Determination Of Tax Filing Requirement Form - Division Of Taxation Extended

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City of Sylvania
City of Sylvania
City of Sylvania
City of Sylvania
DIVISION OF TAXATION
ANGELA J. KUHN, COMMISSIONER
6730 MONROE STREET
SYLVANIA, OHIO 43560-1949
419-885-8940 FAX 419-885-3442
Determination of Tax Filing Requirement
The information contained on this form is necessary to determine whether a taxpayer is required to
file a City of Sylvania income tax return. A response is required within five (5) days. Please correct
name and address if needed.
Your name: ___________________________________ Your S.S.# _______________________________
Spouse name: __________________________________ Spouse S.S.# _____________________________
Address: _______________________________________________________________________________
Are you the homeowner? Yes _____ No _____ If no, list name and address of homeowner:
_______________________________________________________________________________________
Date moved to Sylvania _____________________ Telephone number _____________________________
Please list your previous address ____________________________________________________________
Have you ever lived in Sylvania before? __________ If so, show approximate date ___________________
If your last name was different, please provide this information ___________________________________
Employer name and location _______________________________________________________________
Is city income tax withheld? ___________ What city? __________________________________________
Unemployed __________ Retired __________ Permanent Disability __________
Spouse employer name and location _________________________________________________________
Is city income tax withheld? ___________ What city? __________________________________________
Unemployed __________ Retired __________ Permanent Disability __________
Excluding interest & dividends, do you have any other taxable income on which there is no withholding?
(Rental property, partnerships, etc.) Yes ______ No ______ If yes, please specify type and location
_______________________________________________________________________________________
If you or your spouse travel for an employer, please show approximate number of full work days spent
outside of city of employment. Days per month: Self ___________________ Spouse _________________
List any additional employed household members and their S.S.#:__________________________________
_______________________________________________________________________________________
I certify the above to be true and correct.
__________________________________________
__________________________________________
Signature
Date
Signature
Date
All information contained in the completed form is mandated "Confidential" by Chapter 171 of the Codified Ordinances of the
City of Sylvania, Ohio.

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