Individual Tax Return Form - City Of Monroe - 2011
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1
2City of Monroe
Individual Tax Return
Income Tax Division
2011
P. O. Box 629
Monroe, Ohio 45050
OR
Phone: (513) 539-7374
FISCAL PERIOD _______ TO _______
Fax: (513) 539-6209
Calendar Year Taxpayers file on or before April 17
Website:
THIS SPACE IS FOR OFFICIAL USE ONLY
th
th
Fiscal Year Due on 15
Day of 4
Month After Year End
Spouse’s Name __________________
Account Number
Spouse’s SSN ______-____-_______
Name
Part-Year Resident From______ to _______
Address
Phone No.
City/State/Zip
Did You File a Return Last Year?
YES
NO
IF INFORMATION ABOVE IS INCORRECT, PLEASE MAKE CORRECTIONS
Part A
Tax Calculation
(Attach front page of Federal Form 1040)
Total Qualifying Wages (Attach W-2 Forms) For multiple W-2s complete Worksheet A on page 2………………
1.
$
Less Employee Deductions (Attach Form 2106, 2% ALLOWANCE)……..………………………………………...…
2.
$
Taxable Wages Before Adjustment. (Line 1 minus Line 2)………………………………………………………………
3.
$
Less Nontaxable Income (part-year or non-residents only) (provide calculations)…………………………………….
4.
$
Taxable Qualified Wages (Line 3 minus Line 4)………………………………………………………...…………………
5.
$
Other Income or (Loss) From Federal Schedules C, E, F, K-1, 1099-MISC (See Worksheet B Line 6)
6.
$
(Attach copies of all Federal Schedules)………………………………………………………………………………..
Monroe Taxable Income (Line 5 plus Line 6) Losses on Line 6 do not offset W-2 Income from Line 5………...
7.
$
Monroe Income Tax (Multiply Line 7 by 1.5% [.0150])…………………………………………………………………...
8.
$
9 a.
Monroe Tax Withheld (per W-2s)…………………………………………...
$
Estimates Paid (including credit from previous year)……………………..
9 b.
$
9 c.
Other Local Taxes Paid (Allowed up to 1.5% credit)………………..……
$
Total Payments and Credits (Lines 9a + 9b + 9c)…….…………………………………………………………………..
10.
$
Tax Due (Subtract Line 10 from Line 8)…………………………………………………………………………………….
11.
$
Penalty $_____________ Interest $______________ …………………….Total Penalty & Interest Due…………..
12.
$
Total Amount Due (Add Line 11 and Line 12)(Amounts less than $5.00 not payable)…..…………………………...
13.
$
Overpayment – Credit to 2012 (Line 10 greater than Line 8)…………….
14.
$
Refunded (Amounts less than $5.00 will not be refunded)……………….
15.
$
Part B
Declaration of Estimated Tax for 2012
Total estimated income subject to tax………………………………………………………………………………………
16.
$______________________
Monroe Income Tax Declared (Multiply Line 16 by 1.5% [.0150])………………………………………………….……
17.
$______________________
Estimated Taxes Withheld from Wages…………………………………………………………………………………….
18.
$______________________
Tax due after Withholding (Line 17 less Line 18) STOP if this amount is less than $0.00..…………………………..
19.
$______________________
Declaration Due (25% of Line 19)…………………………………………………………………………………………...
20.
$______________________
Less credits (from Line 14 above)…………………………………………………………………………………………...
21.
$______________________
Net estimated tax due if Line 20 minus Line 21 is greater than zero*…………………………………………………...
22.
$______________________
23.
TOTAL AMOUNT DUE—Combine Line 13 above with Line 22 (
)
$______________________
Make checks payable to the City of Monroe
*Subsequent estimated payments are due by the 31st of July, October, and January.
The undersigned declares that this return (and accompanying schedules) is a true, correct and complete return for the taxable period stated
and that the figures used herein are the same as used for Federal Income Tax purposes.
SIGNATURE OF TAXPAYER
SIGNATURE OF PERSON PREPARING IF OTHER THAN TAXPAYER
DATE
DATE
SIGNATURE OF SPOUSE
NAME AND ADDRESS OF PREPARER
PHONE NUMBER
DATE
Check here if we may contact the above preparer with questions regarding the preparation of this return.
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