Income Tax Return Form - Springfield Income Tax Division - 2009

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2007 INCOME TAX RETURN
CITY OF SPRINGFIELD
CITY OF SPRINGFIELD
2009 INCOME TAX RETURN
DIVISION OF TAXATION
DIVISION OF TAXATION
CITY OF SPRINGFIELD
Due by April 15, 2008
P.O. Box 5200
P.O. BOX 5200
DUE BY APRIL 15, 2010
DIVISION OF TAXATION
SPFLD, OH 45501
SPRINGFIELD, OH 45501
eld.oh.us
P.O. BOX 5200
Telephone: (937) 324-7357
TELEPHONE: (937) 324-7357
SPRINGFIELD, OH 45501
INDIVIDUAL FILING ONLY
Fax: (937) 328-3471
INDIVIDUAL FILING ONLY
FAX: (937) 328-3471
TELEPHONE: (937) 324-7357
INDIVIDUAL FILING ONLY
FAX: (937) 328-3471
If you moved during the year: Date moved in
moved out
If you moved during the year: Date moved in
moved out
TAXPAYER
Former Address
Former Address
ACCT # 
SPOUSE
ACCT # 
TAXPAYER
Telephone
ACCT # 
Telephone
SPOUSE
ACCT # 
PART A
PART A
I AM NOT REQUIRED TO FILE
SEE INSTRUCTIONS I AM NOT REQUIRED TO FILE
SEE INSTRUCTIONS
STATE REASON
STATE REASON
TAXPAYER
SPOUSE
ACCT #
ACCT #
TELEPHONE
NUMBERr
TELEPHONE
NUMBERr
TELEPHONE 
TELEPHONE 
IF YOU MOVED DURING THE YEAR: DATE MOVED: IN 
OUT 
IF YOU MOVED DURING THE YEAR: DATE MOVED: IN 
OUT 
TELEPHONE 
TELEPHONE 
FORMER ADDRESS 
FORMER ADDRESS 
IF YOU MOVED DURING THE YEAR: DATE MOVED: IN 
OUT 
IF YOU MOVED DURING THE YEAR: DATE MOVED: IN 
OUT 
FORMER ADDRESS 
FORMER ADDRESS 
I AM NOT REQUIRED TO FILE. SEE INSTRUCTIONS.
I AM NOT REQUIRED TO FILE. SEE INSTRUCTIONS.
PART I
PART I
I AM NOT REQUIRED TO FILE 
SEE INSTRUCTIONS
I AM NOT REQUIRED TO FILE 
SEE INSTRUCTIONS
STATE REASON ________________________________
STATE REASON ________________________________
STATE REASON 
STATE REASON 
I AM NOT REQUIRED TO FILE 
SEE INSTRUCTIONS
I AM NOT REQUIRED TO FILE 
SEE INSTRUCTIONS
STATE REASON 
STATE REASON 
PART B
PART B
PART II
PART II
INCOME
ATTACH W-2’S AND FEDERAL SCHEDULES ON REVERSE SIDE
INCOME
INCOME
(See instructions)
1.
1.
TOTAL WAGES AND COMPENSATION (See W2 Sample)                             
1.
1. $
TOTAL WAGES AND COMPENSATION (See W2 Sample)
1. $
(From Worksheet B on reverse side. See instructions.)
1.
1.
TOTAL WAGES AND COMPENSATION (See W2 Sample)                             
1.
2.
2.
TOTAL OTHER INCOME (From Worksheet B on reverse side, Not Less Than -0-)
2.
2.
TOTAL OTHER INCOME (From Worksheet B on reverse side, Not Less Than -0-)
2.
2.
2.
TOTAL OTHER INCOME (From Worksheet B on reverse side, Not Less Than -0-)
2.
3.
3.
NET ADJUSTMENTS (From Worksheet C on reverse side)                               3.
3.
4.
3.
4.
NET ADJUSTMENTS (From Worksheet C on reverse side)                               3.
TOTAL TAXABLE INCOME (Add lines 1 through 3)                                       
4.
3.
NET ADJUSTMENTS (From Worksheet C on reverse side)
3.
4.
4.
TOTAL TAXABLE INCOME (Add lines 1 through 3)                                       
4.
5.
5.
SPRINGFIELD CITY TAX – 2% (Multiply line 4 by .02)                                                                   
5.
4.
TOTAL TAXABLE INCOME (Add lines 1 through 3)
4.
