Form Fr 1172 - Individual Income Tax Return - West Union - 2010

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FORM FR
1172
INDIVIDUAL - 2010
INCOME TAX RETURN
MAKE CHECK OR MONEY ORDER TO:
Taxpayer's Social
WEST UNION INCOME TAX BUREAU
Security No.
WEST UNION
HomeTelephone No.
BusinessTelephone No.
Due Date 04/15/2011
P.O. Box 529
FILING REQUIRED EVEN IF NO TAX IS DUE
Mt. Orab OH 45154
Spouse's Social
INCLUDE COPIES OF ALL W-2 FORMS
Security No.
INSTRUCTIONS ON BACK AND AT:
Spouse's
Name
Voice 800-779-3165 Fax 937-444-9241
HomeTelephone No.
BusinessTelephone No.
westuniontax@fuse.net
Filing Status
IF YOU HAVE MOVED DURING
Name
TAX YEAR - GIVE DATES
RESIDENT
Single
INTO
/
/
Married filing joint
NON-RESIDENT
And
Married filing separate
/
OUT OF
/
IF YOU RENT, PLEASE GIVE LANDLORDS INFORMATION
Address
NAME
ADDRESS
Income
1 Wages, salaries, tips,etc.
1
2 Other taxable income
2
3 Total taxable income (add lines 1 and 2)
3
Tax and Credits
4 West Union tax due before credits (1.000% of line 3)
4
5 Estimated tax payments made to West Union
5
6 Taxes withheld and paid to West Union
6
7 Overpayment from prior year(s)
7
8 Taxes withheld and paid to other localities
SEE INSTRUCTIONS FOR LINE 8 ON PAGE 2
8
9 Total credits (add lines 5 through 8)
9
Refund
( Issued if greater than 5.00 )
10 If line 9 is greater than line 4, subtract line 4 from line 9. This is the amount you overpaid
10
11 Amount of line 10 to be credited to next years estimate
11
12 Amount of line 10 to be refunded
12
Tax Due
( if greater than 5.00 )
13 If line 4 is more than line 9, subtract line 9 from 4, this is the tax amount you owe
13
14 Penalties and interest
Late File __________
Late Pay __________
Late Estimate_______
Interest __________
14
Declaration of Estimate For 2011
15 Estimated income
15
16 Estimated tax due. Multiply line 15 by 1.000%
16
17 Taxes to be withheld and paid to West Union and other localities
17
18 Prior credit applied to estimated tax payments (From line 11)
18
19 Net estimated tax due (subtract line 17 and 18 from 16)
19
20 Minimum amount due for first quarter (multiply line 19 by .25)
20
Amount You Owe
21 Total amount due (add lines 13, 14 and 20)
21
Tax Office Use Only : Tax Office Use Only : Tax Office Use Only
I certify that I have examined this return and any accopanying schedules and to the best of my knowledge and belief confirm that it is
true, complete and correct.
Taxpayer's Signature
Date
Spouse's Signature
Date
Tax Preparer's Signature
Date
(If other than taxpayer)
Phone No.
May VILLAGE OF WEST UNION discuss this return with the preparer shown above ___Yes ___No

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