Form Rc - Income Tax Return - City Of Cuyahoga Falls - 2009 Page 2

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Attach W-2s, taxable 1099s and copies of applicable federal forms and schedules here
Copy for State, City or Local Tax Department
50,000.00
5,000.00
3,410.00
55,000.00
55,000.00
797.50
55,000.00
1,750.00
55,000.00
1,100.00
CUY FALLS
Highlighted areas are possible locations for the
(Box 19)
highest amount of gross wages on W-2s.
The arrow indicates the box in which local income
tax withheld will be located on your W-2.
WORKSHEET TABLE
Number of W-2 and 1099 forms attached: ________________
COLUMN 1
COLUMN 2
COLUMN 3
Date wages were
Tax Paid to
earned (Month/Day)
Gross Income
Cuyahoga
Other Localities*
Locality Where
(Largest figure
Falls Tax
(not to exceed
From
To
Print Employerʼs Name
Employed*
on W-2)
Withheld
2% of gross income)
___/___
___/___
___/___
___/___
___/___
___/___
___/___
___/___
___/___
___/___
___/___
___/___
___/___
___/___
* Including JEDD
TOTALS: $
$
$
DEDUCTIONS
29. Cuyahoga Falls wages and salaries earned while under the age of 18 (please provide proof of age)
29
30. Age 65 and over deduction (for residents only)
30a. Income of resident age 65 and over (Cuyahoga Falls taxable income only)
30a
30b. Maximum amount of deduction
30b
($3,000 per person over age 65 with Cuyahoga Falls income)
Taxpayerʼs birthdate ____/____/____
Spouseʼs birthdate ____/____/____ (please provide proof of age)
30c. Enter lower amount of line 30a or line 30b
30c
31. Non-resident deductions
31
(please provide calculations)
32. Employment expense
32
(attach Form 2106 and Schedule A)
33. Total deductions
Enter here and on line 5 on front of return
33
(add lines 29, 30c, 31 and 32)
PENALTY AND INTEREST
34a. Penalty: Failure to file a tax return by April 15th
34a
($25, $50 or $100, see instructions)
34b. Penalty: Non Payment of estimated tax
34b
(see instructions)
35. Interest:
35
(1.5% per month on unpaid taxes)
36. Total penalty and interest: Add lines 34a, 34b and 35
36
(enter here and on line 20 on front of return)

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