Form Ir - Income Tax Return - City Of Forest Park - Income Tax Division Page 5
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5ANNUAL TAX QUESTIONNAIRE UPDATE
DUE BY APRIL 18, 2017
This information is required. Please complete and enclose with tax return.
Resident Name:
Social Security Number:
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Spouse Name:
Social Security Number:
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Home Address:
Mailing Address
:
(if different from Home Address)
Home Telephone Number:
Do you own your home?
Yes
No
Do you Rent?
Yes
No
Landlord's Name, Address and Telephone Number:
RESIDENT
SPOUSE
DATE MOVED INTO FOREST PARK:
MONTH / DAY / YEAR
MONTH / DAY / YEAR
DATE MOVED OUT (IF APPLICABLE):
MONTH / DAY / YEAR
MONTH / DAY / YEAR
NEW HOME ADDRESS:
PHONE NUMBER:
HAVE YOU AND/OR YOUR SPOUSE HAD A CHANGE IN MARITAL STATUS OR NAME? IF YES, PLEASE ADVISE CHANGE
AND DATES EFFECTIVE:
EMPLOYMENT INFORMATION
RESIDENT
SPOUSE
Name of Employer:
Address of Employer:
Employer Telephone Number:
Your Occupation:
If you are retired, please
give date of retirement:
Did you and/or your spouse receive a City tax refund for the previous tax year?
Yes
No
If YES, please supply refund amount and name of city:
Does anyone in your household own rental property?
Yes
No
If YES, list address and total annual rent expected:
OTHERS LIVING IN HOUSEHOLD
Name
Social Security Number
Age or Date of Birth
Name of Employer (if applicable)
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I declare the above information is true and complete to the best of my knowledge.
Signature
Date
Thank you for your response.
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