CITY OF FOREST PARK 2016 INCOME TAX RETURN - FORM IR DUE ON OR BEFORE APRIL 18, 2017

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1 City of Forest Park Income Tax Division 1201 West Kemper Road Forest Park, Ohio Phone (513) Fax (513) IF TAXPAYER AND SPOUSE ARE FULLY RETIRED AND WITHOUT TAXABLE INCOME, PLACE AN X IN THIS BOX SIGN, DATE, AND RETURN BY APRIL 18, 2017 TAXPAYER NAME(S) AND ADDRESS (CORRECT IF NECESSARY) CITY OF FOREST PARK 2016 INCOME TAX RETURN - FORM IR DUE ON OR BEFORE APRIL 18, 2017 ALL RESIDENTS 18 AND OLDER MUST FILE LATE FILING OR PAYMENT OF THIS RETURN SUBJECTS YOU TO INTEREST AND PENALTY(S). Did you file a Forest Park Return in 2015? Yes Check your taxpayer status in 2016: Full-Year Resident Partial-Year Resident Non-Resident If you moved into Forest Park in 2016 what was the move in date?.... If you moved out of Forest Park what was the move out date? FILE # SS# TAXPAYER SS# SPOUSE TELEPHONE HOME TELEPHONE WORK No Cashier s Validation 1. ENTER TOTAL COMPENSATION/WAGES BEFORE ANY PAYROLL DEDUCTIONS (ATTACH ADDITIONAL PAGES, IF NEEDED) ATTACH FORM 1040, 1040A OR 1040EZ AND W-2S HERE PRINT EMPLOYER S NAME DATES EMPLOYED CITY WHERE EMPLOYED $ CITY TAX WITHHELD $ WAGES, ETC. 1A. TOTAL: IF NO OTHER TAXABLE INCOME, COMPUTE YOUR TAX ON LINE 4 2. TOTAL PROFIT FROM INCOME OTHER THAN WAGES: A. PROFIT FROM ANY SOLE PROPRIETORSHIP (Attach Federal Schedule C and/or Form 1099) $ B. RENTAL INCOME (Attach Federal Schedule E) $ C. OTHER INCOME (Attach appropriate Federal Schedule) (Corporation, Partnership, Fiduciary fees, Gambling Income, etc. ) $ D. DEDUCTIBLE INCOME/NON-TAXABLE INCOME (Explain: ) $ < > E. TOTAL A,B,C, AND D $ $ 3. TOTAL TAXABLE INCOME (line 1A plus 2E) $ 4. MULTIPLY TAXABLE INCOME BY 1.5% (.015) (Tax amount before any credits) $ 5. LESS PAYMENTS AND CREDITS: A) FOREST PARK TAX WITHHELD BY EMPLOYER(S) $ B) ALLOWABLE CREDIT ON INCOME TAXED BY ANOTHER CITY/COUNTY $ (See instructions, not to exceed.375% of income taxed) Go to this link for a tool to help calculate your return: C) 2016 ESTIMATED PAYMENTS AND PRIOR YEAR OVERPAYMENT $ D) TOTAL PAYMENTS AND CREDITS $ 6. TAX LESS CREDITS (Subtract Line 5D from Line 4) (If overpayment, see line 9 and instructions) $ 7. ADD PENALTY(S): $ AND/OR INTEREST $ IF FILING OR PAYING AFTER DUE DATE (see instructions) $ 8. TOTAL AMOUNT DUE FOR (Payment to accompany return if $10.00 or more to City of Forest Park ) $ Amounts of $10.00 or less are not payable, refundable, or credited. For tax years 2015 and prior, the amount must be more than $ OVERPAYMENT FOR RECORD HERE AND CARRY TO LINE $ (OVER, PLEASE)

