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

City of Sylvania

DIVISION OF TAXATION

ANGELA J. KUHN, COMMISSIONER

6730 MONROE STREET

SYLVANIA, OHIO 43560-1949

419-885-8940 FAX 419-885-3442

Determination of Tax Filing Requirement

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. Please correct

name and address if needed.

Your name: ___________________________________ Your S.S.# _______________________________

Spouse name: __________________________________ Spouse S.S.# _____________________________

Address: _______________________________________________________________________________

Are you the homeowner? Yes _____ No _____ If no, list name and address of homeowner:

_______________________________________________________________________________________

Date 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 ___________________________________

Employer name and location _______________________________________________________________

Is city income tax withheld? ___________ What city? __________________________________________

Unemployed __________ Retired __________ Permanent Disability __________

Spouse employer name and location _________________________________________________________

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, partnerships, etc.) Yes ______ No ______ If yes, please specify type and location

_______________________________________________________________________________________

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

outside of city of employment. Days per month: Self ___________________ Spouse _________________

List any additional employed household members and their S.S.#:__________________________________

_______________________________________________________________________________________

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 Extended