Form Br - Income Tax Return - City Of Springdale - 2003

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2003
INCOME TAX RETURN
City of Springdale
FORM BR
FILE WITH
FOR OFFICE
USE ONLY
SPRINGDALE TAX COMMISSION
PRINCIPAL BUSINESS ACTIVITY:
11700 SPRINGFIELD PIKE
PHONE (513) 346-5715 • FAX (513) 346-5756
SPRINGDALE, OH 45246
FILING REQUIRED EVEN IF NO TAX DUE
LATE FILING WILL RESULT IN PENALTY AND INTEREST CHARGES
IF YOU ARE A NEW BUSINESS, FILING FOR
CORPORATION
THE FIRST TIME OR HAVE MOVED SINCE
EXTENSIONS MUST BE REQUESTED IN WRITING BEFORE THE DUE DATE.
THE LAST FILING DATE, PLEASE FURNISH
CURRENT ADDRESS AND DATE OF MOVE
S-CORP
FOR YEAR ENDING DECEMBER 31, 2003
OR FOR FISCAL YEAR
MOVE IN: ____________________________
PARTNERSHIP
BEGINNING: ___________________________________ ENDING: ___________________________________
MOVE OUT: __________________________
SOLE PROPRIETOR
DUE APRIL 30, 2004 OR 4 MONTHS
TAXPAYER(S) NAME(S) AND ADDRESS (CORRECT IF NECESSARY)
FEDERAL ID NO.
AFTER FISCAL YEAR END.
YES
NO
REQUIRED:
HAS THE IRS INCREASED YOUR
TAX LIABILITY FOR ANY YEAR?
IF SO, HAS AN AMENDED
SPRINGDALE ACCOUNT NO.
BUSINESS TELEPHONE NO.
SPRINGDALE RETURN BEEN
FILED?
2003 SPRINGDALE TAX RETURN
OFFICE USE ONLY
1. TOTAL INCOME
$__________________ $__________________
(ATTACH COPIES OF FEDERAL RETURN AND ALL APPLICABLE SCHEDULES)
2. ADJUSTMENTS TO INCOME
A. ITEMS NOT DEDUCTIBLE
$_________________
$__________________
(FROM LINE M SCHEDULE X ON PAGE 2)
ADD
(
)
(
)
B. ITEMS NOT TAXABLE
$_________________
$__________________
(FROM LINE Z SCHEDULE X ON PAGE 2)
DEDUCT
C. NET ADJUSTMENTS TO INCOME
$__________________ $__________________
(LINE 2A MINUS LINE 2B)
3. TAXABLE INCOME
A. ADJUSTED NET INCOME
$__________________ $__________________
(LINE 1 PLUS OR MINUS LINE 2C)
B. AMOUNT OF LINE 3A ALLOCATED TO SPRINGDALE
$__________________ $__________________
( __________________% FROM LINE 5 SCHEDULE Y)
(
)
(
)
C. LOSS ALLOCATED TO SPRINGDALE PER PREVIOUS SPRINGDALE RETURN
$
$__________________
D. TAXABLE INCOME
$
$__________________
(LINE 3B LESS LINE 3C)
4. SPRINGDALE TAX
$
$__________________
(1% OF LINE 3D)
5. TAX PAYMENTS AND CREDITS
A. TOTAL 2003 ESTIMATED TAXES PAID TO THE CITY OF SPRINGDALE
$__________________
$__________________
B. PRIOR YEAR TAX OVERPAYMENT AMOUNT
$__________________
$__________________
(
)
(
)
C. TOTAL TAX PAYMENTS AND CREDITS
$
$__________________
(ADD LINES 5A AND 5B)
6. IF LINE 4 IS GREATER THAN LINE 5C ENTER THE DIFFERENCE ON THIS LINE
$
$__________________
2003 TAX DUE
7. IF LINE 5C IS GREATER THAN LINE 4, YOU MUST MARK THIS BOX FOR A REFUND OR
$
$__________________
REFUND
CREDIT WILL BE APPLIED TOWARD 2004 ESTIMATED TAX
$
$__________________
2004 CREDIT
NOTICE: BY LAW REFUNDS AND CREDITS IN EXCESS OF $10 ARE BEING REPORTED TO THE APPROPRIATE TAXING AUTHORITIES.
NOTICE: NO ADDITIONAL TAXES OR REFUNDS OF LESS THAN $3 SHALL BE COLLECTED OR REFUNDED.
DECLARATION OF 2004 ESTIMATED INCOME TAX
(NOT REQUIRED FOR TRAVEL REFUNDS)
THIS SECTION IS REQUIRED TO BE COMPLETED.
FAILURE TO PAY 70% OF YOUR 2004 ESTIMATED TAX DUE WITHIN 30 DAYS OF YOUR 2004 FISCAL YEAR END WILL RESULT IN A MINIMUM $25 PENALTY.
8. ENTER TOTAL ESTIMATED 2004 INCOME SUBJECT TO TAX $__________________ MULTIPLY BY 1% = TOTAL 2004 ESTIMATED TAX
$
$
9. AMOUNT PAID WITH THIS DECLARATION
$
$
(NOT LESS THAN 1/4 OF LINE 8)
FOR
RETURN FILED __________ MONTHS LATE
INTEREST DUE $______________
PENALTY DUE $__________________
OFFICE
70% TAX PAID ___________ MONTHS LATE
INTEREST DUE $______________
PENALTY DUE $__________________
USE
TOTAL PENALTY AND INTEREST DUE
$
ONLY
TOTAL TAX, PENALTY AND INTEREST DUE
$
I CERTIFY THAT I HAVE EXAMINED THIS RETURN (INCLUDING ACCOMPANYING SCHEDULES AND STATEMENTS) AND TO THE BEST OF MY KNOWLEDGE AND BELIEF IT IS TRUE, CORRECT AND COMPLETE. IF PREPARED BY A
PERSON OTHER THAN THE TAXPAYER, THE DECLARATION IS BASED ON ALL INFORMATION OF WHICH PREPARER HAS ANY KNOWLEDGE.
SIGNATURE OF PERSON PREPARING IF OTHER THAN TAXPAYER
PREPARER'S ADDRESS
TELEPHONE NO.
PREPARER'S FID OR SSN
SIGNATURE OF TAXPAYER OR AGENT (REQUIRED TO BE VALID)
DATE

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