                                                                                                                                     %

                                              RECONCILIATION TO FORM W-3 (WITHHOLDING RECONCILIATION)

   Total Wages allocated to Fairfield
1. (From Business Apportionment Formula Step 3)                                                  $
   Total Wages reported on Form W-3 
2. (Withholding Annual Reconciliation)                                                           $
3. Please explain any difference

4. Are there any employees leased in the year covered by this return?                             Yes   No
If Yes, please provide the name, address, and FID number of the leasing company.