DW1 Dayton, Ohio                                                                                                          
   Employer’s return of employee income tax withheld.                                                                        
Dayton payroll this period             $___________                                                                          
Dayton payroll tax (@ 2.5%)            $___________              Is this an amended return?                                 I certify that the information and statements contained herein  
                                                                 
Dayton resident withholding (various %)  $___________               NO                                                      are true and correct.   (DECLARATION SIGNATURE IS REQUIRED) 
Total Dayton tax withheld              $___________                YES                                                     (Signed) ____________________________ 
Prior period adjustment                $___________                Additional Withholding                                  (Print Name / Title)_______________________ 
(If adjusted, provide explanation on back of this form)          Is this a Final return?                                    Date ___________ Phone # ______________ 
                                                                 
Amount remitted                        $___________                 NO                                                      Federal tax ID# _________________________ 
                                                                   YES                                                     Returns are due 15 days after the end of the withholding period (for 
Number of employee’s                     ___________                                                                        Monthly)  and  the  last  day  of  the  month  after  the  end  of  the 
ACCOUNT NUMBER              ______________                         For the tax period ending                                withholding period (for Quarterly). 
                                                                   _____________________                                                                         
                                                                   YOU MUST STATE THISTHEPAYMENTMONTHISANDFORYEAR ENDING                   Make Check or money order payable to 
NAME AND ADDRESS                                                   Filing Monthly                                                    City of Dayton and Mail only to: 
                                                                   Filing Quarterly*                                                                            
_______________________________                                     *Quarterly cannot exceed $600.00.                                           City of Dayton 
_______________________________                                                                                                            P. O. Box 643700 
_______________________________                                                           
                                                                                                                                Cincinnati, Ohio 45264-3700 
                                                                                                                             
                                                                 ________                                          ________  
                                                                             CUT HERE
                                                                                                                             
NEW TAX FORM                                                        IMPORTANT                                               DO NOT ALTER        any pre-printed payment coupon 
Please fill in your account information, then                                                                               with a bar-code at the bottom. Your payment will 
copy this form for future use.                                     WITHOLDING                                               only be processed electronically to the account and 
Your account number should be the same as                                                                                   specific tax period encoded on that line, regardless 
your Federal Tax ID#, plus the suffix –1.                              NOTICE!                                              of any comments you write on the form. 
                                                                                                                             
The  City  of  Dayton  Finance  Department                                                                                   
administers on the Municipal Income Tax for                                                                                 DO NOT USE THIS FORM TO SUBMIT PAYMENT OF ANY 
                                                                                                                            PRIOR  BALANCE  DUE  THAT  HAS  ALREADY  BEEN 
the City of Dayton, Ohio.                                                                                                   REPORTED. 
For additional information call 937-333-3500 or                                                                              
E-mail   taxquestions@daytonohio.gov  or  visit                                                                             Dayton Income Tax Ordinance: 36.111 VIOLATIONS AND 
www.daytonohio.gov for more tax forms.                                                                                      PENALTIES.  
1. Each employer within or doing business within the City of                                                                Any person shall be guilty of a separate misdemeanor of the 
   Dayton, who employs one or more persons is required to                                                                   first degree if he shall: 
   withhold the tax from all Employee compensation and remit                                                                   Fail, neglect or refuse to make any return or declaration 
   the amount to the City of Dayton.                                                                                            required by this chapter; or 
2. A  fully  completed  return  of  withholding  taxes  withheld                                                               Knowingly make an incomplete, false or fraudulent 
   (Form DW1) and payment is due on the 15 thday (Monthly)        
   or last day of the month (Quarterly) after the end of the                                                                    return; or 
                                                                                                                               Willfully fail, neglect or refuse to pay the tax, penalties or 
   withholding  period.  Certifying  declaration  signature  is   
                                                                                                                                interest imposed by this chapter; or 
   required.                                                                                                                   Attempt to do anything whatever to avoid the payment 
3. Every  employer,  resident  or  non-resident,  required  to                                                                  of the whole or any part of the tax, penalties or interest 
   withhold the tax at the source, is liable for payment of such                                                                imposed by this chapter. 
   tax  whether  or  not  actually  withheld  from  his  or  her                                                               The failure of any employer, taxpayer or person to 
   employees income                                                                                                             receive or procure a city income tax return, declaration 
4. Employers are to file MONTHLY if tax withheld exceeded                                                                       or other required form shall not excuse such employer, 
   $600.00  for  the  previous  quarter  or  $2,399.00  for  the                                                                taxpayer or person from making any information return 
   previous calendar year.                                        
5. Delinquent payments are subject to interest and penalty                                                                      or city income tax return or declaration, from filing such 
   charges as provided by ordinance.                                                                                            return or from paying city income tax. 
6. Failure to receive or procure forms shall not excuse the                                                                  
   employer from filing a return and remitting the tax due on                                                                
   schedule.                                                      
7. Do not report names of employees with this form. See           
   DW3 year end reconciliation for instructions on individuals    
   W2 reported information.                                       
                                                                  
DW1 REVISED 12-2016