Form Ir - Income Tax Return - City Of Springdale - 2003
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1
22003
FORM IR
FILING REQUIRED EVEN IF NO TAX DUE
INCOME TAX RETURN
FILE WITH
IF TAXPAYER AND SPOUSE ARE FULLY RETIRED
WITHOUT TAXABLE INCOME, MARK THIS BOX,
SPRINGDALE TAX COMMISSION
City of Springdale
SIGN, DATE & RETURN THIS FORM.
11700 SPRINGFIELD PIKE
SPRINGDALE, OH 45246
DID YOU HAVE W-2 INCOME?
YES
NO
PHONE (513) 346-5715
DID YOU OWN RENTAL PROPERTY?
YES
NO
LATE FILING WILL RESULT IN PENALTY AND INTEREST CHARGES
FAX (513) 346-5756
DID YOU PARTICIPATE IN A BUSINESS,
PARTNERSHIP OR S-CORPORATION?
YES
NO
EXTENSIONS MUST BE REQUESTED IN WRITING BEFORE THE DUE DATE.
IF ALL ANSWERS ARE "NO", PLEASE MARK, SIGN,
(ON OR BEFORE APRIL 30, 2004)
DATE AND RETURN THIS FORM.
TAXPAYER:
CURRENT EMPLOYER:
IF YOU ARE A NEW RESIDENT, FILING FOR THE FIRST
CITY WHERE EMPLOYED:
ACCOUNT NO.
TIME OR HAVE MOVED SINCE THE LAST FILING DATE,
SPOUSE:
PLEASE FURNISH CURRENT ADDRESS, DATE OF
CURRENT EMPLOYER:
MOVE AND COMPLETE LINE 20C.
CITY WHERE EMPLOYED:
MOVE IN: ___________________________________
TAXPAYER NAME(S) AND ADDRESS (CORRECT IF NECESSARY)
SOCIAL SECURITY NO.(S)
MOVE OUT: _________________________________
TAX OFFICE ONLY
LOCAL TELEPHONE NO.
H:
W:
2003 SPRINGDALE TAX RETURN
OFFICE USE ONLY
1. GROSS W-2 INCOME USUALLY BOX 5
$__________________ $__________________
(ATTACH ALL W-2'S AND PAGE ONE OF APPLICABLE FEDERAL 1040)
2. OTHER INCOME OR DEDUCTIONS FROM LINE 21 PAGE 2
$__________________ $__________________
3. TAXABLE INCOME
$__________________ $__________________
(LINE 1 PLUS OR MINUS LINE 2)
4. SPRINGDALE TAX
$__________________ $__________________
(1% OF LINE 3)
5. TAX PAYMENTS AND CREDITS:
A. ENTER TOTAL TAXES WITHHELD BY EMPLOYER(S) FOR THE CITY OF SPRINGDALE
$__________________
$__________________
B. ENTER 2003 TOTAL ESTIMATED TAXES PAID TO THE CITY OF SPRINGDALE
$__________________
$__________________
C. ENTER CREDIT FOR 2003 TAX PAID TO ANOTHER CITY FROM WORKSHEET PAGE 2
$__________________
$__________________
D. ENTER PRIOR YEAR TAX OVERPAYMENT AMOUNT
$__________________
$__________________
(
)
(
)
E. TOTAL TAX PAYMENTS AND CREDITS
$
$__________________
(ADD LINE 5A THROUGH 5D)
6. IF LINE 4 IS GREATER THAN LINE 5E ENTER THE DIFFERENCE ON THIS LINE
$
$__________________
2003 TAX DUE APRIL 30, 2004
7. IF LINE 5E IS GREATER THAN LINE 4, YOU MUST MARK THIS BOX FOR A REFUND OR
$
$__________________
REFUND
CREDIT WILL BE APPLIED TOWARD 2004 ESTIMATED TAX
$
$__________________
2004 CREDIT
TAX PAID TO ANOTHER CITY SHALL NOT BE REFUNDED OR CREDITED BY THE CITY OF SPRINGDALE.
NOTICE: BY LAW ALL REFUNDS AND CREDITS IN EXCESS OF $10 ARE BEING REPORTED TO THE APPROPRIATE TAXING AUTHORITIES.
NOTICE: NO ADDITIONAL TAXES OR REFUNDS OF LESS THAN $3 SHALL BE COLLECTED OR REFUNDED.
DECLARATION OF 2004 ESTIMATED INCOME TAX
FAILURE TO PAY 70% OF YOUR 2004 ESTIMATED TAX DUE BY JANUARY 31, 2005 WILL RESULT IN PENALTY AND INTEREST CHARGES.
8. ENTER TOTAL ESTIMATED 2004 INCOME SUBJECT TO TAX $__________________ MULTIPLY BY 1% = TOTAL 2004 ESTIMATED TAX
$_____________________ $_____________________
(
)
(
)
9. 2004 TAX PAID TO A CITY AND/OR WITHHELD BY EMPLOYER(S)
$__________________ $__________________
(NOT TO EXCEED 1% OF THE INCOME TAXED)
10.TOTAL 2004 ESTIMATED TAX DUE AND PAYABLE BY JANUARY 31, 2005
$__________________ $__________________
11.AMOUNT PAID WITH THIS DECLARATION
$
$
(NOT LESS THAN 1/4 OF LINE 10)
RETURN FILED __________ MONTHS LATE
INTEREST DUE $______________
PENALTY DUE $__________________
FOR
70% TAX PAID ___________ MONTHS LATE
INTEREST DUE $______________
PENALTY DUE $__________________
OFFICE
USE
TOTAL PENALTY AND INTEREST DUE
$
ONLY
TOTAL TAX, PENALTY AND INTEREST DUE
$
I CERTIFY THAT I HAVE EXAMINED THIS RETURN (INCLUDING ACCOMPANYING SCHEDULES AND STATEMENTS) AND TO THE BEST OF MY KNOWLEDGE AND BELIEF IT IS TRUE, CORRECT AND COMPLETE. IF PREPARED BY A
PERSON OTHER THAN THE TAXPAYER, THE DECLARATION IS BASED ON ALL INFORMATION OF WHICH PREPARER HAS ANY KNOWLEDGE.
TO PAY BY CREDIT CARD:
Enter number and expiration date fully and accurately.
No.
SIGNATURE OF TAXPAYER OR AGENT (REQUIRED)
DATE
s
r
r
TM
No.
EXP.
/
AMOUNT
$
DATE:
AUTHORIZED:
SIGNATURE OF PERSON PREPARING IF OTHER THAN TAXPAYER
DATE
PHONE
( H )
( W )
NUMBER:
CARDHOLDER
SIGNATURE:
ADDRESS
TELEPHONE NO.
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