Exemption Certificate Form - 2008 Page 2
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2*All individuals who are 18 years of age and older are subject to local income tax.
Note: Geneva On The Lake uses 15 as a minimum age. Grand River, Medina and
Painesville use 16 as the minimum age.
To request a refund you must complete a Refund Request Form or the City Tax Form.
SHOW NAME AND ADDRESS CHANGES BELOW
Social Security No.
Taxpayer Name
–
–
Name of spouse if joint return
–
–
Move In
Address
Apt. #
/
/
Move Out
City
State
Zip
/
/
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