Individual Income Tax Return Form - City Of Parma Heights - 2004
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1
2OFFICE
USE
CITY OF PARMA HEIGHTS
PH IR
ONLY
Page 1
6281 Pearl Road, Parma Heights, Ohio 44130-3084
INDIVIDUAL INCOME TAX RETURN
DUE DATE APRIL 15, 2005
PHONE (440) 888-6440 FAX (440) 885-8228
Returns must be delivered in person or postmarked by due date
2004
Minimum Penalty of $25.00 if Filed After April 15, 2005
EXTENSIONS – Due on or before April 15, 2005
Read Extension Instructions to Avoid Penalties
Your Social Security No.
Spouse’s Social Security No.
Spouse’s Name
Make Checks Payable to City of Parma Heights
Your Name and Address as they appear on our records. Make any Necessary Corrections
If Retired, give date
IF YOU MOVED, COMPLETE THIS BLOCK
Date moved into Parma Heights
Previous Address
Date moved out of Parma Heights
Present Address
Other Status Change & Date
Phone No.
Daytime No.
READ INSTRUCTIONS BEFORE PREPARING THIS RETURN TO AVOID PROCESSING DELAYS OR PENALTIES
1. WAGES, SALARIES, TIPS, COMMISSIONS AND OTHER EMPLOYEE COMPENSATION BEFORE PAYROLL DEDUCTIONS. IF PARTIAL YEAR RESIDENT, SEE INSTRUCTIONS.
C. Tax Withheld
D. Parma Heights
E. Gross Earnings
W-2
A. Names of Employers
B. City Where Employed
COPIES
In Other City
Income Tax Withheld
Before Deductions
MUST BE
$
$
$
ATTACHED
OR
TAX CREDIT
LINE 7 (a3)
WILL BE
DISALLOWED
Attach Copy Federal Form 1040 – Page 1
TOTALS
$
$
$
$
2.
Net Profit or Loss, Pg. 2 (Sch. C, E & H) DO NOT DEDUCT LOSS FROM W-2 INCOME.
Copy of Federal Schedules Required
..
$
3.
TAXABLE INCOME (Total COL. E & Line 2) ....................................................................................................................................
$ (
)
4.
ADJUSTMENTS: A. Business Expense (Disallowed if Federal 1040, Sched A & 2106 NOT ATTACHED) See Instructions ......
$ (
)
B. Less Income Earned While Non-Resident (Income Earned In Parma Heights Cannot Be Prorated) ..........
$
5.
TOTAL ADJUSTED TAXABLE INCOME SUBJECT TO PARMA HEIGHTS INCOME TAX..............................................................
$
6.
Parma Heights Income Tax 2% of Line 5 ........................................................................................................................................
7.
CREDITS: (a1) Tax Withheld In Other Cities (Total Col. C) ......................................$
(a2) Reduce Taxes Withheld In Other Cities (SEE TAX CREDIT
COMPUTATION INSTRUCTIONS NO’S 4 THROUGH 9) ..............$ (
)
(a3) Credit for Taxes Withheld In Other Cities; (a1) Less (a2) X .50 ............................ $
(b)
Tax Withheld In Parma Heights (Total Col. 1D)...................................................... $
(c)
Payments TO PARMA HEIGHTS ON 2004 ESTIMATE.
(As of _____________)
$
*
(d)
Overpayment FROM PRECEDING YEAR ............................................................ $
(e)
RESIDENTS WITH LINE 2 PROFIT – 50% Of Tax Paid To Other Cities .............. $
$ (
)
(f)
TOTAL CREDITS (Add Lines 7 a3, b, c, d, e) ....................................................................................................
$
8.
(a) TAX DUE (Line 6 Less Line 7f) – No credit/payment if less than $1.00 ....................................................................................
(b) Overpayment Claimed (If Line 7f exceeds Line 6 enter difference here) ........................ $
(c) Enter Amount of Line 8b you want Credited to your 2005 Estimated Tax ........................ $
(d) Amount to be refunded (Line 8b Less Line 8c) (NO REFUND LESS THAN $5.00) ........ $
$
9.
PENALTY (10%) (See Instructions) (MINIMUM PENALTY OF $25.00 IF FILED AFTER APRIL 15, 2005) ..................................
$
10.
PENALTY (10%) (Underpayment of Estimated Tax (See Instructions) Penalty is figured separately for each installment ............
$
11.
INTEREST (18%) (See Instructions)................................................................................................................................................
$
12.
TOTAL AMOUNT DUE FOR 2004 (PAYABLE WITH THIS RETURN ON OR BEFORE APRIL 15, 2005) ......................................
MANDATORY – DECLARATION OF ESTIMATED TAX FOR 2005
(PENALTY ASSESSED FOR FAILING TO PAY ESTIMATED TAX - SEE INSTRUCTIONS)
$
13.
Total Estimated Income Subject to Tax ____________________ X TAX RATE OF 3% FOR GROSS TAX OF ............................
14.
Credits: Parma Heights Tax withheld $
100% of 2% Tax withheld/paid to another city $
$ (
)
15.
Total of Line 14 (Box 1 plus 2)..........................................................................................................................................................
$
16.
NET TAX DUE (Subtract Line 15 from Line 13) ..............................................................................................................................
$
17.
AMOUNT DUE WITH ESTIMATE 1/4 of Line 16 (Payable with this return on or before April 15, 2005) ........................................
$ (
)
18.
Overpayment from previous year - Credit from (Line 8c) (If Applicable)..........................................................................................
$
19.
Subtract Line 18 From Line 17 - AMOUNT DUE WITH THIS FORM on or before April 15, 2005
..................................................
TOTAL TAX DUE -
ADD LINES 12 & 17 OR LINES 12 & 19 REMIT THIS AMOUNT ON OR BEFORE
APRIL 15, 2005
$
I certify that this return including present address, schedules and statements are to the best of my knowledge and belief true, correct and complete.
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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