Form Ez - Income Tax Return - City Of Perrysburg - 2015
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CITY OF PERRYSBURG
(TAX OFFICE USE)
Review list of conditions on
Income Tax Return Form EZ
reverse side to determine if
NTL
___________
________________
you are eligible to file Form EZ
For Calendar Year 2015
OF/OR ___________ DATE_________Yr_____
Due on or before April 18, 2016
EST
___________ CSR ________________
TAXPAYER’S NAME(S), ADDRESS & FILE NUMBER
File #
All residents must file a tax return — either Form EZ or
Form P. The City of Perrysburg has universal filing.
Taxpayer’s social security number ________________________________
___________________________
Spouse’s social security number
If you have moved, what is your new address? _________________________________________________________________
Date moved ______________________
Landlord’s name and address if applicable: _______________________________________________________________________________________________________
Should we deactivate your account?
YES
NO
Effective date: ____________________
Reason for deactivation:
Moved
Deceased
No future tax filing required because:* _____________________________________________________
*If you have taxable income again, you will be required to file.
Complete item 1 or item 2 below; then sign, date, and submit your tax return by the filing due date.
1.
I(We) have read and understand the instructions and have no taxable income.
2.
Taxable income as shown in either Box 5 or Box 18 whichever is higher on the W-2 form(s) ....................................
___________________
(Attach W-2’s to this return)
Attach W-2's to this return showing amounts in Box 5 (Medicare wages) and Boxes 18-20 (local wages and withholding)
A. Tax at 1.5% of income
Multiply amount on line 2 above by .015
______________________
A
B.
Perrysburg income tax withheld by employer
(school district tax 8708 is NOT a credit on your city return)
______________________
B
C. Other city income tax withholding credit (attach W-2’s)
From Worksheet on back
______________________
C
D. Estimates paid:
1Q – 04/15/2015
Date Paid ______________
Amt Paid ______________
2Q – 07/31/2015
Date Paid ______________
Amt Paid ______________
3Q – 10/31/2015
Date Paid ______________
Amt Paid ______________
4Q – 01/31/2016
Date Paid ______________
Amt Paid ______________
Total ............................................
______________________
D
E.
Carryover credit from prior tax year ...............................................................................................................................
______________________
E
F.
Tax due = Line A less Lines B, C, D, E
(You must make estimates if A-B-C is $200 or more)..........................
______________________
F
G. Refund or Carryover amount – Check box below .............................................................................................................
______________________
G
Refund __________________
Use toward 201 Estimate __________________
Office Use Only:
Penalty _____________
Interest _____________
Late Filing Fee _____________
.......
______________________
Total
______________________
City of Perrysburg Tax Commissioner
Make checks payable to:
Mail payment to:
Mail refund request to:
Mail all others to:
CITY OF PERRYSBURG TAX COMMISSIONER
CITY OF PERRYSBURG TAX COMMISSIONER
CITY OF PERRYSBURG TAX COMMISSIONER
P.O. BOX 490
P.O. BOX 428
201 W. INDIANA AVENUE
PERRYSBURG, OH 43552-0490
PERRYSBURG, OH 43552-0428
PERRYSBURG, OH 43551-1582
• Estimates are required for all taxpayers with a tax liability after withholding credits of more than $200.
• Penalty is 1% per month, minimum of 10%, assessed on unpaid or under paid tax estimates. Interest is 1% per month on unpaid taxes.
• If your return is postmarked after midnight of the due date, a late fee of the lesser of the amount due or $25 will be assessed.
THE UNDERSIGNED DECLARES THAT THIS RETURN IS A TRUE, CORRECT, AND COMPLETE RETURN FOR THE TAX PERIOD STATED.
Check box to authorize the Income Tax Division to discuss your return with your preparer.
______________________________________________________________________________________________
Signature of Taxpayer
Date
Phone Daytime
Evening
________________________________________________________________________________________________________________________________________
Signature of Taxpayer
Date
Phone Daytime
Evening
________________________________________________________________________________________________________________________________________
Signature of Preparer
Date
Print or Type Preparer’s Name, Address, and Phone Number
NOTE: ATTACH ALL W-2’S SHOWING MEDICARE WAGES AS WELL AS CITY WAGES AND CITY WITHHOLDING
NOTE: Attach all W-2's showing amounts in Box 5 (Medicare wages) as well as Boxes 18-20 (local wages and withholding)
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