Individual Income Tax Return Form - City Of Fairlawn, Ohio
ADVERTISEMENT
1CITY OF FAIRLAWN, OHIO
Individual Income Tax Return
Tax Office Use Only
Year Ending Dec 31, 2004
PO Box 5433 Fairlawn OH 44334
Due on or before April 15, 2005
(330) 668-9525 Fax (330) 668-9565
Social Security # ________-_______-__________
Acct #
Spouse # ________-_______-__________
Check box if first time filing.
Check box if only income is from Social Security,
Pension, Unemployment, Interest, Dividends…
Check box if you moved during the year.
Prorate wages and tax
______
Date Moved In: _______ Date Moved Out:
If preprinted information is incorrect, please make necessary changes.
1. Enter Total Compensation Received, Including All Deferred Income
Employed
Qualifying Wages
Fairlawn
Other City/JEDD
Print Employer’s Name
City Where Employed
From
To
(Medicare Wage, W-2 Box 5)
Tax Withheld
Tax Withheld
Not To Exceed 2% per W-2
→
1a $
1b $
1c $
Attach W-2’s and 1099-MISC on back
Column Totals
2. Other Taxable Income:
2a. Business Income (attach Schedule C)
__________
2b. Rental Income (attach Schedule E & copy of other city return if outside Fairlawn)
__________
2c. Other Income (attach Documentation)
__________
2d. Loss Carry Forward from Previous Years
__________
3. TOTAL OTHER TAXABLE INCOME (add lines 2a, 2b, 2c, subtract 2d; if amount is less than zero, enter zero)
__________
4. Total Taxable Income Before Deductions (add lines 1a and 3)
__________
5. Deductions for Unreimbursed Expenses (see instructions & attach Form 2106)
__________
6. FAIRLAWN TAXABLE INCOME (subtract line 5 from line 4)
__________
7. Fairlawn Tax Due Before Credits (multiply line 6 by 2%)
__________
8. Refunds Received from Other Cities or JEDD
__________
9. TOTAL INCOME TAX DUE BEFORE CREDITS (add lines 7 and 8)
__________
10. Credits:
10a. Fairlawn Income Tax Withheld by Employer (line 1b)
__________
10b. Other City/JEDD Tax Withheld by Employer (line 1c, not to exceed 2% per W-2)
__________
10c. Payments Made to Another City (attach Documentation)
__________
10d. Fairlawn Estimated Tax Payments
__________
10e. Prior Year Overpayment
__________
11. TOTAL CREDITS PAID (add lines 10a thru 10e)
__________
12. BALANCE OF TAX DUE (subtract line 11 from line 9)
__________
13. Late Fee, if received after due date ($50 First Offense, $100 Subsequent Offenses)
__________
14. Interest, if received after due date (1.5% of Balance of Tax Due per Month)
__________
15. Penalty, if received after due date (1.5% of Balance of Tax Due per Month)
__________
16. BALANCE OF TAX AND FEES DUE (add lines 12 thru 15)
__________
17. Overpayment (if line 16 is less than zero): Credit to 2005 _________ Refund _________
Amounts Less Than $1.00 Will Not Be Collected, Credited or Refunded
DECLARATION OF ESTIMATED TAX FOR 2005
18. Estimated Taxable Income for Current Year
__________
19. Estimated Tax Due (2% of line 18)
__________
20. Tax Withheld or Paid to Another City
__________
21. Total Estimated Tax Due (subtract line 20 from line 19)
__________
22. First Quarter Estimated Payment (not less than ¼ of line 21)
__________
23. First Quarter Estimated Balance Due (subtract line 17 credit from line 22)
__________
24. AMOUNT PAID WITH THIS RETURN (add lines 16 and 23) Make Check Payable to City of Fairlawn
_________
I certify I have examined this return including accompanying schedules and statements and to the best of my knowledge believe it is true, correct and complete.
________________________________________
_____________________________________________
Printed name & number of person preparing, if other than taxpayer.
Phone Number
Signature of Taxpayer
Date
__________________________________________________________________________________________
Signature of Spouse
Date
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial