Form Ir - Mt. Healthy Income Tax Return - 2009 (Page 2 of 3) in pdf

Page 2

13.

TAXABLE INCOME NOT REPORTED ON A W-2 FORM: ATTACH APPROPRIATE FEDERAL INCOME REPORTING

FORMS (NOTE: INCOME REPORTED ON 1099-INT, 1099-D, 1099-G ARE NOT TAXABLE)

$_________________

14.

NET PROFIT(S) FOR PROFESSION AND/OR BUSINESS OPERATION(S): ATTACH SCHEDULE C

$_________________

15.

NET PROFIT(S) (LOSSES) FROM RENTAL AND/OR PARTNERSHIP(S): ATTACH FEDERAL SCH. E

$_________________

(S CORPORATIONS ARE EXCLUDED FROM INDIVIDUALS INCOME)

16.

TOTAL NET PROFIT(S) (LOSSES) FROM BUSINESS ACTIVITIES: LINE 14 + LINE 15, IF RESULT IS A LOSS

$_________________

AMOUNT ONLY MAY BE CARRIED FORWARD TO LINE 17 ON TAX RETURNS FOR 3 YEARS

17.

BUSINESS LOSS TOTAL FROM PREVIOUS TAX RETURNS: LIMITED TO THREE (3) YEARS

$_________________

18.

SUBTRACT LINE 17 FROM LINE 16

$_________________

19.

IF THE CALCULATION ON LINE 18 (LINE 16 MINUS LINE 17) RESULTS IN A NET GAIN LIST THE AMOUNT

ON THIS LINE

$_________________

IF THE CALCULATION RESULTS IN A NET LOSS, A PORTION AS CALCULATED BY THE 3 YEAR LIMITATION

MAY BE USED TO OFFSET FUTURE PROFITS. HOWEVER, A LOSS MAY NOT BE USED AS A DEDUCTION FROM

WAGE/SALARY TYPE EARNINGS OR MISC. INCOME

20.

DEDUCTIONS AND NON-TAXABLE:

A._______________________________________________________________________

$_________________

B._______________________________________________________________________

$_________________

C. TOTAL DEDUCTIONS AND/OR NON-TAXABLE INCOME: LINE 20A PLUS LINE 20B

$_________________

21.

TOTAL OTHER TAXABLE INCOME OR DEDUCTIONS: LINE 13 PLUS LINE 20C

$_________________

(ALSO ENTER THIS TOTAL ON LINE 2)

INSTRUCTIONS: Lines 1 through 12

NOTE: BE SURE NAME AND ADDRESS ARE CORRECT. PLEASE LIST PHONE NUMBERS AS INDICATED. IF YOU ARE A

PART-YEAR RESIDENT, BE SURE TO INDICATE YOUR MOVE-IN OR MOVE-OUT DATE. YOU MUST FILE THIS RETURN IF YOU RESIDED IN

MT. HEALTHY FOR ANY PART OF THE TAX YEAR.

Attach a copy of each W-2 to the return. Enter the totals of all gross wages (usually box 5 on W-2). DEFERRED COMP, PENSION PLANS,

401K, ETC. ARE TAXABLE TO MUNICIPALITIES IN THE YEAR EARNED. Income should be pro-rated if you resided in Mt. Healthy for less

than a full year (please attach explanation).

List all taxable income reported on lines 13 through 18. All income reported must be documented by appropriate Federal Schedules (C, E

etc.) or other documentation. Business losses may not be used to offset W-2 wages. INTEREST, DIVIDEND, RETIREMENT INCOME

(SOCIAL SECURITY, PENSIONS), ACTIVE DUTY MILITARY PAY, AND UNEMPLOYMENT COMPENSATION ARE NOT TAXABLE TO MT.

HEALTHY.

List tax withheld by your employer for Mt. Healthy.

Estimated tax paid to Mt. Healthy.

Credit for tax paid to another municipality. Multiply wages taxed by another city times 1.25%. Total the credits for each W-2 and

enter amount on line 5C. If wages are pro-rated, credit is computed only on wages taxable to Mt. Healthy. Wages not taxed by

another city are not eligible for the credit. Business accounts (Schedule C filers) must attach a copy of the tax return filed with

another city in order to verify the credit claimed. NO CREDIT IS ALLOWED FOR COUNTY TAXES PAID.

Total of lines 5A through 5C.

Subtract line 5D from line 4. Balance due must be paid in full by the due date of the return. MINIMUM LATE PAYMENT PENALTY IS $75.00.

No additional taxes of less than two dollars ($2.00) shall be collected.

Overpayment will be applied to your next year estimate unless you request a refund. No refunds under $2.00.

ESTIMATE INCOME FOR THIS YEAR. IF YOUR EMPLOYER DOES NOT WITHHOLD MT. HEALTHY TAX FROM YOUR PAYCHECK, YOU ARE

REQUIRED BY THE MT. HEALTHY TAX ORDINANCE TO FILE A DECLARATION OF ESTIMATED TAX AND MAKE QUARTERLY

ESTIMATED TAX PAYMENTS. ESTIMATED TAX PENALTIES WILL BE CHARGED FOR FAILING TO MAKE THE REQUIRED QUARTERLY

PAYMENTS.

Tax withheld by your employer for Mt. Healthy.

Credit for tax paid to another city (not to exceed credit limit of 1.25%).

Total credits (add line 8A & 8B).

Subtract line 8C from line 8 for the net estimated tax due.

10.

Divide amount by 4 (quarters).

Subtract prior year overpayment (credit from line 7).

11.

The first quarter 2010 must be paid with the filing of this return.

12.

TOTAL BALANCE DUE FROM LINE 6 & LINE 11 MUST BE PAID WITH THIS RETURN.

LATE FILING AND PAYMENT CHARGES

INTEREST:

ALL TAXES AND DECLARATIONS REMAINING UNPAID AFTER PRESCRIBED DUE DATES SHALL BE CHARGED INTEREST AT

THE RATE OF 1-1/2% PER MONTH OR FRACTION THEREOF.

PENALTY:

FILING AND/OR PAYING TAXES AFTER APRIL 15, 2010 SHALL BE CHARGED THE PENALTY OF SEVENTY-FIVE ($75.00)

DOLLARS.

FILING IS REQUIRED EVEN IF NO TAX IS DUE!!!!!

TAX RETURN FILING AND PAYMENT CALENDAR

APRIL 15

JULY 15

OCT. 15

JAN. 15

APRIL 15

File Declaration

Make 2

Make 3

Make 4

File return. Pay

With 1

quarter payment

quarterly payment

Form Ir - Mt. Healthy Income Tax Return - 2009 Page 2

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