2 DECLARATION OF ESTIMATED TAX FOR YEAR 2017 Was a declaration of estimated tax for 2017 made with a request for extension of time to file the 2016 tax return? Yes No If a declaration has been made, the declaration below need only be completed if you wish to amend what was filed previously. 10. TOTAL ESTIMATED 2017 INCOME $ MULTIPLIED BY TAX RATE OF 1.5% = TOTAL 2017 ESTIMATED TAX PRIOR TO CREDITS $ 11. ESTIMATED TAX CREDITS: A. ESTIMATED TOTAL TAXES TO BE WITHHELD BY EMPLOYER(S) FOR CITY OF FOREST PARK $ B. ESTIMATED 2017 FOREST PARK TAX CREDIT $ (See instructions, not to exceed.375% of income taxed) Go to this link for a tool to help calculate your return: C. PAYMENT MADE WITH REQUEST FOR EXTENSION $ D. TOTAL ESTIMATED TAX PAYMENTS AND CREDITS (Total Lines 11A, 11B and 11C) $ < > 12. TOTAL ESTIMATED TAX DUE AND PAYABLE TO FOREST PARK DURING 2017 (Subtract Line 11D from Line 10) $ If line 12 is $200 or more, you MUST pay quarterly estimated payments to avoid a penalty. 13. AMOUNT TO BE PAID WITH THIS DECLARATION (1/4 of Line 12 due by 4/18/2017) $ 14. TAX OVERPAYMENT FROM PREVIOUS TAX YEAR: ENTER AMOUNT FROM LINE $ 15. CONTRIBUTION TO ENVIRONMENTAL AWARENESS PROGRAM $ CONTRIBUTION TO HOME IMPROVEMENT PROGRAM $ 16. TOTAL: LINE 8 $ PLUS LINE 13 $ MINUS LINE 14 $ PLUS LINE 15 $ = AMOUNT ENCLOSED $ 17. IF OVERPAYMENT GREATER THAN $10 -REFUND $ OR APPLY TO NEXT YEAR S ESTIMATE $ DECLARATION AND RETURN PAYMENT CALENDAR APRIL 18, 2017 JUNE 15, 2017 SEPT. 15, 2017 DEC. 15, 2017 APRIL 15, 2018 File 2016 Return, Make 2nd Make 3rd Make 4th File 2017 Return, File 2017 Declaration, quarter 2017 payment quarter 2017 payment quarter 2017 payment File 2018 Declaration and make 1st and make 1st quarter payment quarter payment PAYING TAX DUE BY CREDIT CARD 1. Circle One: MasterCard Visa Discover 2 Account Number (16 Digits): 3. Expiration Date: Three Digit Verification Code: 4. Amount To Be Paid: $ plus applicable service fee 5. Your Signature For Authorization: Date: 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 TAXPAYER, THE DECLARATION IS BASED ON ALL INFORMATION OF WHICH PREPARER HAS ANY KNOWLEDGE. May we discuss your taxes with your preparer? YES NO Signature of Person Preparing if Other Than Taxpayer Date Signature of Taxpayer or Agent (Required) Date Address Signature of Taxpayer or Agent (Required) Date Telephone Number and address Telephone Number and address NOTE: Unless this tax form is signed and accompanied by payment of the tax due (Line 16), it is not a legal and FINAL return. FOR ADDITIONAL ASSISTANCE CALL (513)

3 EXTENSION POLICY: If your return cannot be filed by April 18, 2017, you need to request an extension in writing by 4/18/2017. We recommend that you use the Forest Park Extension Request Form. It provides a means to calculate any current year tax due as well as the amount of the declaration of estimated tax for next year. The balance of the current year tax and one-fourth of the estimated tax for next year must be paid with the extension request. Visit our website at for additional information and to print the form NOTE: Unless tax return is signed and accompanied by payment of the balance of the tax declared due (Line 8) and at least one-quarter of the estimated tax (Line 13), it is not a legal final return or declaration. INSTRUCTIONS FOR 2016 INCOME TAX RETURN (FORM IR) Line No. 1 List employment and W-2 information requested. Attach Federal Form 1040, 1040A or 1040EZ and all W-2 Forms. 1A Total W-2 income (generally the Local wage box of the Form W-2). 2A, B, C ATTACH COPIES OF YOUR FEDERAL 1040, 1040A or 1040EZ WITH ALL APPLICABLE FEDERAL SCHEDULE(S). BUSINESS LOSSES MAY NOT BE USED TO OFFSET WAGES. LOSSES CAN BE CARRIED FORWARD FOR FIVE (5) YEARS. INCLUDE DOCUMENTATION OF LOSSES APPLIED. NEW: LOTTERY, SWEEPSTAKES, GAMBLING AND SPORTS WINNINGS, PRIZES & AWARDS, WINNINGS FROM GAMES OF CHANCE, ETC. ARE TAXABLE NOT TAXABLE: INTEREST, DIVIDEND, CAPITAL GAIN, PENSION & UNEMPLOYMENT INCOME 2D EXAMPLES OF ITEMS WHICH MAY BE DEDUCTED: * Employee business expenses reported on Form ATTACH FEDERAL 2106 and SCHEDULE A as filed with IRS. * Income may be prorated for residents who moved into or out of Forest Park during E Total Lines 2a through 2d. 3 Total Lines 1a and 2e. This is taxable income. 4 Multiply Line 3 by 1.5% (.015) Forest Park tax rate. 5A Tax withheld by employers for Forest Park. 5B Credit for tax paid to another City or County. This may not exceed credit limit of.375% of income taxed or 25% of other city s tax rate. For example: If you work in Cincinnati and 2.1% Cincinnati tax is withheld, you will receive credit of.375% on Cincinnati income taxed (.25% of our 1.5% tax rate). Example 2: If you work in Mason and 1.12% Mason tax is withheld, you will receive credit of.28% (.25 x 1.12%) Credit must be adjusted for any refunds from another city/county. Example: o In 2016, a Forest Park resident works in Cincinnati and earns $50,000/year. o Person has Cincinnati tax of 2.1% withheld from paycheck totaling $1,050. o Forest Park credit is.375% of $50,000 or $ o Total Forest Park Liability: $50,000 x 1.5% = $750 - $ credit = $ balance due Forest Park. Go to this link for a tool to help calculate your return: Be certain the W-2(s) attached show the tax paid to another city/county or attach copy of other city/county tax return, if applicable, for proper credit. You must compute the tax credit on each W-2 and each city/county tax withheld separately. PARTIAL YEAR RESIDENT: Credit is based on number of months you worked at a job while a Forest Park resident. Please attach your computation. 5C Total estimated tax payments and prior year overpayments credited to D Total Lines 5A through 5C. 6 Subtract line 5D from line 4. 7 FOR LATE RETURNS: Late filing penalty is $25/month for each month the return is late filed, to a maximum of $150. In addition, there is a late pay penalty of 15% of the amount not timely paid. Interest is calculated at the Federal short-term rate effective January 1, plus 5 percent per annum on tax due and assessed monthly. 8 Total Line 6 and Line 7. If amount due is $10 or less you need not pay. If overpayment, leave blank and record on Line 9. 9 Record overpayment, if applicable.

