Form D1 - Individual/joint Filing Declaration Of Estimated Tax
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1Form D1
DAYTON
Individual/Joint Filing DECLARATION OF ESTIMATED TAX
Tax year
ending DECEMBER or
__________
_____________________
1. Total Estimated Income subject to Dayton tax
$ ________________________
2. Dayton tax due @ 2.25%
$ ________________________
3. Estimated tax withheld by employer (not to exceed 2.25%)
$ ________________________
4. Total estimated tax due (line 2 - line 3)
$ ________________________
5. Credit from prior year tax return
$ ________________________
6. Net estimated tax due (line 4 — line 5)
$ ________________________
D1 filing is due by April 15, and quarterly estimated payments are due July 31, October 31, of the year the income is earned,
and January 31, following the year the income is earned.
Make Checks Payable To The City Of Dayton, and Mail to City of Dayton, P0 Box 2806, Dayton Ohio 45401-2806
Signature _____________________________________
Date _____________
Phone# ________________
Name ________________________________________
Account # or SS# ___________________________
Spouses name _________________________________
Spouse SS# ________________________________
Address _______________________________________
Federal ID# ________________________________
City, State, Zip _________________________________
¼ due April 30, Paid $ ________________________
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DAYTON DCM 2nd
ESTIMATED TAX PAYMENT
Tax year
ending DECEMBER or
__________
_____________________
2nd estimated tax payment due July 31, of the year the income is earned.
Estimated full year TAX DUE (from declaration) $ ________________________
Name ________________________________________
Account # or SS# ___________________________
Spouses name _________________________________
Spouse SS# ________________________________
Address _______________________________________
Federal ID# ________________________________
City, State, Zip _________________________________
¼ due July 31, Paid $ ________________________
------------------------------------------------------------------------------- CUT HERE -------------------------------------------------------------------------------
DAYTON DCM 3rd
ESTIMATED TAX PAYMENT
Tax year
ending DECEMBER or
__________
_____________________
3rd estimated tax payment due October 31, of the year the income is earned.
Estimated full year TAX DUE (from declaration) $ ________________________
Name ________________________________________
Account # or SS# ___________________________
Spouses name _________________________________
Spouse SS# ________________________________
Address _______________________________________
Federal ID# ________________________________
City, State, Zip _________________________________
¼ due October 31, Paid $ _____________________
------------------------------------------------------------------------------- CUT HERE -------------------------------------------------------------------------------
DAYTON DCM 4th
ESTIMATED TAX PAYMENT
Tax year
ending DECEMBER or
__________
_____________________
4th estimated tax payment due January 31, following the year the income is earned.
Estimated full year TAX DUE (from declaration) $ ________________________
Name ________________________________________
Account # or SS# ___________________________
Spouses name _________________________________
Spouse SS# ________________________________
Address _______________________________________
Federal ID# ________________________________
City, State, Zip _________________________________
¼ due January 31, Paid $ _____________________
In the event your check is returned unpaid for insufficient funds or uncollected funds, we may electronically debit your account
for the principal amount of the check.
FORM D1 10/04
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