City Of Norwalk Income Tax Department Form - 2008
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1CITY OF NORWALK
MAIL COMPLETED FORMS TO:
SECTION 1: EXEMPTION CERTIFICATE
INCOME TAX DEPARTMENT
NORWALK CITY INCOME TAX DEPT.
38 WHITTLESEY AVE.
SECTION 2: ALTERNATE 1040
38 WHITTLESEY AVE., P.O. BOX 440
P.O. BOX 440
SECTION 3: SIGNATURES
NORWALK, OHIO 44857-0440
NORWALK OHIO 44857-0440
ALL RESIDENTS OF THE CITY OF NORWALK MUST FILE A
TAX RETURN BY
APRIL 15, 2009
IF REQUIRED TO FILE
FEDERAL 1040, COPY MUST BE
ATTACHED OR NORWALK ALTERNATE 1040 FORM MUST BE
COMPLETED, SIGNED & ATTACHED
FOR QUESTIONS OR ASSISTANCE IN PREPARING YOUR
RETURN, CALL (419) 663-6720 OR VISIT THE INCOME TAX
DEPARTMENT AT 38 WHITTLESEY AVENUE, NORWALK, OHIO
(NEXT TO THE FIRE STATION). NORWALK TAX FORMS MAY BE
DOWNLOADED FROM OUR WEBSITE:
Soc. Sec. #
e-mail:
Spouse Soc. Sec. #
SECTION 1 - EXEMPTION CERTIFICATE
(If a joint return, spouse’s first name, initial and Soc. Sec. #)
I AM NOT REQUIRED TO FILE A 2008 INCOME TAX RETURN BECAUSE MY SOLE INCOME IS DERIVED FROM THE FOLLOWING SOURCE(S):
SIGNATURE REQUIRED, SEE SECTION 3
SOCIAL SECURITY BENEFITS, PENSION
WORKERS COMPENSATION
MILITARY SERVICE
INTEREST AND/OR DIVIDEND INCOME
TOTAL PERMANENT DISABILITY
ALIMONY
A.D.C./GENERAL PUBLIC ASSISTANCE
UNEMPLOYMENT COMPENSATION
UNDER AGE 18 FOR ENTIRE TAX YEAR (If applying for a refund, copy of driver’s license or birth certificate required)
BUSINESS CEASED OPERATION EFFECTIVE
(DATE)
RENTAL OR BUSINESS SOLD
(DATE) TO
OTHER (PLEASE EXPLAIN)
TAXPAYER DECEASED PRIOR TO 2008
(DATE)
MOVED OUT OF NORWALK IN 2007
(DATE) (Partial Year Residents In 2008 Are Required To File)
SECTION 2 - ALTERNATE 1040
****THIS SECTION MUST BE COMPLETED ONLY IF YOU CHOOSE NOT TO SUBMIT A PHOTO
COPY OF YOUR FEDERAL 1040, 1040A OR 1040EZ. IT IS FILED ALONG WITH YOUR CITY OF NORWALK FINAL INCOME TAX RETURN AND ANY COPIES
OF FEDERAL SCHEDULES C, C-EZ, 4797, E, F, IF APPLICABLE. SCHEDULES A AND 2106 ARE NECESSARY IF TAXPAYER SEEKS EMPLOYEE BUSINESS
EXPENSE DEDUCTION.****
SIGNATURE REQUIRED, SEE SECTION 3
FILING STATUS:
Single
Married filing joint return (even if only one had income)
Married filing separate return
Enter spouse’s social security number above and full name here:
Head of household (with qualifying person). If the qualifying person is a child but not your dependent, enter
the child’s name here:
Qualifying widow(er) with dependent child. Year spouse died:
ENTER THE EXACT FIGURES USED ON YOUR FEDERAL FORM 1040, 1040A, 1040EZ AND 1040TEL.
1040
1040A
1040EZ
1040TEL
Line
7
7
1
Wages, salaries, tips, etc. (attach Form(s) W-2)
If using 1040TEL, DO NOT INCLUDE INTEREST
Line
12
N/A
N/A
N/A
Business income or (loss) (attach Schedule C or C-EZ,
including cost of goods manufactured and/or sold)
Line
14
N/A
N/A
N/A
Other gains (losses) (attach Form 4797)
Line
17
N/A
N/A
N/A
Rental real estate, royalties, partnerships,
S Corporations, trusts, etc. (attach Schedule E)
Line
18
N/A
N/A
N/A
Farm income or (loss) (attach Schedule F)
Line
21
N/A
N/A
N/A
Other income (list type and amount)
SECTION 3 - SIGNATURES
CHECK BOX NEXT TO SIGNATURE TO AUTHORIZE CITY TO DISCUSS RETURN WITH PREPARER.
THE UNDERSIGNED DECLARES THAT THIS FORM (AS COMPLETED IN LIEU OF FORM 1040, 1040A, 1040EZ OR 1040TEL), IS A TRUE, CORRECT AND
COMPLETE FORM FOR THE TAXABLE PERIOD STATED AND THAT THE FIGURES USED HEREIN ARE THE SAME AS USED FOR FEDERAL INCOME TAX
PURPOSES.
I certify that all information in Section 1 (Exemption) to be true & correct.
Signature of Person Preparing, if Other than Taxpayer
Date
Signature of Taxpayer or Agent (Required)
Date
Address or Name and Address of Firm or Employer - Phone No. (
)
Signature of Spouse, if joint return
Date
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