Fillable Individual Income Tax Return Form - Village Of Evendale

VILLAGE OF EVENDALE

PHONE 513.563.2671

File With

Form IR IR

FAX 513.563.4636

2016 – INDIVIDUAL INCOME TAX RETURN – 2016

VILLAGE OF EVENDALE

TAX DEPARTMENT

Make check or

FILE ON OR BEFORE APRIL 18, 2017. FILING REQUIRED EVEN IF NO TAX IS DUE.

10500 Reading Road

money order payable to

Evendale, Ohio 45241

Federal Forms, including your Federal Form 1040 and all W-2’s must be attached to your Evendale Tax Return.

VILLAGE OF EVENDALE

TAXPAYER NAME AND ADDRESS

SS# TAXPAYER __________________ SS# SPOUSE ____________________

HOME PHONE # _________________ WORK PHONE # _________________

(*required if paying by credit card)

IF MOVED SINCE THE PREVIOUS RETURN WAS FILED GIVE DATE:

INTO EVENDALE _________________ OUT OF EVENDALE _______________

INCOME

1. TOTAL QUALIFYING WAGES (Generally Medicare Wage, Box 5 of Form W-2) ATTACH ALL W-2’S See Worksheet A ........................ $ ________________

2. OTHER TAXABLE INCOME/LOSS - from Federal Schedules C, E, F, K-1, 1099-MISC, W-2G, Other See Worksheet B ...................... $ ________________

(Interest, Dividends, Capital Gains, Alimony, Military Pay and State Unemployment Compensation are not taxable income)

3. TAXABLE INCOME: (Line 1 plus Line 2) Losses on Line 2 may not offset Wages reported on Line 1 ............................................. $ ________________

TAX

4. EVENDALE TAX: 1.2% OF LINE 3 .................................................................................................................................................... $ ________________

CREDITS

5. CREDITS:

a: TAX WITHHELD BY EMPLOYER FOR EVENDALE ............................................................................... $ ________________

b: 2016 ESTIMATED TAX PAID TO EVENDALE ...................................................................................... $ ________________

c: 2016 TAX PAID TO ANOTHER CITY OR VILLAGE

See Worksheet A ........................ $ ________________

(Residents only - Not to exceed 1.2%)

d: PRIOR YEAR OVERPAYMENTS ......................................................................................................... $ ________________

e: TOTAL CREDITS (Total of Line 5a through 5d) ............................................................................................................................. $ ________________

BALANCE DUE,

6. 2016 VILLAGE OF EVENDALE TAX DUE ....................................................................................................................................... $ ________________

If Line 4 is greater than Line 5e enter amount due

REFUND OR

CREDIT

a: LATE FILING FEE ($25.00 PER MONTH OR FRACTION THEREOF, NOT TO EXCEED $150.00) ................ $ ________________

b: PENALTY DUE (15% OF THE AMOUNT NOT TIMELY PAID) ............................................................... $ ________________

c: INTEREST DUE (6% ON ALL TAX NOT TIMELY PAID) See Instructions ..............................................$ ________________

No taxes or refunds

d: TOTAL 2016 BALANCE DUE (Line 6 plus Line 6a through Line 6c) ............................................................................................... $ ________________

of less than $10.00

(Payment must accompany this return; No payment is due if Line 6d is less than $10.00)

shall be collected or

7. 2016 OVERPAYMENT  REFUND $ _____________ OR  CREDIT $ _____________ TO NEXT YEAR’S ESTIMATE

refunded. Refunds

(If Line 5e is greater than Line 4, check the box above to indicate if the overpayment should be credited to next year or refunded.) If you wish to have your refund

and Credits will be

directly deposited into your savings or checking account, complete the information below. Otherwise, your refund will be mailed to you at the taxpayer address

reported to the IRS as

indicated above. TYPE:  CHECKING OR  SAVINGS

required by law.

ROUTING NUMBER

ACCOUNT NUMBER

DECLARATION OF ESTIMATED TAX FOR YEAR 2017

DECLARATION REQUIRED IF ESTIMATED TAX (LINE 10) EXCEEDS $200.00

ESTIMATE FOR

8. TOTAL ESTIMATED INCOME SUBJECT TO TAX $ ___________ MULTIPLY BY TAX RATE OF 1.2% ............................................. $ ________________

NEXT YEAR

9. EXPECTED TAX CREDITS:

a: TAX WITHHELD BY EMPLOYER FOR EVENDALE (Not to exceed 1.2% of that portion taxed) ........... $ ________________

b: PAYMENTS TO ANOTHER MUNICIPALITY (Not to exceed 1.2% of that portion taxed) .................... $ ________________

c: PRIOR YEAR OVERPAYMENT (From Line 7 above) ........................................................................... $ ________________

d: TOTAL CREDITS (Line 9a through Line 9c) ................................................................................................................................... $ ________________

TOTAL DUE

10. NET ESTIMATED TAX DUE FOR 2017: (Line 8 minus Line 9d) ....................................................................................................... $ ________________

11. AMOUNT DUE WITH THIS DECLARATION (Line 10 multiplied by 22.5%) .................................................................................... $ ________________

12. TOTAL OF THIS PAYMENT (Line 6d plus Line 11) Make remittance payable to the Village of Evendale ......................................... $ ________________

To pay by credit card, complete the information below.

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. IF PREPARED BY A PERSON OTHER THAN TAXPAYER, THIS DECLARATION IS



BASED ON ALL INFORMATION OF WHICH PREPARER HAS ANY KNOWLEDGE.

CHECK HERE IF WE MAY CONTACT THE TAX PREPARER DIRECTLY WITH QUESTIONS REGARDING THIS RETURN.

IMPORTANT! Do not digitally sign this form until side 2 has been completed! Once signed you will not be able to edit the form.

TO PAY BY CREDIT CARD

Enter card number and expiration date exactly as it appears on your card.

______________________________________________________________________

Signature of Taxpayer

Date



______________________________________________________________________

Signature of Taxpayer