5.
5.
SPRINGFIELD CITY TAX – 2% (Multiply line 4 by .02)                                                                   
5.
5. $
SPRINGFIELD CITY TAX - 2% (Multiply line 4 by .02)
PAYMENTS AND CREDITS
5. $
PAYMENTS AND CREDITS
PAYMENTS AND CREDITS
6.
6.
ESTIMATED PAYMENTS / PRIOR YEAR OVERPAYMENT CREDIT                
6.
6.
6.
ESTIMATED PAYMENTS / PRIOR YEAR OVERPAYMENT CREDIT                
6.
6. $
7.
7.
WITHHELD FOR SPRINGFIELD (From W-2)                                                 
ESTIMATED PAYMENTS / PRIOR YEAR OVERPAYMENT CREDIT
7.
6. $
7.
7.
WITHHELD FOR SPRINGFIELD (From W-2)                                                 
7.
8.
8.
OTHER CITY TAX CREDIT OR J.E.D.D. TAX CREDIT (From Worksheet D on reverse side)
8.
7.
WITHHELD FOR SPRINGFIELD (From W-2)
7.
(Add Lines 6 through 8. See Instructions)
8.
8.
OTHER CITY TAX CREDIT OR J.E.D.D. TAX CREDIT (From Worksheet D on reverse side)
8.
9. 
9.
TOTAL PAYMENTS AND CREDITS (Add lines 6 through 8)                           
9.
8.
OTHER CITY TAX CREDIT OR J.E.D.D. TAX CREDIT (From Worksheet D on reverse side)
8.
9. 
9.
TOTAL PAYMENTS AND CREDITS (Add lines 6 through 8)                           
9.
10.                                  10.
BALANCE OF TAX DUE (line 5 minus line 9)                                                                               
10.
9.
TOTAL PAYMENTS AND CREDITS (Add lines 6 through 8)
9.
10.                                  10.
BALANCE OF TAX DUE (line 5 minus line 9)                                                                               
10.
11.
11.
UNDER-PAYMENT OF ESTIMATE PENALTY                                                 11.
11.
11.
INTEREST DUE (See Instructions.)
11.
11.
12.
11.
12.
UNDER-PAYMENT OF ESTIMATE PENALTY                                                 11.
LATE PENALTY                                                                                           12.
10. $
BALANCE OF TAX DUE (line 5 minus line 9)
10. $
12.
12.
LATE PENALTIES (See Instructions.)
12.
12.
12.
LATE PENALTY                                                                                           12.
13.
13.
INTEREST                                                                                                  13.
11. $
OVERPAYMENT
11. $
13.
TOTAL PENALTY AND INTEREST (add Lines 11 and 12)
13.
13.
13.
13.
INTEREST                                                                                                  13.
14.    
14.
TOTAL PENALTY AND INTEREST (Add Lines 11 through 13)                                                        
14.
_____ CREDIT TO 2008 _____ REFUND
_____ CREDIT TO 2008 _____ REFUND
14.
TOTAL TAX, PENALTY AND INTEREST (Add Lines 10 and 13)
14.
14.
14.    
14.
TOTAL PENALTY AND INTEREST (Add Lines 11 through 13)                                                        
14.
15.    
15.
TOTAL TAX, PENALTY AND INTEREST (Add Lines 10 and 14)                                                       15.
15.
OVERPAYMENT (If Line 9 is more than Line 5. See Instructions)
15.
15.
15.    
15.
TOTAL TAX, PENALTY AND INTEREST (Add Lines 10 and 14)                                                       15.
16.    
16.
OVERPAYMENT (If Line 9 exceeds Line 5)                                                                                   
16.
16.    
16.
OVERPAYMENT (If Line 9 exceeds Line 5)                                                                                   
16.
2010
2010
CHECK ONE:   
CREDIT TO 
   
REFUND   
TRANSFER TO SPOUSE (NO REFUNDS OR CREDIT IF LESS THAN $1.00)   CHECK ONE:  
CREDIT TO 2008   
REFUND   
TRANSFER TO SPOUSE
OFFICE USE ONLY
OFFICE USE ONLY
CHECK ONE:   
CREDIT TO 
   
REFUND   
TRANSFER TO SPOUSE (NO REFUNDS OR CREDIT IF LESS THAN $1.00)   CHECK ONE:  
CREDIT TO 2008   
REFUND   
TRANSFER TO SPOUSE
PART C
PART C
The undersigned declares that this return (and accompanying schedules) is a true, correct and complete return for the taxable period stated and that the figures used herein are the
The undersigned declares that this return (and accompanying schedules) is a true, correct and complete return for the taxable period stated and that the figures used herein are the 
PART III
same as used for Federal Income Tax purposes, and if an audit of Federal return is made which affects tax liability shown on this return, an amended return will be filed within 3 months.
same as used for Federal Income Tax purposes, and if an audit of Federal return is made which affects tax liability shown on this return, an amended return will be filed within 3 months.
