Individual Earning Tax Return - Elmwood Place Income Tax Bureau
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1
2INDIVIDUAL
ELMWOOD PLACE EARNING TAX RETURN
Elmwood Place
TAX OFFICE #’s
TAX YEAR:
Income Tax Bureau
Email:
P-(513) 242-3920
RETURNS WILL NOT BE PROCESSED WITHOUT W-2’S AND SCHEDULES
6118 Vine St. Elmwood
F- (513) 242-4578
MANDATORY FILING:
FILING REQUIRED EVEN IF NO TAX IS DUE. $50.00 FINE FOR FAILURE TO FILE
Place, OH 45216
ELMWOOD PLACE RESIDENTS WHOSE ENTIRE INCOME WAS FROM EMPLOYMENT SOURCES AND TAX WAS WITHHELD FOR ELMWOOD OR ANY OTHER
MUNICIPALICTY AT THE RATE OF 2% OR MORE ARE PERMITTED TO ATTACH W-2 FORMS (OR OTHER PROOF OF TAXES PAID). SIGN AND RETURN THIS FORM.
Account Number
________________________________
IF MOVED SINCE THE PREVIOUS FINAL RETURN WAS DUE GIVE DATE:
Taxpayer(s) Name and Address
INTO
__________________________________, _________________
OUT OF
_______________________________, _________________
New Address __________________________________________________
Taxpayer
_______________________________Phone ________________________
Social Security Number _______________________________________________
Spouse
RETIRED?
If taxpayer & spouse are fully retired and
Home Telephone: ___________________________________________________
have no taxable income, sign, date & return form.
Social Security Number _______________________________________________
1. HIGHEST GROSS WAGES, SALARIES, TIPS AND OTHER EMPLOYEE COMPENSATION
(ATTACH ALL W-2’S)
$
INCOME
2. OTHER TAXABLE INCOME FROM LINE 18, PAGE 2 – SEE INSTRUCTIONS
$
3. TAXABLE INCOME: (LINE 1 + LINE 2)
$
TAX
4. ELMWOOD PLACE TAX: (2% OF LINE 3)
$
CREDITS
- ATTACH W-2’S FOR VERIFICATION
5.
TAX
a. TAX WITHHELD BY EMPLOYER FOR ELMWOOD PLACE
$
WITHHELD
b.
ESTIMATED TAX YOU PAID ELMWOOD PLACE
$
PAYMENTS
c.
TAX PAID CITY OR VILLAGE OF (2% MAXIMUM)
$
AND
CREDITS
d. PRIOR YEAR OVERPAYMENTS
$
e. TOTAL CREDITS
$
BALANCE
6. TAX DUE
FR TOTAL
(IF LINE 4 IS GREATER THAN LINE 5 E – THE BALANCE MUST ACCOMPANY THIS RETURN)
$
DUE
a. PENALTY $
INTEREST $
P & I TOTAL
_________
$
b. LATE FEE $
TOTAL OF ALL (TAX, LATE FEE, PENALTY AND INTEREST)
$
REFUND
_________
* TOTAL TAX DUE (INCLUDES ANY LATE FEES, INTEREST, PENALTIES, ETC.)
$
CREDIT
7. OVERPAYMENT TO BE REFUNDED $
$
FORWARD
OVERPAYMENT TO BE CREDITED TOWARD NEXT YEAR ESTIMATE
$
DECLARATION OF ESTIMATE TAX FOR YEAR
8. TOTAL INCOME SUBJECT TO TAX $
MULTIPLY BY TAX RATE OF 2% FOR GROSS TAX OF
$
9. LESS EXPECTED TAX CREDITS
a. WITHHELD BY AN EMPLOYER FOR ELWOOD PLACE (NOT TO EXCEED 2%)
ESTIMATE
$
TAX FOR
b. OVERPAYMENT FROM PRIOR YEAR(S)
$
NEXT YEAR
C. PAYMENTS TO ANOTHER MUNICIPALITY (NOT TO EXCEED 2%)
$
d. TOTAL CREDITS
$
10. NET ESTIMATED TAX DUE FOR
(LINE 8 LESS 9d)
YEAR
$
11. AMOUNT PAID WITH DECLARATION (NOT LESS THAN ¼ OF LINE 10)
$
TOTAL OF THIS PAYMENT (LINE 6 (a, b) PLUS 11)
$
TAX DUE
MAKE YOUR CHECK PAYABLE TO THE ELMWOOD PLACE TAX DEPARTMENT
I CERTIFY THAT I HAVE EXAMINED THIS RETURN (INCLUDING ACCOMPANYING SCHEDULES AND STATEMENTS) AND TO THE BEST OF MY KNOWLEDGE AND BELIEF IT IS TRUE, CORRECT AND COMPLETE. IF
PREPARED BY A PERSON OTHER THAN TAXPAYER, THE DECLARATION IS BASED ON ALL INFORMATION OF WHICH PREPARER HAS ANY KNOWLEDGE.
_____________________________________________________________________
_______________________________________________________________________
Signature of Taxpayer
Date
Address
Telephone Number
_____________________________________________________________________
_______________________________________________________________________
Signature of Person Preparing if other than Taxpayer
Date
Print Name of Person Preparing if other than Taxpayer
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