Determination Of Tax Filing Requirement Form - Division Of Taxation printable pdf download

Determination of Tax Filing Requirement

Division of Taxation

City of Sylvania, 6730 Monroe St, Sylvania OH 43560-1949

Phone: (419) 885-8940

Fax:

(419) 885-3442

The information contained on this form is necessary to determine whether a taxpayer is required to file

a city of Sylvania income tax return. A response is required within five (5) days.

Your Name ________________________________ Your S.S. # _____________________________

Spouse Name_______________________________ Spouse S.S. # ___________________________

Address___________________________________________________________________________

Are you the homeowner? Yes_____ No_____ If no, list name & address of homeowner:

__________________________________________________________________________________

Date you moved to Sylvania ____________________ Telephone Number _______________________

Please list your previous address ________________________________________________________

Have you ever lived in Sylvania before? ______ If so, show approximate date ___________________

If your last name was different, please provide this information________________________________

Your employer’s name _______________________________________________________________

Address where you work _____________________________________________________________

Is city income tax withheld? ______ What city? ___________________________________________

Unemployed ______

Retired ______

Permanent Disability ______

Name of spouse’s employer __________________________________________________________

Address where spouse works _________________________________________________________

Is city income tax withheld? ______ What city? ___________________________________________

Unemployed ______ Retired ______ Permanent Disability ________

Excluding interest & dividends, do you have any other taxable income on which there is no

withholding? (Rental Property, Partnership K-1(s), Sub S K-1’s, etc) Yes ______ No ______ If yes,

please specify type and location of the other income ________________________________________

__________________________________________________________________________________

If you or your spouse travel for an employer, please show the approximate number of full work days

spent outside of Toledo or other city of employment. Days per month

self ______ spouse ______

I CERTIFY THE ABOVE TO BE TRUE AND CORRECT.

_____________________________________

______________________________________

Signature

Date

Signature

Date

ALL INFORMATION CONTAINED IN THE COMPLETED FORM IS MANDATED

“CONFIDENTIAL” BY CHAPTER 171 OF THE CODIFIED ORDINANCES OF THE

CITY OF SYLVANIA, OHIO.

Determination Of Tax Filing Requirement Form - Division Of Taxation