Income Tax Return Form - Village Of Westfield Center
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1FILE WITH:
MAKE CHECK OR MONEY
Village of Westfield Center
Westfield Center
ORDER PAYABLE TO:
Income Tax Dept.
Westfield Center
P.O. Box 750
Income Tax
Westfield Center, OH 44251
Income Tax Return
Phone (330) 887-5151
For the Calendar Year of
– Filing Deadline
Acct. Number
Estimated Tax Paid: $
(enter for part C line 2)
Did you live in Westfield Center all year?
Yes
No
If No, Move in date _____________ Move out date _____________
W-2 Income: List Gross Income by Employer To The Right (attach W-2s)
Amount
__________________________________________________________________________
________________________
__________________________________________________________________________
________________________
__________________________________________________________________________
________________________
__________________________________________________________________________
________________________
Total
________________________
Income: Business, Rents, or Professional: (Attach Federal Schedule C or E)
Amount
__________________________________________________________________________
________________________
__________________________________________________________________________
________________________
A Total Gross Income subject to Westfield Center Tax
A___________________
B Total Westfield Center Income Tax Due (“A” multiplied by .01)
B___________________
C Credits paid on Westfield Center Income Tax:
_________________
1. Westfield Center Income Tax Withheld
_________________
2. Payments on Declaration of Estimated Income Tax for
_________________
3. Tax Credit for taxes paid to another city, NOT TO EXCEED 1% EACH W-2
C___________________
D Balance of Tax Due (
)
D___________________
must be paid with the filing of this return
E If your credits (C) are larger than your tax due (B) then enter Overpayment here
E___________________
(Amount of $1.00 or less is not refundable or payable)
Use X to indicate whether overpayment is to be refunded to you
or applied against your Declaration of Estimated Tax
.
Declaration of Estimated Income For:
Amount
F Total Estimated Income subject to Westfield Center Tax
________________________
G Total Estimated Tax Due (“G” multiplied by .01)
________________________
H Amount Due with Declaration (“H” multiplied by .25)
________________________
I Amount Paid with Declaration
________________________
I hereby certify that this is a true, correct, and complete return pursuant to the Westfield Center Ordinances and Regulations.
Signed_________________________________ date_________ Signed_______________________________ date_________
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