City Of Fairlawn, Ohio Individual Income Tax Return
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1CITY OF FAIRLAWN, OHIO
Individual Income Tax Return
Tax Office Use Only
PO Box 5433 Fairlawn OH 44334
Year Ending Dec 31, _________
(330) 668-9525 Fax (330) 668-9565
Due on or before April 30
Social Security #
Acct #
Spouse #
Check box if first time filing.
Check box if only income is from Social
Security, Pension, Alimony, Etc.
Name
Address
Check box if you moved during the year:
City/Zip
Into Fairlawn:
Out of Fairlawn
If preprinted information is incorrect, please make necessary changes.
1.
Print Employer’s Name
City Where Employed
Gross Wages*
Fairlawn
Tax Withheld
Wages
Tax Withheld
Other City
Attach
W-2’s
and 1099’s
on back
→
1a $
1b $
1c $
Column Totals
*HIGHEST WAGE ON W-2 IS TAXABLE
2. Other City Rental Income (attach Schedule E & copy of other city return)
2.)
3. Other Taxable Income:
3a. Business Income (attach Schedule C)
3a.)
3b. Fairlawn or Non-Taxing City Rental Income (attach Schedule E)
3b.)
3c. Other Income (attach documentation)
3c.)
3d. Loss Carry Forward from Previous Years
3d.)
4. Total Other Taxable Income (add lines 3a, 3b, 3c, subtract 3d; if amount is less than zero, enter zero)
4.)
5. Total Taxable Income Before Deductions (add lines 1a and 4)
5.)
6. Deductions for Unreimbursed Expenses Incurred by a Fairlawn or Non-Taxing Employer (attach Form 2106)
6.)
7. Fairlawn Taxable Income (subtract line 6 from line 5)
7.)
8. Fairlawn Tax Due Before Credits (multiply line 7 by 2%)
8.)
9. Credits:
9a. Fairlawn Income Tax Withheld by Employer (line 1b)
9a.)
9b. Other City Tax Withheld by Employer (line 1c, not to exceed 2%)
9b.)
9c. Payments Made to Another City (attach documentation)
9c.)
9d. Payment on Declaration of Fairlawn Estimated Tax
9d.)
9e. Prior Year Overpayment
9e.)
10. Total Credits (add lines 9a thru 9e)
10.)
11. Balance of Tax Due (subtract line 10 from line 8)
11.)
12. Late Fee, if received after due date ($50 first offense, $100 subsequent offenses)
12.)
13. Interest, if received after due date (1.5% of balance of tax due per month)
13.)
14. Penalty, if received after due date (1.5% of balance of tax due per month)
14.)
15. Total Balance Due (add lines 11 thru 14) Make Check Payable to City of Fairlawn
15.)
16. Overpayment (if line 11 is less than zero): Credit to Next Year _________ Refund _________
No Tax or Refunds of Less Than $1.00 Will Be Collected or Refunded
Declaration of Estimated Tax for Current Year
17. Estimated Taxable Income for Current Year
17.)
18. Estimated Tax Due (2% of line 17)
18.)
19. Less Fairlawn Tax to be Withheld and/or Paid to Another City
19.)
20. Less Overpayment (line 16)
20.)
21. Total Estimated Tax Due (line 18 minus 19 and 20)
21.)
22. Amount Paid with this Return (not less than ¼ of line)
22.)
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.
X
Printed name of Person Preparing if other than taxpayer
Phone Number
Signature of Taxpayer
Date
Signature of Taxpayer
Date
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Parent category: Financial