Form L-1 - City Income Tax Return For Individuals - 2016
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City of Lakewood - Division of Municipal Income Tax
L-1
2016
Change tax year
if necessary
City Income Tax Return for Individuals
Due By: April
18 2017
,
DATE OF MOVE DURING
2016
:
Refund
Prior Address: _________________________________________________
Into Lakewood
______________
Extension
Out of Lakewood ______________
Current Address: _______________________________________________
Amended - Year ___________
Contact Information:
Taxpayer's Social Security Number
Make checks payable and mail to:
City of Lakewood - Division of Tax
Spouse's Social Security Number (if joint)
PO Box 77047
Cleveland, OH 44194
Filing Status - CHECK ONLY ONE
Phone: (216) 529-6620
Telephone: (_______________) _______________-____________________________________
Single
Fax: (216) 529-6099
Website:
Married - Filing Joint
DO NOT FORGET TO ATTACH THE FOLLOWING DOCUMENTS (AS APPLICABLE):
Email: taxdept@lakewoodoh.net
W-2 |1099-MISC/K| Page 1 of Federal 1040/1040A/1040-EZ | Schedules C, E, and/or K-1 | Schedule A w/ Form 2106
Married - Filing Separately
If you want Lakewood to calculate your tax - STOP, check the box, sign and date the return. Submit with W-2s before March 15,
2017
.
TABLE A: WAGES AND COMPENSATION
Attach W-2s, Forms 1099-MISC and 1099-K, W-2Gs, and Page 1 of Federal 1040/1040A/1040-EZ per instructions
SECTION A-1: Part-Year Resident Calculation
1.
Number of Months Lived in Lakewood:
This section should only be used for moves within the State of Ohio. If you lived
2.
Divide Section A-1, Line 1 by 12:
in Lakewood for the entire year, or if you moved directly into Lakewood from a
residency out of state, calculate Columns 1 and 3 by 100%.
3.
Multiply Section A-1, Line 2 by 100:
%
SECTION A-2: W-2 Income Calculation
Column 1
Column 2
Column 3
Column 4
Column 5
Column 6
Dates wages
LOCATION WHERE EARNED
were earned
Total Wages
Withheld for
Withheld for
Tax Credit Limit
Smaller of
Tax Credit
List each W2 separately
or Compensation
Lakewood
other localities
(Column 1 x .01)
Column 3 or 4
(Column 5 x .50)
MM DD MM DD
Enter Section A-1, Line 3 in Column 1 and
100%
__________%
__________%
Column 3, and multiply each listing in Columns 1
& 3 by percentage before entering on form.
Lakewood (Calculate at 100%)
Lakewood (Calculate at 100%)
Total from Table C:
Overall Total:
Total
(to Line 1)
(to Line 6)
(to Line 7)
INCOME
1.
Wages and compensation (from Table A, Section A-2, Column 1)
1.
2.
Non-Wage Income not reported on Table B (i.e. Gambling Winnings, 1099-MISC income, 1099-K income)
2.
3.
Total Taxable Non-Schedule Income (add Lines 1 and 2)
3.
4.
Schedule Income (From Table B, Column 6, Line 9) - DO NOT enter amount less than zero
4.
TAX AND CREDITS
5.
Total Non-Schedule Lakewood tax due before credits (multiply Line 3 by 1.5% or .015)
5.
6.
Taxes withheld and paid to Lakewood (from Table A, Section A-2, Column 2)
6.
7.
Wage income tax credit (from Table A, Section A-2, Column 6)
7.
8.
Total Non-Schedule Credits (add Lines 6 and 7)
8.
9.
Total Non-Schedule tax due before estimated payments (subtract Line 8 from Line 5)
9.
10.
Total Schedule tax due before estimated payments (from Table B, Column 6, Line 16)
10.
11.
Total tax due before estimated payments (add Lines 9 and 10)
11.
12.
estimated tax payment(s) and unused prior year credits- up-to-date amounts available at
12.
2016
13.
Total net tax - Subtract Line 12 from Line 11 and proceed to Line 16. If less than $10.00, enter zero and proceed to Line 14
13.
OVERPAYMENT
Overpayment - If Line 12 is greater than Line 11, and not less than $10.00, subtract Line 11 from Line 12
14.
14.
15.
From Line 14 - Amount to be credited to
2017
- $_______________ Amount to be refunded - $_______________ (Proceed to Line 17)
BALANCE DUE
16.
Balance Due - If Line 11 is greater than Line 12, and not less than $10.00, subtract Line 12 from Line 11
16.
ESTIMATED INCOME TAX FOR
2017
17.
Estimated income tax for
2017
(form Line 11)
17.
18.
First quarter payment (multiply Line 17 by 25% or .25)
18.
19.
2016
credit applied to first quarter
2017
estimate (from Line 15)
19.
20.
Total amount due by April
18
,
2017
(add Line 16, 18, and subtract Line 19)
20.
The undersigned declares this to be a true, correct, and complete return of Lakewood Income Tax for the period stated.
Pay by Credit Card - Mastercard/Visa/Discover/American Express
_______________________________________________________________________________________________
Taxpayer's Signature
Date
Acct. Number _________________________________
Exp. Date ____________ Security Code ___________
_______________________________________________________________________________________________
Spouse's Signature
Date
Amount Paid $________________________________
_______________________________________________________________________________________________
______________________________________________
Signature
Tax Preparer's Signature (if other than taxpayer)
Phone #
Date
I authorize the City of Lakewood - Division of Municipal Income Tax to discuss my account and enclosures with my preparer (above)
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