Form Ir - City Of Middletown Individual Income Tax - 2009 Page 2
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1
2INCOME OTHER THAN WAGES
A. INCOME FROM ANY BUSINESS OWNED (ATTACH FEDERAL SCHEDULE C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
A.
B. RENTS, ROYALTIES, PARTNERSHIPS, ESTATES, TRUSTS, ETC. (ATTACH FEDERAL SCHEDULE E & FORM(S) K-1) . . B.
C. OTHER INCOME (ATTACH APPROPRIATE FEDERAL SCHEDULE OR 1099-MISC.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C.
D. TOTAL OTHER INCOME (BOXES A, B & C) IF LOSS, STOP HERE AND ENTER IN BOX 2a. IF PROFIT CONTINUE TO BOX E. . . . . . . . . . .
D.
E. PRIOR YEARS LOSSES (LIMITED TO LAST 5 YEARS) MAY NOT EXCEED BOX D . . . . . . . . . . . . . . . . . . . . . . . .
E.
F.
NET OTHER TAXABLE INCOME (BOX D LESS BOX E) ENTER IN BOX 2b, PAGE 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F.
Column 1
Column 2
Column 3
Column 4
Column 5
QUALIFYING
LESSER OF
WAGES ETC.
LIST ALL CITIES
TAX WITHHELD
1.75%
COLUMN 3
(USUALLY BLOCK 18
EXCEPT MIDDLETOWN
OF COLUMN 2
OR COLUMN 4
OF THE W-2)
CARRY TOTAL OF COLUMN 5 TO LINE 5b, PAGE 1
TOTAL ALLOWED:
e
y
1.
Circle One:
2.
Account Number (16 digits)
_________________
_________________
_________________
_________________
3.
Expiration Date: _________________________
4.
Amount to be Paid: $ _______________________
5.
Your Signature for Authorization: _______________________________________________________________________________
FAILURE TO FILE BY APRIL 15:
$10 IN MAY, $25 THEREAFTER
FAILURE TO PAY THE REQUIRED ESTIMATE BY JANUARY 31 ON BALANCES GREATER THAN $100:
INTEREST:
1% PER MONTH
PENALTY:
2% PER MONTH OR $25, WHICHEVER IS GREATER
FAILURE TO PAY TAX DUE BY APRIL 15:
INTEREST:
1% PER MONTH
PENALTY:
2% PER MONTH OR $25, WHICHEVER IS GREATER
HAVE YOU BEEN AUDITED BY IRS IN THE PAST YEAR? (YOU ARE REQUIRED TO NOTIFY US.)
______ Yes
______ No
INCLUDE A COPY OF YOUR 1040, PAGE 1
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