Form Ir - Individual Income Tax Return - City Of Fairfield - 2016

CITY OF FAIRFIELD

FORM IR

File with Fairfield Income Tax

INDIVIDUAL INCOME TAX RETURN 2016

701 Wessel Drive

Fairfield OH 45014-3611

Your Social Security Number

(513) 867-5327

OR

Fax (513) 867-5333

FISCAL PERIOD ___________ TO _____________

___________________________________________

Forms available on Internet at

CALENDAR YEAR TAXPAYERS FILE ON OR BEFORE APRIL 18TH

AND FISCAL YEAR TAXPAYERS FILE BY THE 15TH DAY OF THE

Spouse’s Social Security Number

FOURTH MONTH AFTER THE CLOSE OF THE PERIOD.

PLEASE PROVIDE NAME AND CURRENT ADDRESS IN SPACE BELOW

___________________________________________

Resident

Part-Year

Non Resident

Date moved in ____________

Sole Proprietor

Date moved out ___________

City of Employment _________________________

Phone#___________________________________

IF TAXPAYER AND SPOUSE ARE FULLY RETIRED AND/OR WITHOUT TAXABLE INCOME, PLACE AN “X” IN THE BOX, COMPLETE SIGNATURE SECTION BELOW.

Attach a copy of 1040,1040A,1040EZ

FILING STATUS

OFFICE USE ONLY

$ ___________________

$ ___________________

$ ___________________

$ ___________________

$ ___________________

$ ___________________

$ ___________________

$ ___________________

$ ___________________

$ ___________________

DECLARATION OF ESTIMATED TAX FOR 2017 (WILL NEED TO BE COMPLETED IF LINE 6 IS $200.00 OR MORE)

ESTIMATE FOR 2017 1ST QUARTER DUE APRIL 18, 2017

OFFICE USE ONLY

$ ___________________

12. Total income subject to tax $__________ multiply by tax rate of 1.5% (.015)..........................................12

$ ____________________

$ ___________________

13. Estimated income tax to be withheld for Fairfield, or paid to other cities..................................................13

$ ____________________

$ ___________________

14. Estimated tax due (Line 12 minus Line 13).

..... 14

$ ____________________

If less than $200.00 estimated payments are not required

$ ___________________

15. First quarter estimated tax payment 25.0% (.25) of Line 14*....................................................................15

$ ____________________

*First quarter estimated tax payment should be paid with this return. Use enclosed estimate forms for 2nd, 3rd and 4th quarters.

$ ___________________

16. Prior year tax credit from Line 11B above ................................................................................................16

$ ____________________

$ ___________________

17. If Line 16 is greater than 15, enter 0, otherwise enter amount of Line 15 less Line 16............................17

$ ____________________

$ ___________________

18. TOTAL TAX DUE (Lines 10 and 17) Make checks payable to FAIRFIELD INCOME TAX ......................18

$ ____________________

Credit Card (Check One)

Discover

Master Card

Visa No. _____________-_______________-_______________-______________

Expiration Date _______/_______/__________ 3 Digit Code (Back of Card) _________________

SIGNATURE(S) REQUIRED

The undersigned declares that this return (and accompanying schedules) is true, correct and complete for the taxable period stated and that the figures used herein are the same as used for Federal Income Tax purposes.

For Tax Division Use Only

May we discuss this return with your tax practitioner?

Yes

No

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Signature of Taxpayer

Date

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Signature of Taxpayer

Date

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Signature of Preparer, If other than taxpayer

Date

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Name & Address of Preparer

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City, State, Zip

Phone Number