2009 EXTENSION AND PAYMENT OF TAX

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					                                  2009
                      EXTENSION AND PAYMENT OF TAX
                 Due on or before April 15, 2010 or 4 months from fiscal year end
                         along with a copy of the federal extension form


____________________________________                                ______________________________
TAXPAYER                                                            SOCIAL SECURITY NUMBER

________________________________________________                    ________________________________________
                                                                     FEDERAL ID NUMBER IF CORP.

________________________________________________
ADDRESS


Total income tax liability for 2009…………………………………………………………….$ ____________________


Less credits………………………………………………….….$ ___________________
a. 2009 estimated payments……………………………….…..$ ___________________
b. Carry forward credit from 2008…………………………….$ ___________________
c. City tax withheld for Monroe……………………………….$ ___________________
d. Other city taxes paid (allowed up to 1.5%) ..…...…………..$ ___________________
e. Total credits…………………………………………………$ ___________________


BALANCE OF TAX DUE AND PAYABLE ON OR BEFORE APRIL 15, 2010………..$ ____________________


YOUR REQUEST WILL BE DENIED IF:


1. Fail to file a copy of the federal return.
2. Owe delinquent tax, penalty, interest or returns.
3. Fail to file the extension by the tax due date.




_________________________________________________________________________
SIGNATURE OF TAXPAYER OR REPRESENTATIVE                                  DATE


                               FILE WITH AND MAKE PAYMENT TO:
                                                CITY OF MONROE
                                                     P.O. BOX 629
                                         MONROE, OHIO 45050-0629