VILLAGE OF BLUFFTON, OHIO
Form R-1 (Rev: 18A)
File with:
Your Soc. Sec. #:
Bluffton Income Tax Department
P.O. Box 228
Bluffton, OH 45817-0228
Spouse Soc. Sec. #:
Business Fed. ID #:
or
Fiscal Tax Year - for Businesses
from:
to:
DID YOU MOVE DURING THE YEAR? ________
I MOVED INTO BLUFFTON I MOVED OUT OF BLUFFTON
DUE DATES:
For CALENDAR Year Filings:
April 15th
or
For FISCAL Year FIilings:
3 1/2 months after the end of
the above fiscal year period.
DATE OF MOVE:
PREVIOUS ADDRESS or NEW
FORWARDING:ADDRESS
Address Line-1
CURRENT NAME AND ADDRESS:
Address Line-2
Your Name.........
City, St.ZipCode
Spouse Name..
IF YOU RENT, PLEASE PROVIDE THE NAME & ADDRESS OF YOUR LANDLORD.
Address Line-1.
Landlord Name
Address Line-2....
Address Line-1
City, St. ZipCode.
Address Line-2
City, St.ZipCode
I am not required to complete this tax return because: (If applicable, check the item below that applies, sign the bottom of this page and file form by due date)
Total/permanent disability
1.
Retirement income only
3.
Moved out prior to above Tax Year, give date:
2.
4.
Taxpayer deceased, give date: Only income is from non-taxable source, list source:
5.
SECTION A: W-2 WAGES & BUSINESS INCOME
No. of Different Employers / No. of W-2s Attached:________
1)
2)
3)
4)
5)
6)
7)
8)
9)
% of line 8 abv)
10)
11)
SECTION B: INCOME TAX OWED & TAX CREDIT
12)
17)
18)
19)
20)
21)
22)
23)
24)
25)
26)
13)
14)
15)
16)
23)
SECTION C: DECLARATION OF ESTIMATED TAX
(from page 3 Estimated Tax Worksheet, line 7)
IMPORTANT: All appropriate supporting documentation must be attached before this return will be processed. The undersigned declares that this
return and attached supporting documentation is a true, correct and complete return for the taxable period stated and that the figures used herein are the
same as what was used for federal income tax purposes. I authorize the Bluffton Income Tax Department to discuss my account, this return and
supporting documentation with my preparer. I understand that this return is subject to further review by the Bluffton Income Tax Department and that I will be
notified if any corrections are made or any additional tax balance is due. THE RETURN MUST BE SIGNED AND DATED TO BE A VALID FILING.
Signature of Taxpayer
Date
Title, if Business Return
Date
Name of Individual & Company Preparing Return (Please print)
Signature of Spouse
Date
Signature of Person Preparing Return
Phone Number of Preparer
Taxpayer Phone Number
INCOME TAX RETURN
for Calendar Tax Year
1) Enter Total GROSS Wages Earned (Use the larger amount in box 5 or 18 on your W-2s.)
2) Less Employee Business Expenses from Federal Form 2106 (Attach copy of your Federal Form 2106)
3) Less Non-Resident Income, if Part Year Resident (Create & attach a worksheet explaining calculation)
4) Calculate Taxable Wages (Subtract lines 2 and 3 from line 1. If no other income, take total to line 11.)
5) Enter Total Business Income (From page 2, line 5. Attach Fed. Schedules.)
6) Enter Adjustments to Business Income (From page 2, line 6)
7) Calculate Adjusted Business Income (Add lines 5 and 6)
8) Calculate Amt Allocable to Bluffton (From pg 2, line 8)
9) Less Net Loss From Previous Returns (From page 2, line 9)
10) Calculate Taxable Business Income (Subtract line 9 from line 7 or 8)
11) Total Taxable Income (Add lines 4 and 10)
12) Bluffton Income Tax (Multiply line 11 by Bluffton's Income Tax rate of .0125 or 1.25%)
13) Less Bluffton Tax Withheld (Look for Bluffton city tax in box 19&20 on your W-2s)
14) Less Credit Carry-over(Enter overpayment from prior yr being carried over to this yr.)
15) Less Estimated Tax Paid (Enter total amt of est. pymts made during year)
16) Less Other City Tax Withheld(Enter other city tax withheld. Cannot exceed 1.25% per W-2)
17) Total Credits Allowable (Add lines 13, 14, 15, and 16)
18) Tax Due (If line 12 is greater than 17, subtract line 17 from line 12. If not go to step 23)
19) Late Filing Penalty (A $25 per month fee will be imposed on returns filed after the due date, up to a max of $150)
20) Late Payment Penalty (A one-time late pymt penalty equal to 15% of amt not paid by the due date will be imposed.)
21) Interest (Interest will be charged at a rate of: .417% for 2016, .50% for 2017 & 2018, .583% for 2019 & 2020.
22) Total Due (Add lines 18, 19, 20, and 21) (Payment must accompany return & be payable to: Village of Bluffton)
Overpayment (If line 17 is greater than line 12, subtract line 12 from 17, then
subtract lines 19, 20 and 21 from 17)
23A)
23A) Refund Requested (Enter birth date if under age 18)
23B) Amount to be Credited to Next Year's Tax Return
23B)
24) Total Estimated Tax declared for next tax YEAR.
25) Amount Paid With This Estimate (from page 3 Estimated Tax Worksheet, line 8)
26) Total Tax & Estimated Payment Due (Add lines 22, and 25)
NOTE: Before remitting, be sure all supplemental documents
(W-2, SCH C, SCH E, K-1, 1099 MISC, etc.) are attached to
your return. RETURNS WILL NOT BE PROCESSED IF THE
SUPPORTING DOCUMENTATION IS MISSING.
NOTE: Return must be signed & dated to be a valid filing.
20 ____
Staple supporting
documentation to the back
of this return in the upper
left-hand corner.
NOTE: No payment is due
or refund will be issued if
LESS THAN $10.00
