Form Ncty-1040 - Income Tax - City Of Norwalk
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1
2
3ALT. 1040
Print Final Return
Please Change Tax Year if Necessary
FOR OFFICE USE ONLY
- CITY OF NORWALK INCOME TAX
MAKE CHECK PAYABLE TO:
DATE REVIEWED
INITIALS
FILING REQUIRED BY ALL RESIDENTS 18 YEARS OR OLDER EVEN IF NO TAX IS DUE
2010
CITY OF NORWALK INCOME TAX
38 WHITTLESEY AVE, P.O. BOX 440
FILE ON OR BEFORE
NORWALK, OH 44857-0440
EXTENSION REQUESTS MUST BE RECEIVED BEFORE
Ph. (419) 663-6720 Fax (419) 663-6795
2011
Email:
FILING IS REQUIRED EVEN IF YOU HAVE
MON-FRI 8:00-4:30
NO INCOME AND NO TAX IS DUE
Check Filing Status
ENTER NUMBER AND EXPIRATION DATE FULLY ANC ACCURATELY
( ) Single
( ) Married
Now Filing With ______________________
SS#_______________________________
Card # (16 Digits) __________________________________
( ) Single Previously Filed With
Exp. Date ____________________
Security Pin#
____________
___________________________________
SS#_______________________________
Total Amt. Authorized $ _____________________________
Are You Required To File A Federal Tax Return?
Signature ________________________________________
( ) Yes, include a copy of your 1040, or a
completed Norwalk Alternate 1040 Form
Daytime Phone # __________________________________
( ) No
CHECK THE APPROPRIATE BOX
FULL YEAR RESIDENT PART YEAR RESIDENT
Please visit for the On-Line Tax Preparation Tool.
MOVE IN DATE __________ MOVE OUT DATE__________
Enter your:
Business Fed. I.D. No.
Social Security No.
Spouse Security No.
Phone #
NORWALK TAX WITHHELD
OTHER MUNICIPAL
QUALIFYING WAGES
EXCLUDE SCHOOL
TAX WITHHELD
EMPLOYER’S NAME
LOCATION
(USUALLY BOX 5 OF THE W-2 FORM)
NOT TO EXCEED 1.50%
DISTRICT INCOME TAX
1a.
1b.
1c.
ON REVERSE SIDE
NO TAX DUE, REFUND OR
CREDIT IF $4.99 OR LESS
*
*
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Multiply by tax rate 1.5 percent for gross tax total................
...........
...........
...........
...........
(At least 22
/
% of Line 3 of Declaration)
1
2
Total Due
& Payable
CHECK BOX NEXT TO SIGNATURE TO AUTHORIZE CITY TO DISCUSS RETURN WITH TAX PREPARER.
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Parent category: Financial