BR-25
CITY INCOME TAX RETURN
2004
FOR THE YEAR
BEGINNING
ENDING
BUSINESS RETURN
EIN/FID Number
Name and Current Address
Check the appropriate box if:
REFUND
(An amount must be placed
in Line 6B for this return to be considered
a valid refund request.)
AMENDED
tax year
Filing Status - check only one
•Did you file a City return last year?
YES
NO
Corporation (including S-Corporation)
•Is this a combined corporation return?
YES
NO
Fiduciary (Trusts and Estates)
•Should your account be inactivated?
YES
NO
Partnership/Association
If YES, please explain:
ATTACH A COPY OF YOUR FEDERAL RETURN INCLUDING ALL SUPPORTING SCHEDULES TO
•City(ies) of Income #1
#2
THE BACK OF THIS RETURN.
•Local business address if different from mailing address:
•Nature of business:
•Trade Name:
List by city in which income was earned or services performed. Complete Tax Calculation only to determine your tax.
Part A
TAX CALCULATION
Taxpayers should not complete Tax Calculation until after Schedule X and Schedule Y, if applicable, are completed.
C
Column E
Column A
Column B
Column C
Column D
Column G
Column F
O
TAX
TAX DUE
CITY
TOTAL NET
NET TAX DUE
UNINCORPORATED
CORPORATE
D
TAX REMITTED ON YOUR
RATE
*
*
INCOME
INCOME
TAXABLE INCOME
BEHALF AS A PARTNER
E
COLUMBUS
2.0%
01
GROVEPORT
09
2.0%
OBETZ
10
2.0%
11
CANAL WINCHESTER
2.0%
MARBLE CLIFF
2.0%
13
BRICE
14
1.0%
15
LITHOPOLIS
1.0%
HARRISBURG
16
1.0%
*
Entry in either Column B or Column C cannot be less than zero (see instructions)
1
$
1. TOTAL NET TAX DUE (TOTAL OF COLUMN G).............................................................................................................................................
2
$
2. LESS CREDITS FOR ESTIMATED TAX PAYMENTS AND OVERPAYMENT FROM PRIOR YEAR RETURN ONLY.............
3. BALANCE DUE (LINE 1 LESS LINE 2).
.........................................................
3
$
If Line 2 is greater than Line 1, enter amount (in brackets) here and carry to Line 6..
4
$
4. PENALTY: 10% $______________ + INTEREST $_____________ + LATE FEE $_____________ = ..............................................................
(see instructions)
(see instructions)
(see instructions)
5
$
5.
...........................................................................
TOTAL AMOUNT DUE (ADD LINES 3 AND 4). NOTE: NO PAYMENT IS DUE IF AMOUNT IS LESS THAN $1.00
6. OVERPAYMENT CLAIMED (IF LINE 2 EXCEEDS LINE 1) ..................................................................................
6
$
A. Enter the amount from Line 6 you want CREDITED to your next year tax estimate............
6A
$
B. Enter the amount from Line 6 you want REFUNDED (must be greater than $1.00)
6B
$
Part B
THESE QUESTIONS MUST BE ANSWERED
A Declaration of Estimated City Tax (Form BR-21) is REQUIRED for all business entities.
Date of incorporation or inception
If YES, please provide the name, address and FID number of the leasing
company
Date City business commenced
Check whether this return was prepared on cash ____ or accrual _____ basis. Has City
income tax been withheld from and remitted for all taxable employees during the period
Gross city wages paid were $
. City tax in the amount of
covered by this return?
If YES, provide the EIN(s) #
$
was withheld from wages and paid to
.
If NO, please explain on an attached statement.
Were 1099-MISC forms issued to central Ohio residents?
YES
NO
Are any employees leased in the year covered by this return?
YES
NO
If YES, attach copies to this return.
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 are the same as used for Federal income tax purposes,
and understands that this information may be released to the I.R.S.
See instructions for due date, penalty, interest and late filing fees.
Signature of
NOTE: DO NOT SEND CASH THROUGH U.S. MAIL
Officer:
Date:
Make checks payable to:
City Treasurer
Mail to:
Columbus Income Tax Division
Signature of Person
PO Box 182158
Preparing Return:
Date:
Columbus, Ohio 43218-2158
- OFFICE USE ONLY-
Paid Preparer’s
SSN or EIN :
Phone:
Our web address is:
Form BR-25/Rev. 08/30/04