Declaration Of Exemption Form printable pdf download

Declaration Of Exemption Form

DECLARATION OF EXEMPTION

If you are not subject to North Ridgeville City Income Tax for 2005, 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 2005

Are You:

Permanently retired with no taxable income

Yes

Unemployed the entire year

Yes

Full time student with no taxable income

Yes

Nonresident for entire year of 2005.

Date of move from N. Ridgeville ______________________

YOUR SOCIAL SECURITY NUMBER

SPOUSE’S SOCIAL SECURITY NUMBER

Under 18 years of age for entire year of 2005.

DECLARATION: I declare this information as true and complete.

Date of birth ____________________

Member of Armed Forces of U.S. for entire year of 2005 (except

civilian employed by Military or National Guard).

Your signature

(Title)

Date

You must qualify under one of the above exemptions to be exempt

from the City Income Tax.

Spouse’s signature (filing jointly, BOTH must sign)

Date

Declaration Of Exemption Form