City of Fairfield
BUSINESS TAX RETURN Income Tax Division
2022 701 Wessel Dr.
TO EXPEDITE PROCESSING, OR Fairfield, OH 45014
Phone: (513) 867-5327
PLEASE DO NOT STAPLE FISCAL YEAR ________ TO ________
THIS SPACE IS FOR OFFICIAL USE ONLY Fax: (513) 867-5333
Website: www.fairfield-city.org/213/Income-Tax-Division
Did you file a City return last year? Is this a combined corporate return? Should this account be inactivated?
YES NO YES NO If YES, please explain: YES NO
ACCOUNT NUMBER: FID #: Filing Status (Check one)
_____________________ ____________________ C-Corporation
BUSINESS NAME: ____________________________ LOCAL ADDRESS: S Corporation
LLC
______________________
MAILING ADDRESS ___________________________ ______________________ Partnership/Association
Fiduciary
____________________________________________
Amended Return
Refund (Amount must be entered on
Line 13 to be a valid refund request)
Part A : 202 2TAX CALCULATION
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 EXTE SION FILED
12. OVERPAYMENT (Line 10 greater then Line 8) 12. N
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 $10.0 1will not be 14.
credited)
Part B: DECLARATION OF ESTIMATED TAX FOR 2023
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
Website Address:
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