Form Ir-1 - Individual Tax Return, City Of Englewood, Ohio

2011 - Individual Tax Return - 2011

City of Englewood

Income Tax Department

333 W National Rd

Englewood, OH 45322

Calendar Year Return and Payment Due April 17, 2012

Phone:

937-836-5106

Fiscal and Partial Years, Due within 3½ months of end of peri

Fax:

937-771-2891

Email:

tax@englewood.oh.us

Fiscal Year Beginning _____________20_____ and Ending ______________20_____

Form IR-1

Name, Address and Account Number

SS # (Primary)

(List both names if filing a joint return)

SS # (Spouse)

Residency Status (

one)

Resident

Non-Resident

Partial Year Resident From ____________To____________

Note: This return must be submitted by every Englewood resident 18 years of age and older.

SECTION A

Enter qualifying wages, bonuses, incentive payments, and commissions received between January 1 and December 31, 2011.

Form 2106 Expenses

Taxable Wages

City or Twp

Englewood City

Other City Tax

Qualifying

(Attach Form 2106 and

(Qualifying Wages

Employer

Where Employed

Tax Withheld

(See Instructions)

Wages

Schedule A)

Less 2106 Expense)

1-A

1-B

1-C

1-D

1-E

1. TOTAL WAGES AND WITHHOLDING………………....….

2. TAXABLE INCOME Line 1-E (or Column 3 on Page 2 if applicable)………..……………….………………………………..……….. 2.

3. TAX DUE 1.75% X Line 2 ………………….…………………………………………………………………………………….…………. 3.

4. TAX CREDITS

4-A. Englewood City Tax Withheld (Line 1-A) .……………………………………………………………….

4-A.

4-B. Other City Tax Credit (Not to exceed 1.75%) (Line 1-B)………………………………………………...

4-B.

4-C. Other: Estimates, Direct Payments, Credit from Prior …………………………………………………..

4-C.

4-D. Total Credits Available (Line 4-A + 4-B + 4-C)………………………………………………………...……………………………. 4-D.

5. BALANCE OF TAX DUE (Line 3 - Line 4-D)………………………………………………………………….…………………………...

6. PENALTY $__________ INTEREST $__________ LATE FEE $__________ ……………………………………..……………….. 6.

7. TOTAL AMOUNT DUE (Make Check Payable to City of Englewood) (No payment due if less than $5.00) ……..……………..

8. IF OVERPAYMENT: CREDIT TO NEXT YEAR $__________

REFUND $__________ (No refund if less than $5.00)

SECTION B — DECLARATION OF ESTIMATED TAX FOR 2012

9. Total Income Subject to Tax $__________ x 1.75%........................................................................................................................ 9.

10. Subtract Credit for Tax Withheld (not to exceed 1.75%) ………………………………………………………………………………….. 10.

11. Net Tax Due (Line 9 - Line 10) ……………………………………………………………………………………………………………… 11.

12. Quarterly Amount Due (1/4 of Line 11) …………………………………………………………………………………………………….. 12.

13. Credit from Line 8 ……………………………………………………………………………………………………… 13.

14. Line 12 - Line 13 ……………………………………………………………………………………………………………………………… 14.

15. TOTAL AMOUNT DUE (Line 7 + Line 14) …………………………………………………………………………………………………..

15.

SECTION C

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, adjusted to the ordinance requirements for local tax purposes, and if an audit of the Federal return is made which

affects the tax liability shown on the return an amended return is required to be filed within three months.

OFFICE USE ONLY

__________________________________________________________

Email _________________________

Signature of Taxpayer

Date

Account # _______________

__________________________________________________________

PH# __________________________

Paid $_________________

Signature of Spouse

Date