2015 Individual Tax Return - Wyoming

TAXPAYER’S SSN

DUE: APRIL 18, 2016

2015 Individual Tax Return

SPOUSE’S SSN

Account No.

City of Wyoming

TAXPAYER’S BIRTHDAY

Tax Department

Telephone Number (

)

800 Oak Avenue

SPOUSE’S BIRTHDAY

Email:

Wyoming, OH 45215

Check your status as a

Date Moved (2015):

taxpayer:

Late Filing of

 Resident-full year

Into Wyoming ____________________

Individual Tax Return Form

 Resident-part year

Out of Wyoming __________________

is Subject to Penalty of $75.00

 Non-Resident

Filing Status

Name

(Check One)

Spouse’s Name

 Single

Office: 513-821-9731

 Married

Fax: 513-821-7962

Filing Joint Return

Address

 Married

Filing Separate Return

City/State

Part (A) Income

(1) Ohio Adjusted Gross Income reported on line 3 of Ohio Form IT 1040

$

(attach copy of the entire State of Ohio Tax Return and the Federal Tax Return page 1)

see instructions

Part (B) Adjustments

[ADD BACK]

(1) Business Income Deduction

Ohio IT 1040 Schedule A Page 1 Line 12 (if applicable)

$

[SUBTRACTION]

(2) Military Duty Pay (copy of W2 required)

$

(3) State Teachers Retirement System of Ohio (copy of 1099 required)

$

(4) Public Employees Retirement System of Ohio (copy of 1099 required)

$

(5) Police and Fire Retirement System of Ohio (copy of 1099 required)

$

(6) City of Cincinnati Retirement System (copy of 1099 required)

$

(7) School Employees Retirement System of Ohio (copy of 1099 required)

$

(8) Exercising of Stock Options (SEE INSTRUCTIONS)

$

(9) Part-year/non-resident income

$

(10) Taxable Income (add line B-1 to A-1 and subtract lines B2-B9 from A-1)

$

(11) Wyoming Tax 1.0% of Line 10 (multiply taxable income (line 10) by .01) DO NOT SEND PAYMENTS OF 1 DOLLAR OR LESS

$

Part (C) Credits

(1)

2015 Estimated Tax Paid to Wyoming Tax Department

$

(2)

Prior Year Overpayments

$

(3)

City of Wyoming Tax Withheld

$

(Attach W2s)

(4)

Total Credits (Add Lines C-1 through C-3)

$

(5)

Balance of tax due for 2015 (Subtract line C-4 from line B-11)

$

(Payment must accompany this return) Make check payable to: City of Wyoming

PLEASE NOTE:

Overpayment--Refunded

Enter amount

$

REFUNDS OF ONE DOLLAR OR LESS

Credited to next year estimate

Enter amount

$

WILL NOT BE MADE

By law, all refunds and credits in excess of $10.00 must be reported to the Internal Revenue Service.

Taxpayer’s Signature

X

FOR TAX OFFICE USE ONLY

Spouse’s Signature

X

Penalty $

Date

Tax Preparer’s Name

Interest $

Tax Preparer’s Telephone Number

Tax Preparer’s Address

Total Due $

Tax Preparer’s City

State

Zip

Declaration of 2016 (see next page)

A federal extension does not automatically create a City of Wyoming Income Tax extension. Provide a copy of your federal extension on or before April 18, 2016. Even though you may have

an extension of time to file your return, you will owe interest on any tax not paid by April 18, 2016 for the balance of 2015 and the first quarter of 2016. Declarations not filed by April 18,

2016, or during an extension period, are subject to additional interest and penalties.