2015 Individual Tax Return Form
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1
2City of Moraine
2015 INDIVIDUAL TAX RETURN
MORAINE
Income Tax Division
DUE ON OR BEFORE APRIL 18, 2016
4200 Dryden Rd
Moraine, OH 45439
Phone: (937) 535‐1026
Fax: (937) 535‐1275
(A copy of the Federal Extension must be filed with city before due date)
This space is for official use only
Website:
Taxpayer(s) Name and Address
Mandatory filing
Primary SSN ______‐____‐______
for ALL Residents
Joint SSN ______‐____‐______
Phone # __________________
Copy of
Federal 1040 Required
Partial Year Resident
From_________to __________
Prior Address:
Did you file a Return Last Year? YES NO If no, please explain:
Part A
Tax Calculation
1.
Total Qualifying Wages (generally found in Box 5 of Form W‐2) (Attach W‐2 Forms)
1
$
For multiple W‐2's complete Worksheet A on page 2
2.
Other Income or (loss) From gambling income, Federal Schedules C, E, F, K‐1, 1099‐MISC
2
$
(See Worksheet B Line 6) (Attach all copies of all Federal Schedules)
3.
Moraine Taxable Income (line 1 plus Line 2). .losses on Line 2 do not offset W‐2 Income from Line 1
3
$
4.
Moraine Income Tax (Multiply Line 3 by 2.5% [.0250])
4
$
5a.
Moraine Tax Withheld
5a
$
5b.
Other City Taxes Paid (Credit limited to 2.5%)
5b
$
5c.
Estimates Paid
5c
$
5d.
Prior Year Credit
5d
$
6.
Total Payments and Credits (Total of Lines 5a through 5d))
6
$
Balance Due (If Line 6 is less than Line 4, enter balance due)
7.
7
$
8.
$25.00 Failure to File Penalty Due (assessed when return is not filed by the due date)
8
$
Total Due (Total of Lines 7 & 8)
9.
9
$
10.
Overpayment (If Line 6 is greater than 4, enter overpayment)
10
$
a. Amount to be refunded $ __________ b. Credit to next year $_________
(Amounts less than $1.00 will not be refunded) (Attach Refund Request form)
Part B
Declaration of Estimated Tax for 2016 ‐ Required if estimated tax liability is $200 or greater
11.
Total estimated income subject to tax $_________ Multiply by Tax Rate of 2.5%
11
$
12.
Estimated Taxes Withheld from Wages
12
$
13.
Tax due after Withholding (line 11 minus Line 12) STOP if this amount is less than $0.00
13
$
14.
Less credits (from Line 10b above)
14
$
15.
Net estimated tax due (Line 13 minus 14 if greater than zero)
15
$
16.
Amount paid with this declaration (not less than 1/4 of Line 15)*
16
$
*Subsequent estimated payments are due by the 15th of June, September and December
17.
TOTAL AMOUNT DUE ‐ Combine Line 9 above with Line 16 (Payable to the City of Moraine)
$
17
The undersigned declares that this return (and accompanying schedules) 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
DATE
SIGNATURE OF TAXPAYER
DATE
NAME AND ADDRESS OF PREPARER
PHONE NUMBER
SIGNATURE OF JOINT
DATE
□
Check here if we may contact the above preparer with questions regarding the preparation of this return.
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