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
Reset Form
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Taxpayer Social Security No (from Page 1):
PAGE 2 - BUSINESS INCOME & ADJUSTMENTS (ALL APPROPRIATE FEDERAL SCHEDULES MUST BE ATTACHED)
LINE 5 - ENTER THE TOTAL OF THIS SECTION ON PAGE 1, SECTION A, LINE 5 - TOTAL BUSINESS INCOME
Schedule 4797 (depreciation recapture) . . . . . . . . . . .
Schedule 1099 MISC, K-1 . . . . . . . . . . . . . . . . . . . . . .
Schedule MISC (From line21 on 1040). . . . . . . . . . . . .
TOTAL OF LINE 5
NET TOTAL INCOME OTHER THAN WAGES
(TO PAGE 1, SECTION A, LINE 5)
LINE 6 - ENTER THE TOTAL OF THIS SECTION ON PAGE 1, SECTION A, LINE 6 - ADJUSTMENTS TO BUSINESS INCOME
(USE ONLY IF THESE INCOME ITEMS ARE INCLUDED IN THE SCHEDULES MARKED ABOVE - LINE 5)
ADDITEMS NOT DEDUCTIBLE
DEDUCTITEMS NOT TAXABLE
N. CAPITAL GAINS (IRC 1221 or 1231) property dis-
positions except to the extent the income and gains
apply to those described in IRC 1245 or 1250
O. Federally reported intangible income such as, but
not limited to interest dividends, and patent and
copyright income
P. Amount of Federal Tax Credits to the extent they
have reduced corresponding operating expenses
Q. Not Previously deducted IRC Sec. 179 expenses
S. Other
T. Total Lines N through S.
NET TOTAL OF J & T
NET TOTAL ADJUSTMENT TO INCOME (TO PAGE 1, SECTION A, LINE 6)
B. LOCATED IN
BLUFFTON
C. PERCENTAGE
(B DIVIDED BY A)
A. LOCATED
EVERYWHERE
Step 1. Average value real and tangible personal property.. . . . . . . . . . .
Gross Annual rentals multiplied by 8. . . . . . . . . . . . . . . . . . . . . .
Total Step 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
%
ALLOCABLE %
NET TOTAL AVERAGE PERCENTAGE ('Total of percentages' divided by number of steps checked) (TO PAGE 1, SECTION A, LINE 8)
%
(enter as negative figures)
LINE 9 - NET OPERATING LOSS DEDUCTION FROM PRIOR VILLAGE RETURNS (attach NOL schedule)
FIFTH PRECEDING YEAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ENTER 'NOL' TO OFFSET
BUSINESS INCOME:
'NOL' USED THIS RETURN
TOTAL NET OPERATING LOSS AVAILABLE
(TO PAGE 1, LINE 9)
Schedule C, E, and/or F. . . . . . . . . . . . . . . . . . . . . . . .
Schedule 1041, 1065, 1120, or 1120S. . . . . . . . . . . . .
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
A. CAPITAL LOSSES (IRC 1221 or 1231 property
dispositions)
B. Five percent (5%) of intangible income reported in
letter 0, except that from IRC 1221 property
dispositions
C. Taxes based on income (State)
D. Taxes based on income (City)
E. Guaranteed payments or accruals to or for current
or former partners or members
F. Federally deducted dividends, distributions, or
amounts set aside for, credited to, or distributed to
REIT or RIC investors
G. Federally deducted amounts paid or accrued to or
for qualified self
employed retirement plans, health
insurance plans, and life insurance plans for
owners or owner-employee of non-C corporation
entities
H. Rental activities by partnership, S Corp, LLC,
trusts
I. Other
J. Total lines A through I
R. Partnership, S Corp, LLC. charitable contributions
Step 2. Gross receipts from sales or services . . . . . . . . . . . . . . . . . . . . .
Step 3. Total wages, salaries and other comp paid. .. . . . . . . . . . . . . . . .
Total of percentages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
FOURTH PRECEDING YEAR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
THIRD PRECEDING YEAR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
SECOND PRECEDING YEAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PRECEDING YEAR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Form R-1 (Rev: 18A)
VILLAGE OF BLUFFTON, OHIO - Income Tax Return -
Page 2
LINE 8 - APPORTIONMENT PERCENTAGE - ENTER THE PERCENTAGE FROM THIS SECTION ON PAGE 1, SECTION A, LINE 8
Use only if you are a business that has
been established/incorporated outside of Bluffton limits and
performs some work inside of Bluffton limits.If you are a business established/incorporated inside of
Bluffton limits, this allocation does not apply.(Each Step used must be selected via check box.)
Schedule C: Profit/Loss Statement from Business or Profession
Schedule E: Rental and Other Income
Schedule F: Farm Income
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DO NOT REMIT DECLARATION WORKSHEET
VILLAGE OF BLUFFTON, OH
DECLARATION OF ESTIMATED INCOME TAX
WORKSHEET
Ending:
For Calendar Year:
or for Fiscal Year: Beginning:
1.
Enter your Estimated Income from Wages, Salaries, Commissions, Etc. for next year (before any payroll deductions) . . . . . . .
$
RECORD OF ESTIMATED TAX PAYMENTS
Voucher
Number
Amount
Check #
Date
Due: 04-15
Due: 9-15
Due: 06-15
2
Due: 12-15
Total:
8. Calculate the Amount due with this Estimate by dividing Line 7 by 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.
Enter your Estimated Net Rental and Other Income Amount for next year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.
Enter your Estimated Net Profit (or Loss) from your Business for next year (If this is a loss, the loss can only be deducted from line 2 above).
$
$
$
$
$
$
$
4.Total Lines 1, 2 and 3 above to determine your Estimated Income Subject to Tax . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . .
5.
Multiply Line 4 by 1.25% or .0125 to determine your Estimated Tax that will be due next year. . . . . . . . . . . . . . . . . . . . . . . . . .
6.
Enter the Estimated Amount of Local Tax you expect to be Withheld at 1.25%. (See General Information #6) . . . . . . . . . . . . . .
7.
Enter the Estimated Tax Amount you expect to owe next year by subtracting Line 6 from Line 5 above . . . . . . . . . . . . . . . . . . . . . . . . .
Voucher
Number
Date
Check #
Amount
1
4
3
Form R-1 (Rev: 18A)
VILLAGE OF BLUFFTON, OHIO
DECLARATION OF
ESTIMATED INCOME TAX WORKSHEET
WHO NEEDS TO FILE A DECLARATION AND MAKE ESTIMATED INCOME TAX PAYMENTS: Every taxpayer having or anticipating income under
withheld or no local withholding being withheld by their employer(s) should file a declaration if the amount owed in income tax is estimated to be two
hundred dollars ($200) or more. Please complete the worksheet below to determine if you need to file a declaration and pay estimated tax payments for
next year.
NOTE: Estimated Income Tax Vouchers can be found on the Village of Bluffton website by to going to: www:bluffton-ohio.com. Click on the Income
Tax tab located on the black bar across the top of the home page. Select either "Individual or Business Tax Forms" as shown in the "Search Tax Forms"
box located on the left-hand side of the screen. Scroll down the page to locate the "V-1 Estimated Tax Voucher" form for the appropriate tax year.
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