Form Q-1 - Quarterly Notice Of Installment Due On Estimated Tax Declared

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