Form I-7 Short Form - Cleveland Heights Individual Income Tax Return - 2009

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FORM I-7 SHORT FORM

CLEVELAND HEIGHTS INDIVIDUAL INCOME TAX RETURN

TAX YEAR 2009

MAIL TO: PO BOX 641747 CINCINNATI OH 45264-1747

(216) 291-3978

MUST BE FILED BY MARCH 15, 2010

OFFICE USE

SS#

SPOUSE’S SS#

THIS YEARʼS FILING STATUS:

JOINT

SEPARATE

ONLY

LAST YEAR’S FILING STATUS:

JOINT

SEPARATE

NAME(S)

RECENT MOVE DATE:

ADDRESS

From Cleveland Heights

To Cleveland Heights

CITY STATE ZIP

Tot.:

Previous or New Address (CIRCLE ONE)

Init.:

City, State, Zip

#Mos

Home Phone (

)

Cell Phone (

)

TABLE I: WAGE INCOME (Income from W-2 and 1099 Misc. Forms)

COLUMN A

COLUMN B

COLUMN C

COLUMN D

COLUMN E

COLUMN F

List Wages From

2106 Expenses (if any)

Subtract B from A

Municipal Tax

City Withholding

Do not

Resident City

Each Employer

(Attach copy Federal

(Income after

Withheld

Paid to

use

(Highest Amount on W-2)

2106 Form & Sch A)

Expenses)

Total

OFFICE USE ONLY

TAX DUE

WHO MAY USE THE I-7 FORM:

EST. DUE

•

The I-7 Short Form is only for people with wage income from Federal Form W-2 or 1099 Misc.

•

If you have Federal Schedule C or Schedule E non-wage income, you must use Cleveland Heights I-8 Long Form.

•

When you use this form, the City will calculate your tax and send you a bill if you owe tax.

•

If you want the city to calculate your tax, make sure your current address is indicated above along with your social security number.

Attach your W2 and sign below.

INSTRUCTIONS:

•

You must attach a copy of all W-2 and 1099 Misc. forms and mail between January 20, 2010 and March 15, 2010.

•

For each employer enter your wages and withholding (if any) in Table I above. If your employer withheld for more than one city on the

same income, only list that income once, but use two lines for the municipal tax withheld, attach copies of all W-2s for each city withheld.

•

This form is due no later than MARCH 15, 2010 so that we can mail you a bill.

•

Tax payments not received by April 15, 2010 are subject to 20% penalty, plus interest charges.

AMENDED 2010 ESTIMATE

•

You must attach copy of Form 2106 to receive deduction.

•

In order to receive workplace withholding credit your W-2 must be attached.

2010 ESTIMATED TAX

•

Estimated tax for 2010 will be calculated based on this year’s income and tax liability.

•

To amend your estimate for 2010, please utilize worksheet on back. Indicate amended estimate in the above box.

•

Estimate is required. May be assessed a $25.00 penalty if not paid.

IF THERE IS AN OVERPAYMENT OF TAX, PLEASE:

CREDIT TO ESTIMATED PAYMENTS FOR TAX YEAR 2009

REFUND

Examples of Taxable Income

Examples of Non-Taxable Income

•

Wage Income:

Interest, dividends or other intangible income

•

All income listed on Federal Forms W-2 or 1099 Misc.

Pensions, Social Security

•

Wages, salaries, bonuses, and other compensation

Welfare, state-paid unemployment benefits

•

(Includes deferred compensation contributions, [e.g. 401(k)]

Workmen’s Compensation, proceeds from insurance

•

Educational grants (except portion for tuition/fees/books)

Active Military pay (does not include civilian personnel)

•

Non-wage income: (STOP – cannot use this form – use I-8 Long Form)

Alimony

•

Sole Proprietorships from business (Federal Schedule C)

Third party sick pay

•

Income from rental property (Federal Schedule E)

Income from Trusts or Estates

•

Lottery winnings equal to or greater than $100,000

Any tax amount that is unpaid after April 15th is subject to 20% penalty plus interest.

Under penalty of perjury, the undersigned declares this return and attached documents to be true and complete:

If this return was prepared by a tax preparer, check here if we may NOT contact him/her directly with questions regarding the preparation of this return.

Taxpayer’s signature

Date

Preparer’s signature (if not taxpayer)

Date

(office use only)

Spouse’s signature

Date

Preparer’s address and phone number