Form Fr 1111 - Individual Income Tax Return - Willard Income Tax

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INDIVIDUAL - 2009
FORM FR
1111
INCOME TAX RETURN
MAKE CHECK OR MONEY ORDER TO:
Taxpayer's Social
CITY OF WILLARD INCOME TAX
WILLARD INCOME TAX
Security No.
HomeTelephone No.
BusinessTelephone No.
Due Date 04/15/2010
631 MYRTLE AVE
P O BOX 367
Spouse's Social
WILLARD OH 44890
Security No.
Spouse's
Voice 419-933-7808 Fax 419-933-4545
Name
HomeTelephone No.
BusinessTelephone No.
Filing Status
IF YOU HAVE MOVED DURING
Name
TAX YEAR - GIVE DATES
RESIDENT
Single
INTO
/
/
Married filing joint
And
NON-RESIDENT
Married filing separate
/
/
OUT OF
Address
IF YOU RENT, PLEASE GIVE LANDLORDS INFORMATION
NAME
ADDRESS
A
TAX PAID TO
B
WILLARD TAX
C
TOTAL W-2 & 1099
EMPLOYER’S NAME
CITY WHERE EMPLOYED
OTHER CITIES
PAID
WAGES
ALL
W-2 & 1099
COPIES
MUST
BE
ATTACHED
Income
1 Wages, salaries, tips,etc. (Total of Column C)
1
2 Other taxable income
2
3 Total taxable income (add lines 1 and 2)
3
Tax and Credits
4
4 Willard Income Tax tax due before credits (1.375% of line 3)
5 Estimated tax payments made to Willard Income Tax
5
6 Taxes withheld and paid to Willard Income Tax (Total of Column B)
6
7 Overpayment from prior year(s)
7
8 Taxes withheld and paid to other localities (Total of Column A)
Credit cannot exceed 100.0% of tax withheld up to 1.38% of income earned in each location.
8
9 Total credits (add lines 5 through 8)
9
Refund
( Issued if greater than 1.00 )
10 If line 9 is greater than line 4, subtract line 4 from line 9. This is the amount you overpaid
10
11 Amount of line 10 to be credited to next years estimate
11
12 Amount of line 10 to be refunded
12
Tax Due
( if greater than 1.00 )
13 If line 4 is more than line 9, subtract line 9 from 4, this is the tax amount you owe
13
14 Penalties and interest
Late File __________
Late Pay __________
Late Estimate_______
Interest __________
14
Declaration of Estimate For 2010
15 Estimated income
15
16 Estimated tax due. Multiply line 15 by 1.375%
16
17 Taxes to be withheld and paid to Willard Income Tax and other localities
17
18 Prior credit applied to estimated tax payments (From line 11)
18
19 Net estimated tax due (subtract line 17 and 18 from 16)
19
20 Minimum amount due for first quarter (multiply line 19 by .25)
20
Amount You Owe
21 Total amount due (add lines 13, 14 and 20)
21
Tax Office Use Only : Tax Office Use Only : Tax Office Use Only
Taxpayer's Signature
Date
Spouse's Signature
Date
Tax Preparer's Signature
Date
(If other than taxpayer)
Phone No.

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