Form R - Business Income Tax Return - 2016

FORM R file with:

CHECK ONE:

VANDALIA • BROOKVILLE • BUTLER TOWNSHIP JEDZ

Income Tax Office

Corporation

2016 BUSINESS INCOME TAX RETURN

P.O. Box 727

Partnership

333 J.E. Bohanan Memorial Dr.

Other ______________

FILING REQUIRED EVEN IF NO TAX DUE

Vandalia, OH 45377

DUE ON OR BEFORE APRIL 18, 2017 OR WITHIN

Phone: (937) 415-2240; Fax: (937) 415-2361

3½ MONTHS FROM END OF FISCAL YEAR

FEDERAL ID NO. _______________________________

Toll free: (866) 898-5891

BEGINNING __________ AND ENDING __________

Email:

Nature of Business _______________________________

LIST NAME AND ADDRESS BELOW.

Old Address ____________________________________

Date Moved (in) ______________ (out) ______________

DID YOU FILE A CITY INCOME TAX RETURN THE

PREVIOUS YEAR?

Yes

No

Email address ____________________________________

CITY OF

CITY OF

BUTLER TWP

SECTION A

VANDALIA

BROOKVILLE

JEDZ

1. Income per attached Federal Return or Schedule Y if applicable …………………………..

1.

1.

1.

2. Adjustment from Schedule X ……………………………………………………………….

2.

2.

2.

3. TAXABLE INCOME (Line 1 +/- Line 2) ………………………………………………….

3.

3.

3.

4.

4.

4.

4. TAX DUE (2% Vandalia; 2% Brookville; 1% Butler Twp JEDZ) x Line 3 ……………….

5. TAX CREDITS

5-A.

5-A.

5-A.

5-A. Estimated Tax Paid …………………………………………………………………...

5-B.

5-B.

5-B.

5-B. Credit from Prior Year ………………………………………………………………..

5-C. Total Credits Available ……………………………………………………………….

5-C.

5-C.

5-C.

6. BALANCE OF TAX DUE (Line 4 - Line 5-C) …………………………………………….

6.

6.

6.

7. Penalty $______________ Interest $______________ Late Fee $______________

7.

7.

7.

8. TOTAL AMOUNT DUE (Make check payable to City of Vandalia)

8.

8.

8.

(No payment due if $10.00 or less) ………………………………………………………………..

9. If overpayment ($10.01 minimum), please indicate below:

9-A.

9-A.

9-A.

9-A. CREDIT TO NEXT YEAR …………………………………………………………..

9-B. REFUND ……………………………………………………………………………..

9-B.

9-B.

9-B.

Reviewed by _______ Check No. __________ Cash __________ Amt. Received _________

SECTION B - Declaration of Estimated Tax for 2017

10. Income Subject to Tax x Tax Rate

10.

10.

10.

(2% Vandalia; 2% Brookville; 1% Butler Twp JEDZ) ...

11. Quarterly Amount Due (1/4 of Line 10) …………………………………………………..

11.

11.

11.

12. Credit from Line 9-A ($10.01 minimum) ………………………………………………….

12.

12.

12.

13. Line 11 - Line 12 (Amount of Estimated Tax Due with this Return) …………………….

13.

13.

13.

14.

14.

14.

14. Total Payment Due (Line 8 + Line 13) …………………………………………………….

SECTION C

PAYMENT BY CREDIT CARD OR ELECTRONIC CHECK

Please refer to the website, , to access the online payment center to pay by credit card or electronic check.

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, adjusted to the ordinance requirements for local tax purposes. If an audit of the federal return is made which affects the tax liability shown on the return, an amended return is required to be filed within 90 days.

If this return was prepared by a Tax Practitioner, may we contact your practitioner directly with questions regarding the preparation of this return?

Yes

No

Signature of Person Preparing Return (If Other Than Taxpayer)

Signature of Taxpayer

Date

Date

Phone Number

Title