Mail Extension to:  City of Wooster Income Tax 
                                                                                                                  P.O. Box 1088 
                                                                                                                  Wooster, Ohio 44691-7081 
                                                                   CITY OF WOOSTER, OHIO 
                                        REQUEST FOR AUTOMATIC EXTENSION OF TIME TO FILE 
                                           WOOSTER NET PROFITS RETURN 
                                                                          
Company Name                                                            Address
 
Federal Employer I.D. Number                                            City, State, Zip Code
                                                                    
  1.  I request an extension of time until                                                    ,                   to file the City of Wooster, Ohio Income Tax Return for 
      taxable year beginning                                                    ,                   and ending                                                    ,                   which is due 
                                          ,                      . 
 
  2.  The extension date requested cannot be later than 10/15/23, or the fifteenth day of the tenth month after the last day of the taxable year.  
 
  3.  Penalty of 15% and interest at the rate of .42% per month or fraction of a month on any taxes paid after the due date.   
 
  4.  A declaration of estimated tax (below) should be filed by every business that will have Wooster income tax due in excess of two hundred 
      dollars ($200.00) 
 
  5.  Estimated balance due, if any, for fiscal year 2022 Wooster Income Tax Return.                             $                                              
                                                                                                                                          
                        DECLARATION OF ESTIMATED WOOSTER TAX FOR FISCAL YEAR 2023 
                                          Due on or before the fifteenth day of fourth month of tax year 
                                          (Extension of time to file tax return does not apply to declaration 
                                          of estimated tax or payment of quarterly installments) 

        6.  Total income subject to Wooster Tax                                  $                                                                             
        7.  Estimated Wooster tax @ 1.5%                                         $                                                                            
         
        8.  Amount of line 7 due with this extension                                                             $                                          
                                                                                                                                                                    
                 Total amount paid with extension request 
                 (Add line 5 and 8 and enter here. Make check payable to "City of Wooster")                      $                                                
                                        
              To receive payment vouchers for the second, third and fourth quarters, complete the estimate on line 7.  Taxpayers are 
                                          responsible for filing and paying any quarterly estimated tax due. 
                                                                          
I declare that I have examined this form and to the best of my knowledge and belief, it is true, correct, and complete. 
  
 Do you authorize your preparer to contact us regarding this return? Yes   □ No   □
  
Signature of Officer                                               Date          Paid Preparer's Signature                                  Date 
 
Title                                                                            Firm (or individual) 
 
Telephone number                                                                 Preparer's address 
 
                                                                                 Preparer's telephone number 

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