Individual/business Income Tax Return - Ashland Municipal Income Tax - 2009
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1
2INDIVIDUAL / BUSINESS
ASHLAND CITY INCOME
2009
TAX RETURN
CALENDAR YR_______ FISCALYR________
RESIDENCY STATUS:
_______RESIDENT _______NONRESIDENT
PART YR. RESIDENT FROM_________ TO__________
DUE APRIL 15TH 0R 15TH DAY OF 4TH MONTH AFTER FISCAL YEAR END. FILING IS REQUIRED EVEN IF NO TAX IS DUE.
:
EXEMPTION CERTIFICATE:
I AM REQUIRED TO FILE SINCE I AM A RESIDENT, BUT I HAVE NO TAXABLE INCOME BECAUSE
CHECK APPROPRIATE BOX:
UNDER 18 FOR THE ENTIRE YR: DATE OF BIRTH____________
AN ACTIVE MEMBER OF THE MILITARY FOR ENTIRE YR.
(16 & 17 YR OLDS NEED TO FILE IF NOT FULLY WITHHELD)
(THIS DOES NOT INCLUDE CIVILIANS EMPLOYED BY THE MILITARY)
RETIRED
DISABLED - INDIVIDUALS RECEIVING ONLY PENSION, SOCIAL SECURITY, DIVIDENDS OR INTEREST
ON PUBLIC ASSISTANCE WITH NO TAXABLE INCOME FOR THE ENTIRE YEAR.
OTHER, EXPLAIN_________________________
NAME:
ACCOUNT NUMBER
ADDRESS:
SOC. SEC. NO. TAYPAYER
SOC. SEC. NO. SPOUSE
BUSINESS/FEDERAL ID NO.
PLEASE SIGN BELOW *
1. WAGES, SALARIES, TIPS, ETC. (BOX 5 OF W-2)
1. $__________________
2. OTHER INCOME. FROM FEDERAL SCHEDULE C, E, F, K-1, 1099-MISC
2. $
____________________
3 FEDERAL FORM 2106 DEDUCTIONS ( if applicable) (Use Federal 2% deduction from schedule A)
3. $ -
___________________
4. TOTAL INCOME. FROM LINES 1, 2 and 3 (if Individual Return) (plus or minus line 20 if Business Return)
4. $
____________________
5. ASHLAND INCOME TAX 1.5% OF LINE 4 (LINE 4 X .015)
5. $
____________________
6. CREDITS
A. ASHLAND INCOME TAX WITHHELD BY EMPLOYER(S)
6A. $
____________________
B. MUNICIPAL TAX PAID TO OTHER CITIES 1% Limit
6B. $
____________________
C. ESTIMATED TAX PAID
6C. $
____________________
D. PRIOR YEAR OVERPAYMENT APPLIED
6D. $
____________________
E. TOTAL CREDITS (ADD A, B, C, D)
- 6E. $
____________________
7. TAX DUE (LINE 5 MINUS 6E)
. $
7
____________________
8 A. OVERPAYMENT CLAIMED IF LINE 7 IS MINUS
8A. $
_______________________
B. ENTER AMT OF LINE 7 YOU WANT APPLIED TO NEXT YR.
8B. $
_______________________
C. ENTER AMT OF LINE 7 YOU WANT TO BE REFUNDED
8C. $
_______________________
9. LATE FILING PENALTY ($25.00) or NON PAYMENT PENALTY ($25.00)
9. $
____________________
10. INTEREST (1.5% PER MONTH)
10. $
____________________
No payment or refund for amount under $5.00
11. AMOUNT DUE - PAY IN FULL WITH RETURN (DUE APRIL 15TH)
11. $
____________________
DECLARATION OF ESTIMATED TAX FOR TAX YEAR__________
Complete this section if amount due is over $100.00
x
12. Total income subject to Ashland tax
12A $___________
Ashland tax at 1.5% =
12B. $___________
13. Estimated credits:
A. Ashland Tax to be withheld
13A $___________
B. 1% of medicare wages in other city(s)
13B $___________
C. Total line 13A and 13B.
13C $___________
D. Total of estimated taxes (12B) Minus (13C)
=
13D. $___________
14. Calculation of 1st Quarter estimate:
A. Multiply line 13D x 22.5%
14A. ___________
B. Less: Overpayment from line 8B
14B. ___________
C. Balance 1st Qtr. estimated due with this return Subtract 14B from 14A
14C $___________
15. TOTAL AMOUNT DUE WITH THIS FILING. ADD LINE 11 AND 14C.
15 $_________________
*
Taxpayer's Signature _____________________________________
Date__________
Spouse's Signature ___________________________ Date _________
Preparer's Signature __________________________________
Date__________
Company Name_________________________Phone No __________
I (We) authorize the Income Tax Department to discuss this return and enclosures with the preparer above…….. Check here
CREDIT CARD INFORMATION FOR PAYMENT
Enjoy the convenience, flexablity and rewards of credit card payments.
MAKE CHECK OR MONEY ORDER PAYABLETO:
ASHLAND MUNICIPAL INCOME TAX
American Express, Master Card, Discover & VISA
218 LUTHER ST, ASHLAND, OH 44805
Call 1-800-2PAY-TAX
PH:419-289-0386
FAX:419-289-9225
(1-800-272-9829) or visit
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