Income Tax Return Form - City Of Massillon - 2011
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1
2City of Massillon, Ohio Income Tax Return
METHOD OF PAYMENT - IF PAYING BY CHECK OR MONEY
ORDER MAKE PAYABLE TO : “CITY OF MASSILLON”
•
P.O. Box 910
Massillon, OH 44648-0910
Massillon
•
•
MeansMore!
(330) 830-1709
Fax (330) 830-2687
2010
MasterCard
Amt
2011
For calendar year ending December 31, 2010
2011
Cash
Check
DUE DATE – APRIL 15, 2011
17, 2012
ACCT. #
FILING REQUIRED IF NO TAX DUE
EXP. DATE:
SIGNATURE
SPOUSE’S SOCIAL SECURITY #
TAXPAYER SOCIAL SECURITY #
Indicate Filing Status:
Individual
Joint Return
Other
PRINT NAME and ADDRESS IF MISSING (Indicate Changes)
BIRTH DATE
Home Phone (
)
Work Phone (
)
Are you or the business entity a resident
(
) Yes
(
) No
Moved INTO MASSILLON on
PREV. ADDRESS
Moved OUT OF MASSILLON on
PRESENT ADDRESS
IF EXEMPT FROM FILING TAX RETURN ENTER CODE # (See reverse side)
#
TAX PAID TO
MASSILLON TAX
TOTAL W-2 & 1099
EMPLOYER’S NAME
WHERE EMPLOYED
OTHER CITIES
PAID
WAGES
ALL
W-2 & 1099
COPIES
MUST
BE
ATTACHED
$
$
$
TOTAL
1.
WAGES AND SALARIES - Use highest dollar amounts on each W-2.
1. $
2.
Total adjustments from Back of Form (if applicable) - Losses cannot reduce W-2 earnings
2. $
3.
Wages earned outside Massillon by part year non-resident or prior to 18th birthday
3. Deduct $
4.
Allowable Employee Business Expenses
(Documentation required. See instruction sheet)
4. Deduct $
5.
Taxable Income (Add Lines 1 and 2 subtract Lines 3 and 4)
5. $
6. $
6.
Massillon City Tax (1.8% of Line 5)
7.
CREDITS
(a) Massillon income tax withheld by employer(s)
7a. $
(b) Municipal Tax paid to other cities (Cannot exceed 1.8% of income earned in each location)
7b. $
(c) Payment of Declaration of Estimated Tax
7c. $
7d. $
(d) TOTAL CREDITS (add a, b, c)
8. $
8.
BALANCE DUE (If Line 6 exceeds Line 7d enter difference here)
9.
Overpayment claimed (If Line 7d exceeds line 6)
9. $
9(a). Overpayment of tax claimed
9(b). Credit to 2012 Estimate
10.
Credit to 2011 Estimate (If no estimate due use Line 11)
10. $
10. TO BE REFUNDED (If estimate due use Line 10)
10. $
11.
11.
TO BE REFUNDED (If estimate due use Line 10)
Late filing fine - (returns filed after filing deadline), enter $25.00 fine
11. $
11. $
Late ling ne - (returns led after ling deadline), enter $25.00 ne
12.
12. INTEREST - 1% PER MONTH - EFFECTIVE THE FIRST DAY OF EACH MONTH
12. $
13.
INTEREST - 1% PER MONTH - EFFECTIVE THE FIRST DAY OF EACH MONTH
13. $
13. PENALTY - 1% PER MONTH FOR 1st SIX MONTHS - 2% PER MONTH THEREAFTER
14.
PENALTY - 1% PER MONTH FOR 1st SIX MONTHS - 2% PER MONTH THEREAFTER
14. $
14. Penalty for Underpayment of Estimated Tax
MUST BE PAID IN FULL WITH THIS RETURN
15.
15.
Total amount due -
15. $
NO TAXES OF LESS THAN $5.00 SHALL BE COLLECTED OR REFUNDED
MANDATORY DECLARATION OF ESTIMATED TAX FOR 2011
2012
(NO ESTIMATE DUE IF TAX DUE IS $100.00 OR LESS)
Must be fi led
1.
Total income subject to Massillon tax $
Massillon tax @ 1.8%
1. $
if a local
2.
LESS TAX TO BE WITHHELD
2. $
tax is
3.
Balance estimated Massillon tax
3. $
not withheld
4.
Less Credits: a. Overpayment on previous year’s return
4a. $
by your
b. Other (Specify)
4b. $
Total Credits
$
employer
5.
Net Tax due (line 3 less total of line 4)
5. $
6.
Amount paid with this return (not less than 1/4 X line 5) Make remittance payable to: City of Massillon
6. $
I CERTIFY I HAVE EXAMINED THIS RETURN (INCLUDING ACCOMPANYING SCHEDULES AND STATEMENTS)
May the City discuss this tax
Yes
AND TO THE BEST OF MY KNOWLEDGE, I BELIEVE IT IS TRUE, CORRECT, AND COMPLETE.
return with preparer?
No
Signature of Person Preparing, If Other Than Taxpayer
Date
Signature of Taxpayer Required
Date
Address or Name and Address of Firm
Preparers Phone
Spouse’s Signature
Date
File this return with MASSILLON TAX DEPARTMENT on or before April 15, 2011 or within 4 months after close of a fiscal
17, 2012
year or period. Requests for extensions must be submitted in writing on or before the filing deadline.
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