4 10 Estimate 2017 income and multiply times 1.5% (.015) tax rate. If income will be different from 2016, please explain. If it is estimated that you will owe $200 or more, you are REQUIRED to make quarterly estimated payments in order to avoid a penalty for failure to pay estimate. 11A Tax to be withheld for Forest Park by employer. 11B Payment to another City or County (not to exceed.375% credit limit). See examples in 5B above. 11C 2016 City of Forest Park Extension Request Form, Line 11 minus Line 12 (if filed). 11D Total Lines 11a, 11b, and 11c. 12 Subtract Line 11d from Line 10. This is your 2017 declaration of estimated tax. If it is estimated that you will owe $200 or more, you are REQUIRED to make quarterly estimated payments in order to avoid a penalty for failure to pay estimate. 22.5% of the unpaid estimate is due by % of the unpaid estimate is due by , 67.5% of the unpaid estimate is due by , 90% of the unpaid estimate is due by Estimated tax due is at least 90% (divide by four (4) to arrive at quarterly payment). You may pay the full amount of estimated tax with the filing of this form. Amount shown must accompany this return. 14 Total from Line Please designate your voluntary contribution to the City's Environmental Awareness and/or Home Improvement Program. Your donation is greatly appreciated. 16 Amount enclosed: Line 8 plus Line 13 minus Line 14 plus Line No refunds or credits of $10.00 or less. Overpayments more than $10.00 will be applied to 2017 estimate unless a refund is specifically requested. Additional forms may be obtained from our website:

5 ANNUAL TAX QUESTIONNAIRE UPDATE DUE BY APRIL 18, 2017 This information is required. Please complete and enclose with tax return. Resident Name: Social Security Number: Spouse Name: Social Security Number: Home Address: Mailing Address (if different from Home Address): Home Telephone Number: Do you own your home? Yes No Do you Rent? Yes No Landlord's Name, Address and Telephone Number: DATE MOVED INTO FOREST PARK: DATE MOVED OUT (IF APPLICABLE): RESIDENT SPOUSE NEW HOME ADDRESS: PHONE NUMBER: HAVE YOU AND/OR YOUR SPOUSE HAD A CHANGE IN MARITAL STATUS OR NAME? IF YES, PLEASE ADVISE CHANGE AND DATES EFFECTIVE: EMPLOYMENT INFORMATION RESIDENT SPOUSE Name of Employer: Address of Employer: Employer Telephone Number: Your Occupation: If you are retired, please give date of retirement: Did you and/or your spouse receive a City tax refund for the previous tax year? Yes No If YES, please supply refund amount and name of city: Does anyone in your household own rental property? Yes No If YES, list address and total annual rent expected: OTHERS LIVING IN HOUSEHOLD Name Social Security Number Age or Date of Birth Name of Employer (if applicable) I declare the above information is true and complete to the best of my knowledge. Signature Thank you for your response. Date