The undersigned declares that this return (and accompanying schedules) is a true, correct and complete return for the taxable period stated and that the figures used herein are the 
same as used for Federal Income Tax purposes, and if an audit of Federal return is made which affects tax liability shown on this return, an amended return will be filed within 3 months.
SOCIAL SECURITY NUMBER  
SOCIAL SECURITY NUMBER  
TAXPAYER
(Date)
SPOUSE
(Date)
SOCIAL SECURITY NUMBER  
SOCIAL SECURITY NUMBER  
Social Security Number
Social Security Number
TAXPAYER 
(DATE) 
SPOUSE 
(DATE) 
TAXPAYER 
(DATE) 
SPOUSE 
(DATE) 
PART IV
PREPARER’S SIGNATURE (OTHER THAN TAXPAYER) 
(DATE) 
F.E.I.N. OR SOC. SEC. NO. 
Preparer’s signature (other than taxpayer)
(Date)
Address (and Zip Code)
F.E.I.N. or Soc. Sec. No.
PREPARER’S SIGNATURE (OTHER THAN TAXPAYER) 
If this return was prepared by a tax practitioner, may we contact your practitioner directly
(DATE) 
F.E.I.N. OR SOC. SEC. NO. 
ADDRESS (AND ZIP CODE) 
TELEPHONE 
with questions regarding the preparation of this return?
YES
NO
IF THIS RETURN WAS PREPARED BY A TAX PRACTITIONER, MAY WE CONTACT YOUR PRACTITIONER DIRECTLY WITH QUESTIONS REGARDING THE PREPARATION OF THIS RETURN?  
YES  
NO
ADDRESS (AND ZIP CODE) 
TELEPHONE 
(make check or money order payable to COMMISSIONER OF TAXATION, SPRINGFIELD, OHIO, if $1.00 or more)
(MAKE CHECK OR MONEY ORDER PAYABLE TO COMMISSIONER OF TAXATION, SPRINGFIELD, OHIO, IF $1.00 OR MORE)
IF THIS RETURN WAS PREPARED BY A TAX PRACTITIONER, MAY WE CONTACT YOUR PRACTITIONER DIRECTLY WITH QUESTIONS REGARDING THE PREPARATION OF THIS RETURN?  
YES  
NO
METHOD OF PAYMENT
METHOD OF PAYMENT
(MAKE CHECK OR MONEY ORDER PAYABLE TO COMMISSIONER OF TAXATION, SPRINGFIELD, OHIO, IF $1.00 OR MORE)
R
R
PART V
METHOD OF PAYMENT
PART V
METHOD OF PAYMENT
i
[  
i
[  
t  
t  
$
CREDIT CARD EXPIRATION DATE
/
/
$
CREDIT CARD EXPIRATION DATE
/
/
i
[  
i
[  
t  
t  
(Amount Authorized)
(Amount Authorized)
$ 
(AMOUNT AUTHORIZED)      CREDIT CARD EXP. DATE 
/
/
$ 
(AMOUNT AUTHORIZED)      CREDIT CARD EXP. DATE 
/
/
PHONE NUMBER
HOME
WORK
PHONE NUMBER
HOME
WORK
$ 
(AMOUNT AUTHORIZED)      CREDIT CARD EXP. DATE 
/
/
$ 
(AMOUNT AUTHORIZED)      CREDIT CARD EXP. DATE 
/
/
PHONE NUMBER: HOME 
WORK 
PHONE NUMBER: HOME 
WORK 
PHONE NUMBER: HOME 
WORK 
PHONE NUMBER: HOME 
WORK 
CARDHOLDER SIGNATURE  
CARDHOLDER SIGNATURE  
CARDHOLDER SIGNATURE
CARDHOLDER SIGNATURE
CARDHOLDER SIGNATURE  
CARDHOLDER SIGNATURE  

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