Individual Income Tax Return Form - City Of Fairlawn, Ohio
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1
2CITY OF FAIRLAWN, OHIO
Individual Income Tax Return
Tax Office Use Only
Year Ending December 31 ______
PO Box 5433 Fairlawn OH 44333
Due on or before April 15 ______
(330) 668-9525 Fax (330) 668-9565
Social Security # ________-_______-__________
Acct #
Spouse # ________-_______-__________
Check box if first time filing.
Name:
Address:
Check box if all income is non-taxable. Such as
Social Security, Unemployment, Interest, Disability.
City, State Zip:
Check box if moved during the year.
______
Date Moved In: _______ Date Moved Out:
If pre-printed information is incorrect, please make necessary changes.
1. Enter Total W-2 Compensation Received, Including All Deferred Income
Employed
1a. Taxable Wage
1c. 2% of Taxable
1d. Enter Smaller
Print Employers Name
City Where Employed
1b. Tax Withheld
From
To
Largest Figure on W-2
Wage Shown in 1a
Column 1b and 1c
0.00
0.00
0.00
0.00
Total Columns
ATTACH W-2S ON BACK
1a.
1b.
1c.
1d.
0.00
0.00
0.00
0.00
2. Other Taxable Income
2a. Business Income (attach Schedule C) …………………………………………………….……_____________
2b. Rental Income (attach Schedule E & copy of other city return if outside Fairlawn).…………._____________
2c. Other Income (attach documentation) …………………………………………………………._____________
2d. Loss Carry Forward from Previous Years …………………………………………………….._____________
3. TOTAL OTHER TAXABLE INCOME (add lines 2a, 2b, 2c, subtract 2d; if amount is less than zero, enter zero)………_____________
4. Total Taxable Income Before Deductions (add lines 1a and 3) …………………………………………_____________
0.00
5. Deductions for Unreimbursed Expenses (see instructions) ……………………..………………………._____________
6. FAIRLAWN TAXABLE INCOME (subtract line 5 from line 4) ……………………………………………………….…._____________
7. Fairlawn Tax Due Before Credits (multiply line 6 by 2%) ……………………………………………..._____________
0.00
8. Refunds Received from Other City/JEDD.…………..………………………………………………….._____________
9. TOTAL INCOME TAX DUE BEFORE CREDITS (add lines 7 and 8) …………………………………………………._____________
0.00
10. Credits
10a. Income Tax Withheld by Employer (total column 1d, not to exceed 2% per W-2) ………..._____________
0.00
10b. Payments Made to Another City (attach documentation) …………………………………..._____________
10c. Fairlawn Estimated Tax Payments…………………………………………………………..._____________
10d. Prior Year Overpayment ……………………………………………………………………._____________
11. TOTAL CREDITS PAID (add lines 10a thru 10d) ………………………………………………………………………..._____________
0.00
12. BALANCE OF TAX DUE (subtract line 11 from line 9) ………………………………………………………………….._____________
13. Late Fee, if return is received after due date ($25/month, maximum of $150) ………………..………._____________
14. Interest, if tax is received after due date (0.42% of balance of tax due per month) …..……..…………_____________
15. Penalty, if tax is received after due date (15% of balance of tax due per month) …….……..…………_____________
16. BALANCE OF TAX AND FEES DUE (add lines 12 thru 15) …………………………………………………................._____________
0.00
17. Overpayment (if line 16 is less than zero) Credit to Next Year _____________Refund _____________
Amounts Less Than $10.00 Will Not Be Collected, Credited or Refunded
DECLARATION OF ESTIMATED TAX FOR YEAR ________
18. Estimated Taxable Income for Current Year …………………………………._____________
19. Estimated Tax Due (2% of line 18) …………………………………………..._____________
20. Tax Withheld or Paid to Another City …………………………………….….._____________
21. Total Estimated Tax Due (subtract line 20 from line 19) ……………………………………….._____________
22. First Quarter Estimated Payment (not less than 22.5% of line 21)……….……_____________
23. First Quarter Estimated Balance Due (subtract line 17 credit from line 22) ……………………. _____________
24. AMOUNT PAID WITH THIS RETURN (add lines 16 and 23)
Make Check Payable to City of Fairlawn ………_____________
0.00
I certify I have examined this return including accompanying schedules and statements and to the best of my knowledge believe it is true, correct and complete.
________________________________________
_____________________________________________
Printed name of person preparing return, if other than taxpayer
Phone Number
Signature of Taxpayer
Date
__________________________________________________________________________________________
Signature of Spouse
Date
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