DW1 BT-DAY JEDD                                                                                                                               
   Employer’s return of employee income tax withheld.                                                                       JEDD
BT-DAY JEDD payroll this period      $___________                                                                            
BT-DAY JEDD payroll tax (@ 1.75% )   $___________                                                                            
Total BT-DAY JEDD tax withheld       $___________                Is this an amended return?                                  
                                                                                                                           I certify that the information and statements contained herein  
Prior period adjustment              $___________                   NO                                                      are true and correct.   (DECLARATION SIGNATURE IS REQUIRED) 
(If adjusted, provide explanation on back of this form)            YES                                                     (Signed) ____________________________ 
Amount remitted                      $___________                  Additional Withholding 
                                                                 Is this a Final return?                                    (Print Name / Title)_______________________ 
Number of employee’s                   ___________                 NO                                                      Date ___________Phone # ______________ 
                                                                                                                            Federal tax ID# _________________________ 
ACCOUNT NUMBER              ______________                         YES                                                     Returns are due 15 days after the end of the withholding period (for 
 
NAME AND ADDRESS                                                   For the tax period ending                                Monthly)  and  the  last  day  of  the  month  after  the  end  of  the 
                                                                   _____________________                                    withholding period (for Quarterly). 
                                                                   YOU MUST STATE THISTHEPAYMENTMONTHISANDFORYEAR ENDING                                         
                                                                                                                                      Make Check or money order payable to 
_______________________________                                    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                                                                                                                 
Please fill in your account information, then 
                                                                                                                             
copy this form for future use.                                      IMPORTANT 
Your account number should be the same as                                                                                   DO NOT ALTER        any pre-printed payment coupon 
your Federal Tax ID#, plus the suffix –1.                          WITHOLDING                                               with a bar-code at the bottom. Your payment will 
                                                                                                                            only be processed electronically to the account and 
The  City  of  Dayton  Finance  Department                             NOTICE!                                              specific tax period encoded on that line, regardless 
administers the Municipal Income Tax for the                                                                                of any comments you write on the form. 
Butler  Township-Dayton  Joint  Economic                                                                                     
                                                                                                                             
Development District.                                             
                                                                                                                            DO NOT INCLUDE CITY OF DAYTON INCOME 
                                                                  
                                                                                                                            TAX ON THIS FORM 
For additional information call 937-333-3500 or                                                                              
E-mail   taxquestions@daytonohio.gov  or  visit                                                                             DO NOT USE THIS FORM TO SUBMIT PAYMENT OF ANY 
www.daytonohio.gov for more tax forms.                                                                                      PRIOR  BALANCE  DUE  THAT  HAS  ALREADY  BEEN 
1. Each employer within or doing business within the Miami                                                                  REPORTED. 
   Township-Dayton  Joint  Economic  Development  District,                                                                  
   who employs one or more persons is required to withhold                                                                  Dayton Income Tax Ordinance: 36.111 VIOLATIONS AND 
                                                                                                                            PENALTIES.  
   the tax from all Employee compensation and remit the                                                                     Any person shall be guilty of a separate misdemeanor of the 
   amount to the City of Dayton. 
                                                                  
2. A  fully  completed  return  of  withholding  taxes  withheld                                                            first degree if he shall: 
   (Form DW1) and payment is due on the 15 thday (Monthly)                                                                     Fail, neglect or refuse to make any return or declaration 
   or last day of the month (Quarterly) after the end of the                                                                    required by this chapter; or 
   withholding  period.  Certifying  declaration  signature  is                                                                Knowingly make an incomplete, false or fraudulent 
   required.                                                                                                                    return; or 
3. Every  employer,  resident  or  non-resident,  required  to                                                                 Willfully fail, neglect or refuse to pay the tax, penalties or 
   withhold the tax at the source, is liable for payment of such                                                                interest imposed by this chapter; or 
   tax  whether  or  not  actually  withheld  from  his  or  her                                                               Attempt to do anything whatever to avoid the payment 
   employees income.                                                                                                            of the whole or any part of the tax, penalties or interest 
4. Employers are to file MONTHLY if tax withheld exceeded                                                                       imposed by this chapter. 
   $600.00  for  the  previous  quarter  or  $2,399.00  for  the  
                                                                                                                               The failure of any employer, taxpayer or person to 
   previous calendar year.                                        
                                                                                                                                receive or procure a city income tax return, declaration 
5. Delinquent payments are subject to interest and penalty                                                                      or other required form shall not excuse such employer, 
   charges as provided by ordinance.                                                                                            taxpayer or person from making any information return 
6. Failure to receive or procure forms shall not excuse the                                                                     or city income tax return or declaration, from filing such 
   employer from filing a return and remitting the tax due on                                                                   return or from paying city income tax. 
   schedule.                                                                                                                 
7. Do not report names of employees with this form. See                                                                      
   DW3 year end reconciliation for instructions on individuals    
   W2 reported information. 
                                                                  
DW1 BT JEDD REVISED 9-2016