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CITY OF GREEN
DIVISION OF TAXATION
P O BOX 460
GREEN, OHIO 44232
Phone (330)896-6622
Fax (330)896-6927
Email:
Website:
____________________________________________________________________________________________
STUDENT CREDIT FORM
Use this form if your income is $15,000 or less. If your income is more than $15,000, contact this office
as additional calculation is necessary to correctly figure the credit.
•
The following documents must be provided to verify eligibility for the credit:
ü W-2(s) and/or Federal Schedules to document income and tax withheld.
ü Name and address of “Qualifying Post-Secondary Institution”.
ü Copy of grades for each academic term.
1. Taxable Income
____________
2. Tax rate
.02
3. Tax Before Credits (line 1 multiplied by line 2)
____________
4. a) City Of Green Tax Withheld
__________
b) Credit for Other City Tax Withheld
__________
c) Total Withholding Credit (4a plus 4b)
____________
5. Tax Before Student Credit (line 3 minus line 4c)
____________
6. City Of Green tax withheld
____________
7. Add line 5 and line 6
____________
8. Enter the larger of line 5 or line 7
____________
9. Enter the smaller of line 8 or $300
____________
10. If line 5 = line 9, enter 0 and Stop. (Student Credit equals Tax Due)
____________
11. If line 5 is larger than line 9, subtract line 9 from line 5 and
enter Balance of Tax Due
____________
12. If line 5 is smaller than line 9, subtract line 5 from line 9 and enter
the Overpayment.
____Refund ____Credit to next year
____________
Under penalty of perjury, I declare that I did not receive any
tuition reimbursement or assistance from my employer.
___________________________ ________
Signature of Taxpayer
Date
•
The completed Student Credit Form must be attached to a signed, dated tax return.
•
If this form is not attached to a signed, dated return, the credit will be disallowed.
(Rev 12/07)