Declaration Of Exemption Form
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1DECLARATION OF EXEMPTION
If you are not subject to North Ridgeville City Income Tax for 2006, please complete this Declaration of Exemption and return it to the Income Tax
Department. To determine what income is not subject to city income tax see instructions.
NAME and ADDRESS (Print or type)
No income subject to tax for 2006
Are You:
Permanently retired with no taxable income
Yes
No
Unemployed the entire year
Yes
No
Full time student with no taxable income
Yes
No
Nonresident for entire year of 2006.
Date of move from N. Ridgeville ______________________
YOUR SOCIAL SECURITY NUMBER
SPOUSE’S SOCIAL SECURITY NUMBER
-
-
-
-
Under 18 years of age for entire year of 2006.
DECLARATION: I declare this information as true and complete.
Date of birth ____________________
Member of Armed Forces of U.S. for entire year of 2006 (except
Your signature
(Title)
Date
civilian employed by Military or National Guard).
Spouse’s signature (filing jointly, BOTH must sign)
Date
You must qualify under one of the above exemptions to be exempt
from the City Income Tax.
E-mail address
Phone
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