Income Tax Return Form - City Of Ontario, Income Tax Department Page 2
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Office Use Only
MAKE PAYABLE AND MAIL TO:
CITY OF ONTARIO
JOINT/INDIVIDUAL INCOME TAX RETURN
INCOME TAX DEPARTMENT
CITY OF ONTARIO, OHIO
555 STUMBO ROAD
ONTARIO, OH 44906-1259
Jan. 1, 2016 – Dec. 31, 2016
Filing Status
PHONE 419-529-3045 FAX 419-529-6132
Single
RESIDENT
DUE: APRIL 18, 2017
Married filing joint
NON-RESIDENT
Married filing separate
IF YOU HAVE MOVED DURING
NAME:
TAXPAYER’S SOC SEC NO:
TAX YEAR - GIVE DATES
INTO
/
/
ADDRESS:
SPOUSE’S SOC SEC NO:
OUT OF
/
/
IF YOU RENT, PLEASE GIVE LANDLORDS INFORMATION
E-MAIL ADDRESS:
NAME
ADDRESS
PHONE NO.:
$
1. WAGES, SALARIES, & TIPS (BOX 5 OF W-2 OR HIGHEST WAGE ON W-2) ..................................................................................................................
1.
(ATTACH ALL W-2’S AND FEDERAL FORM 1040, PAGES 1 AND 2)
$
2.
2.
FEDERAL FORM 2106 DEDUCTIONS – SEE INSTRUCTIONS .........................................................................................................................
(BOTH FORM 2106 AND FEDERAL SCHEDULE A MUST BE ATTACHED TO RECEIVE DEDUCTION)
$
3. OTHER INCOME: FROM FED SCHEDULES – SEE INSTRUCTIONS .............................................................................................................
3.
(ATTACH ALL DOCUMENTATION) = 1099-R’s ARE NOT TAXABLE AT CITY LEVEL
$
4. TOTAL INCOME (SUBTRACT LINE 2 FROM LINE 1 AND ADD LINE 3) .............................................................................................................
4.
$
5.
ONTARIO INCOME TAX 1.5% OF LINE 4 (LINE 4 x .015)...................................................................................................................................
5.
6.
CREDITS
A. TAX WITHHELD BY EMPLOYER FOR CITY OF ONTARIO .................................................................. 6A.________________________
B. ESTIMATED TAX PAID CITY OF ONTARIO .......................................................................................... 6B. ________________________
C. PRIOR YEAR OVER PAYMENTS .......................................................................................................... 6C. ________________________
D. TAX PAID CITY OF _________________________________________ Not to exceed 1.0%
6D. ________________________
of taxed gross earnings
(Limit per each W-2)
$
E. TOTAL CREDITS (ADD A, B, C, and D) ................................................................................................................................................ 6E.
TAX DUE (LINE 5 MINUS LINE 6E)
7.
.......................................................................................................................................................
7.
$
8. LATE FILING FEE ($25.00 EACH MONTH FILED LATE UP TO $150.00).......................................................................................................
8.
$
9/10. PENALTY/INTEREST (PLEASE SEE INSTRUCTIONS TO CALCULATE) IF PAID AFTER DUE DATE..................................................... 9/10.
$
$
11. TOTAL AMOUNT DUE ........................................................................................................ (No payment or refund for amount under $10.00) 11.
PAYMENT OF BALANCE MUST ACCOMPANY THIS RETURN
$
12
OVERPAYMENT: LINE 6E MINUS LINE 5. NOT LESS THAN ZERO .............................................................................................................
12.
12A. AMOUNT OF OVERPAYMENT YOU WANT REFUNDED ................................................................................. 12A. ___________________
12B. AMOUNT OF OVERPAYMENT YOU WANT CREDITED TO 2017 ESTIMATED TAX ....................................... 12B. ___________________
2017 DECLARATION OF ESTIMATED TAXES
**REQUIRED IF YOUR ONTARIO TAX LIABILITY WAS OVER $200.00 LAST YEAR**
$
13. TOTAL INCOME SUBJECT TO TAX $ _____________________ MULTIPLY BY 1.5% ......................................................................... 13.
14. ESTIMATED CREDITS (TAX WITHHELD, PAID BY PARTNERSHIPS, PAID TO OTHER CITIES) ................................................................... 14.
$
15. NET TAX DUE (SUBTRACT LINE 14 FROM LINE 13) ....................................................................................................................................
15. __________________________
$
16. FIRST INSTALLMENT OF DECLARATION (NOT LESS THAN 22.5% OF LINE 15) .....................................................................................
16. __________________________
$
17. LESS OVERPAYMENT FROM LINE 12B ABOVE: ($__________________) = BALANCE DUE WITH RETURN: ........................................
17. __________________________
$
$
18. TOTAL AMOUNT DUE (ADD Lines 7 and 17) ......
PAY THIS AMOUNT
........ 18.
(Make Checks Payabable to City of Ontario)
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 where applicable. This Tax Return is Not Legally filed if not signed by the Taxpayer(s) or a legally Authorized Agent.
Signature of Person Preparing if Other Than Taxpayer
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Date
Address of Firm or Preparer
Signature of Spouse (If filing Jointly)
Date
If this return was prepared by a tax practitioner, may we contact your practitioner directly with questions regarding the preparation of this return? .....................Yes
No
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