Form Kr-1040 - Income Tax Return
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I
T
R
(F
KR-1040)
NCOME
AX
ETURN
ORM
FOR CALENDAR YEAR ENDED DECEMBER 31,
OR FISCAL YEAR
TO
P.O. B
293100 / K
, O
45429-9100
OX
ETTERING
HIO
SOCIAL SECURITY #/FED ID#
SPOUSE’S SOCIAL SECURITY #
P
: (937) 296-2502 • F
: (937) 296-3242
HONE
AX
Your Occupation
Spouse's Occupation
Account Number
Please Provide Your Name and Address Below
City of Residence
NAME
Cities of Income
ADDRESS
Phone
ADDRESS 2
Did you file a City of Kettering Income Tax Return last year?
Yes
No
CITY / STATE / ZIP
If no, please explain: ______________________________________________
Did you move
Into or
Out of Kettering during the year?
If so, complete the following: Date Moved_____________________________
DUE ON OR BEFORE APRIL 30 OR WITHIN
4 MONTHS FROM END OF FISCAL YEAR
Old Address ___________________________________________________
PART A
TAX CALCULATION
CREDIT FOR OTHER CITY
EMPLOYER’S NAME
EMPLOYMENT ADDRESS
KETTERING TAX WITHHELD
TAX - CANNOT EXCEED 1.75%
GROSS W-2 WAGES
(+)
(+)
(+)
(+)
LESS 2106 EXPENSES (ATTACH COPY OF FEDERAL FORM 2106)
(-)
1. NET WAGES
1.
2. INCOME OTHER THAN WAGES FROM PAGE 2 - (ATTACH SUPPORTING DOCUMENTS)
DO NOT ENTER A LOSS 2.
3. TOTAL INCOME (ADD BOXES 1 AND 2)
3.
4. TAX (BOX 3 MULTIPLIED BY 1.75% or .0175)
4.
5. A. KETTERING TAX WITHHELD
5A.
B. CREDIT FOR OTHER CITY TAX WITHHELD AND/OR PAID
B.
C. ESTIMATED TAX PAYMENTS/EXTENSION PAYMENTS
C.
D. PRIOR YEAR CREDIT
D.
E. TOTAL TAX CREDITS (ADD BOXES A, B, C, AND D)
5E.
6. IF BOX 4 IS GREATER THAN BOX 5E, ENTER BALANCE DUE
6.
7. IF BOX 5E IS GREATER THAN BOX 4, ENTER OVERPAYMENT
7.
AMOUNT TO BE REFUNDED
OR CREDITED TO NEXT YEAR
NOTE: IF ANY PORTION OF OVERPAYMENT IS DUE TO EXCESS WITHHOLDING, THE REFUND REQUEST FORM MUST BE
COMPLETED AND SUBMITTED ALONG WITH FORM KR-1040.
8. PENALTY
AND INTEREST
8.
9. BALANCE DUE (ADD BOXES 6 AND 8) - INCLUDE CHECK OR MONEY ORDER PAYABLE TO: CITY OF KETTERING
9.
PART B
DECLARATION OF ESTIMATED TAX — 1st Quarter Voucher
Complete the computation below if total tax liability is $100 or greater.
10. ESTIMATED TAXABLE INCOME FOR CURRENT YEAR $
x 1.75% = ESTIMATED TAX
10.
(+)
11. LESS ALLOWABLE CREDITS:
KETTERING TAX TO BE WITHHELD
11A.
(+)
CREDIT FOR OTHER CITY TAX (CANNOT EXCEED 1.75%)
11B.
(+)
OVERPAYMENT FROM PRIOR YEARS
11C.
(=)
11D.
12. BALANCE OF ESTIMATED TAX DUE (LINE 10 LESS LINE 11D)
12.
13. AMOUNT DUE WITH THIS DECLARATION AT TIME OF FILING (NOT LESS THAN 1/4 OF LINE 12)
13.
14. TOTAL DUE (BOX 9 PLUS LINE 13) - INCLUDE CHECK OR MONEY ORDER PAYABLE TO CITY OF KETTERING
14.
The undersigned declares that this return (and accompanying schedules) is a true, correct and complete return for the taxable period stated and understands that this information may be released to the Tax
Administrator of the City of Residence. If this return was prepared by a Tax Practitioner, may we contact your practitioner directly with questions regarding the preparation of this return?
Yes
No
DO NOT WRITE IN THIS AREA
Auditor_________________
Date ___________________
Your Signature
Date
Spouse’s Signature
Date
Signature of Tax Preparer if Other Than Taxpayer
Date
Revised 10/02
Address
Telephone Number
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