Application For Income Tax Refund - City Of Cleveland Heights
Download a blank fillable Application For Income Tax Refund - City Of Cleveland Heights in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Application For Income Tax Refund - City Of Cleveland Heights with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2Press Here To Print This Form
Save Form
Reset Form
APPLICATION FOR INCOME TAX REFUND
CITY OF CLEVELAND HEIGHTS
P.O. BOX 18850
CLEVELAND HEIGHTS, OH 44118-0850
(216) 291-3978
TAXPAYER'S NAME
SOCIAL SECURITY #
ADDRESS
MUNICIPALITY OF EMPLOYMENT
CITY,STATE,ZIP
TAX YEAR OF CLAIM
1.
AMOUNT OF GROSS REFUND CLAIMED.
$_________________
2.
MINUS THE AMOUNT YOU WANTED CREDITED TO
YOUR ACCOUNT.
$_________________
3.
NET AMOUNT TO BE REFUNDED.
$_________________
INDICATE THE REASON FOR CLAIM BY CIRCLING THE APPROPRIATE NUMBER BELOW:
Employer's Certification on the reverse side must be completed for all refund request, except for those who
were under 18 years of age for the entire year.
1.
TAX PAID OR WITHHELD ON INCOME EARNED WHILE UNDER
18 YEARS OF AGE.
(W-2 FORM AND COPY OF BIRTH CERTIFICATE MUST BE ATTACHED).
2.
UNREIMBURSED EMPLOYEE EXPENSES - ATTACH W-2, FEDERAL
FORM 2106 AND/OR ANY SUPPORTING DOCUMENTS.
3.
OTHER (STATE REASON AND ATTACH DOCUMENTATION).
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
I CERTIFY THAT THE FACTS AND ALLEGATION CONTAINED IN THE ABOVE
STATEMENT ARE TRUE AND CORRECT.
_______________________________________
___________________________
TAXPAYER'S SIGNATURE
DATE
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial