STATEMENT OF CANFIELD, OHIO CITY INCOME TAX
Form Q-1
Quarterly Notice of Installment Due on Estimated Tax Declared
FOR OFFICE
AMOUNT
REC’D.
DATE
USE ONLY
PAID
$
CASH
CHECK #
BY
PAID
Make check or Money Order Payable to:
Do not remit cash by mail. Postage is not accepted as payment.
City of Canfield, Ohio
Please send statement with your payment.
Income Tax Department
Paid check will be your receipt.
104 Lisbon Street,
Notify Tax Department of change in ownership or name and address.
Canfield, Ohio 44406
AMOUNT ENCLOSED $__________________________
ESTIMATED TAX
DATE OF LAST
TOTAL AMOUNT
AMOUNT OF
QUARTERLY
DECLARED
CREDIT
CREDITED
UNPAID
INSTALLMENT DUE
BALANCE
_______________________________________________________
ACCOUNT NUMBER
NAME
_______________
________________________________________________________
ADDRESS
________________________________________________________
CITY, STATE, ZIP
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STATEMENT OF CANFIELD, OHIO CITY INCOME TAX
Form Q-1
Quarterly Notice of Installment Due on Estimated Tax Declared
FOR OFFICE
AMOUNT
REC’D.
DATE
USE ONLY
PAID
$
CASH
CHECK #
BY
PAID
Make check or Money Order Payable to:
Do not remit cash by mail. Postage is not accepted as payment.
City of Canfield, Ohio
Please send statement with your payment.
Income Tax Department
Paid check will be your receipt.
104 Lisbon Street,
Notify Tax Department of change in ownership or name and address.
Canfield, Ohio 44406
AMOUNT ENCLOSED $__________________________
ESTIMATED TAX
DATE OF LAST
TOTAL AMOUNT
AMOUNT OF
QUARTERLY
DECLARED
CREDIT
CREDITED
UNPAID
INSTALLMENT DUE
BALANCE
_______________________________________________________
ACCOUNT NUMBER
NAME
_______________
________________________________________________________
ADDRESS
________________________________________________________
CITY, STATE, ZIP