Form W-2 - Income Tax Worksheet - City Of Lorain - 2011

2011

CITY OF LORAIN

INCOME TAX DEPARTMENT

(440) 204-1002 FAX (440) 204-1006

605 WEST 4TH ST, LORAIN, OH 44052-1605

th

DUE DATE APRIL 15

OR

If under 18 - Attach proof of age

FISCAL YEAR FILERS MUST FILE ON OR BEFORE THE 15TH DAY OF

FISCAL PERIOD

TO

THE FOURTH MONTH AFTER THE CLOSE OF THAT FISCAL YEAR.

FOR INCOME TAX DEPARTMENT USE ONLY

YOUR NAME AND ADDRESS AS THEY APPEAR ON OUR RECORDS:

MAKE NECESSARY CORRECTIONS

NO EARNED INCOME

Exemption Certificate on back of form Must be completed

IF YOU MOVED DURING THE TAX YEAR, COMPLETE THIS BLOCK

Date moved into Lorain

Email Address

Phone#

Previous Address

Your Social Security No. or Federal ID

Spouse”s Social Security No.

Date moved out of Lorain

Present Address

W-2 WORKSHEET

SEE INSTRUCTIONS BEFORE COMPLETING

COLUMN 1

COLUMN 2

COLUMN 3

COLUMN 4

COLUMN 5

Date wages were

GROSS WAGES–HIGHEST

2106 EXPENSES, REDUCES

LORAIN

OTHER CITY TAX WITHHELD LIMIT

CITY WHERE EMPLOYED

Earned (Month/Day)

CREDIT ALLOWED IN COL. 5

2% OF COL. 2 MINUS COL. 3

WAGE ON W-2

TAX WITHHELD

W-2

From

To

COPIES

/

/

MUST

/

/

BE

/

/

ATTACHED

/

/

TOTALS

ATTACH A COPY OF 1040 (1ST PG. ONLY), ALL APPLICABLE W-2S, FEDERAL SCHEDULES, EXPLANATIONS ETC.

INCOME

$

1. Total W-2 wages from column 2 ...............................................................................................................1

2. 2106 Expenses from column 3, Sch. A & Form 2106 Must Be Attached ..................................................2

$

3. TAXABLE WAGES. SUBTRACT LINE 2 FORM LINE 1 ...........................................................................3

$

$

4. Other income. From schedule C, E or H on reverse .................................................................................4

5. TOTAL LORAIN INCOME. ADD LINE 3 AND 4 ........................................................................................5

$

TAX

$

6. LORAIN INCOME TAX. MULTIPLY LINE 5 BY 2% (.02) .........................................................................6

TAX

7. Lorain income tax withheld from column 4 ....................................................7

$

WITHHELD,

8. Prior year credits ...........................................................................................8

$

PAYMENTS

9. Estimated payments .....................................................................................9

$

AND

10. Credit for taxes withheld to other cities from column 5 ...............................10

$

CREDITS

11. TOTAL PAYMENT AND CREDITS. ADD LINES 7 THROUGH 10 ............

11

$

12. BALANCE DUE. If line 6 is more than 11, enter balance due here ........................................................12

$

BALANCE

13. Late Filing Penalty. $25, plus 10% of balance due (If paid after April 15

th

) .............................................13

$

DUE,

14. Interest. 1.0% per month, if applicable ....................................................................................................14

$

REFUND

15. TOTAL DUE. Add lines 12 through 14. Carry to line 25 below (No tax due if less than $2.01) ...............15

$

OR

16. OVERPAYMENT. If line 6 is less than line 11, enter overpayment here ....16

$

$

CREDIT

17. AMOUNT FROM LINE 16 TO BE REFUNDED

......17

$

(No refund if less than $2.01)

18. AMOUNT FROM LINE 16 TO BE CREDITED TO NEXT YEAR ................18

$

DECLARATION OF ESTIMATED TAX FOR 2012 (MANDATORY - When tax due is $100.00 or more)

$

ESTIMATE

19. Total estimated income subject to tax $__________ Multiply by tax rate of 2% (.02) ..............................19

20. Subtract tax to be withheld or paid to other cities (limit 2% of wages) ......................................................20

$

FOR

$

21. Balance of city income tax declared. Subtract line 20 from line 19 ..........................................................21

NEXT

22. Tax due before credits. Enter at least 25% of line 21 ...............................................................................22

$

YEAR

23. Less credits. Enter line 18 from above ......................................................................................................23

$

24. Net estimated tax due. Subtract line 23 from line 22 ................................................................................24

$

25. Enter balance due from line 15 above (No tax due if less than $2.00) .....................................................25

$

TAX DUE

26. TOTALTAX DUE ADD LINES 24 & 25. PLEASE MAKE CHECK PAYABLE TO LORAIN INCOME TAX DEPT. ......................26

$

If this return was prepared by a tax practitioner, check here if we may NOT contact him/her directly with questions regarding the preparation of this return.

The undersigned declares that this return (and accompanying schedule) is a true, correct and complete return for the taxable period stated and that the figures used herein are the same as used for Federal Income Tax purposes.

SIGNATURE OF PREPARER, IF OTHER THAN TAXPAYER

DATE

SIGNATURE OF TAXPAYER

DATE

SIGNATURE OF SPOUSE

DATE