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Form L-Es - Declaration Of Estimated Tax Form - City Of Lakewood - Division Of Municipal Income Tax

City of Lakewood

Division of Municipal Income Tax

12805 Detroit Avenue Lakewood, OH 44107

Telephone: (216) 529-6620 Fax: (216) 529-6099

Form L-ES -

Tax Year: ___________

Declaration of Estimated Tax

Per Lakewood Ordinance §128.1303 and 128.1304, taxpayers owing one hundred dollars ($100.00) or more of estimated

tax are required to file a declared estimate of income tax on or before April 15

or within four (4) months of the date the

taxpayer becomes subject to tax for the first time.

Federal Identification Number

Business Name

Contact Name

Phone Number

Present Address

Suite #

City

State

Zip Code

ESTIMATED TAX CALCULATION

1. a. Total taxable income for current tax year

$____________

Prorated Income (use this calculation if located in Lakewood part of the year)

b. Annual income Line 1a / 12 months = $______________

c. Monthly income Line 1b x _______ months in Lakewood =

$____________

Enter the applicable amount on Line 1 from Line 1a or Line 1c. This is your estimate income tax for the entire year. If

this amount is less than $100, stop—no estimate is required.

1. ___________________

(Line 1a or Line 1c)

2. Multiply Line 1 by 25% or 0.25.

2. ___________________

3. Estimated income tax payments are BILLED quarterly on the following dates:

3. ___________________

March 1

July 1

October 1

December 1

Circle the dates that already passed as of the date you are completing this form and

enter the number of the dates circled above on Line 3.

4. Multiply Line 2 by Line 3. Enter the amount on Line 4. This is the amount due with

4. ___________________

this form.

I hereby declare the information supplied above to be true, correct and complete

Signature

Date

Mail completed form to the above Lakewood address or fax to: 216-529-6099

Form L-Es - Declaration Of Estimated Tax Form - City Of Lakewood - Division Of Municipal Income Tax

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