Individual Refund Tax Return - City Of Cincinnati - 2005
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12005
INDIVIDUAL REFUND TAX RETURN
CITY OF CINCINNATI
REFUND DESK: (513) 352-2558
THIS SPACE IS FOR OFFICAL USE ONLY
THIS RETURN IS TO BE USED TO FILE FOR A REFUND OF TAXES OVERWITHHELD.
MAIL TO: P. O. BOX 5489 CINCINNATI, OH 45201- 5489
YOUR SOCIAL SECURITY NUMBER
SPOUSE’S SOCIAL SECURITY NUMBER
ACCT #
YOUR FIRST NAME
YOUR LAST NAME
M.I.
SPOUSE’S FIRST NAME
SPOUSE’S LAST NAME
M.I.
STREET ADDRESS
COMPLETE THE BLOCKS TO THE RIGHT ONLY
IF THIS SPACE IS BLANK OR THE PREPRINTED
CITY
STATE
ZIP CODE
INFORMATION IS INCORRECT.
RESIDENCY STATUS (CHECK ONLY ONE) ( ) FULL YEAR RESIDENT (
) NON-RESIDENT (
) PART YEAR RESIDENT ( FROM ___ /___/___ TO ____/____/____)
DAYTIME PHONE #
ADDRESS/ CITY WHERE
EMPLOYED
PLEASE COMPLETE BOTH THE ADDRESS AND DAYTIME PHONE NUMBER BLOCKS.
1)
(
.)
W-2 EARNINGS
GROSS WAGES, TIPS, SALARIES, COMMISSIONS, ETC
INCLUDE COPIES OF ALL W-2 FORMS
*IF YOU HAVE ANY ADDITIONAL TAXABLE INCOME PLEASE USE OUR REGULAR INDIVIDUAL TAX RETURN*
2)
LESS UNREIMBURSED EMPLOYEE BUSINESS EXPENSE
{
}
INCLUDE COPY OF FEDERAL FORM 2106(EZ)
3)
ADJUSTED EARNINGS
(
) (
)
LINE 1 MINUS LINE 2
FULL YEAR RESIDENTS SKIP TO LINE 5
4)
AMOUNT OF LINE 3 ALLOCABLE TO CINCINNATI FROM L-2-C
%
(PART YEAR AND NON-RESIDENTS ONLY)
5)
CINCINNATI INCOME TAX 2.1% (.021) OF LINE 3 OR 4.
6)
TOTAL CINCINNATI TAX WITHHELD BY EMPLOYER (S)
7)
TOTAL INCOME TAXES PAID TO ANOTHER
(
)
CITY OR COUNTY
RESIDENTS OR PART YEAR RESIDENTS ONLY
8)
TOTAL TAX CREDIT (
)
ADD LINES 6 AND 7
9) ENTER AMOUNT TO BE REFUNDED (
)
LESS THAN $5.00 WILL NOT BE REFUNDED
I CERTIFY THAT I HAVE EXAMINED THIS RETURN INCLUDING ACCOMPANYING SCHEDULES AND STATEMENTS AND TO THE BEST OF MY
KNOWLEDGE AND BELIEF IT IS TRUE, CORRECT AND COMPLETE AND THE FIGURES USED HEREIN ARE THE SAME AS FOR FEDERAL INCOME TAX
PURPOSES.
May the C.I.T.B. discuss this return
SIGNATURE OF PERSON PREPARING IF OTHER THAN TAXPAYER DATE
SIGNATURE OF TAXPAYER OR AGENT
DATE
with the preparer shown to the left?
(
) YES
(
) NO
NAME AND ADDRESS OF FIRM OR EMPLOYER
SIGNATURE OF SPOUSE
DATE
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