Income Tax Return Form - City Of Ontario, Income Tax Department Page 3

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WORKSHEET A – SALARIES AND WAGES (W2 INCOME)
Column 1
Column 2
Column 3
Column 4
Column 5 (B)
Income From
2106
Ontario Tax
Other City Tax
Employer, City, State
Each W-2 Box 5/18 Expenses Adj.
Withheld
Withheld
A.
B.
C.
D.
Totals
ENTER ON
Line 1
Line 2
Line 6A
Line 6D
(A) 2106 expenses can only be used if used federally. To calculate the acceptable adjustment (Column 3), use line 10 of Form 2106 minus
2% of line 38 of Form 1040. Please include a copy of Federal Forms 2106, 1040, and Schedule A for documentation. Income reduced by
this 2106 adjustment and (B) Other City Tax Withheld (Column 5) cannot exceed 1% of income from each W-2 (Column 2).
WORKSHEET B – OTHER INCOME
1. Schedule C (If taxes paid to other cities, ATTACH OTHER CITIES’ RETURNS
(Attach copy of Schedule C)
(A)
(B)
(C)
(D)
(E)
(C times D)
Net Profit/
Allocation
Amount
Business Name
Business Address
(Loss)
Percentage
Subject to Tax
A.
B.
TOTAL (1)
$
2. Schedule E – Income From Rents (Attach Federal Schedule E)
TOTAL (2)
$
3. Schedule H – Other Income Not Included in Schedules C or E (Attach Federal Schedules)
Income from Partnerships, Estates, Trusts, Fees, Tips, 1099’s, etc.
Received From Name/ID#
For (Description and/or Location)
Amount
A.
B.
TOTAL (3)
$
TOTAL OTHER INCOME (ADD LINES 1 – 3)
ENTER ON LINE 3 OF RETURN
TOTAL
$
NOTE: The net loss from an unincorporated business activity may not be used to offset salaries, wages, commissions or other
compensation. However, if a taxpayer is engaged in two or more taxable business activities to be included on the same return, the net
loss of one unincorporated business activity may be used to offset the profits of another for purposes of arriving at overall net profits.
(Final Return Line 3 cannot be less than zero, if you have W-2 income)
2016
VERIFICATION REQUIRED
WORKSHEET C – EXEMPTION
I AM EXEMPT BECAUSE:
❒ I AM UNDER 18 YEARS OF AGE - BIRTH DATE ___________________
❒ I HAD NO TAXABLE INCOME IN 2016
❒ ACTIVE MILITARY*
❒ UNEMPLOYED
❒ DISABLED
❒ SOCIAL SECURITY
❒ PENSION*
I UNDERSTAND THAT I MUST FILE A CITY OF ONTARIO,OHIO TAX RETURN IF ANY OF THESE EXEMPT CONDITIONS CHANGE IN FUTURE YEARS.
I DECLARE THE INFORMATION SUPPLIED TO BE TRUE, CORRECT AND COMPLETE. ANY MISREPRESENTATION WILL BE IN VIOLATION OF THE
CODIFIED ORDINANCES OF THE CITY OF ONTARIO, OHIO AND SUBJECT TO PENALTIES THEREIN IMPOSED.
Name
Address
Social Security Number
Exempt Person’s
Date
Phone
Signature

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