Individual Declaration Of Estimated Income Tax Form/form D-1 - Quarterly Payment Of Estimated Net Profit Tax - 2003 Page 3

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D-1
QUARTERLY PAYMENT OF ESTIMATED NET PROFIT TAX
CINCINNATI INCOME TAX BUREAU
2003
P O BOX 640770
CINCINNATI OH 45264-0770
FOR OFFICIAL USE ONLY
ACCOUNT NO:
FED ID NO:
Enter your name and address here
SSNNO:
TAX RATE: 2.10%
QUARTER ENDING: DECEMBER 31, 2003
DUE DATE: JANUARY 31, 2004
AMOUNT DUE: $
DATE
PHONE (
)_________________SIGNATURE______________________TITLE____________
------------------------------------------------------------------------------------------------------------------------------------------------

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