Form Bq-1 - Statement Form Of Estimated Tax Due

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CITY OF BROOK PARK
BQ-1
TAX OFFICE USE ONLY
INCOME TAX DEPARTMENT
USE THIS BOX ONLY FOR ADJUSTING YOUR ORIGINAL DECLARATION
216 433-1533
STATEMENT OF ESTIMATED TAX DUE
AMENDED ESTIMATED INCOME
Exclusive of taxpayers filing on a fiscal basis, a declaration shall be filed on or
before April 30 of each year and accompanied by a payment of at least one-
AMENDED DUE OTHER CITY
fourth of the estimated tax. At least a similar amount shall be paid on or before
July 31, October 31 and January 31 of each year. Such estimates may be
YEAR
ACCOUNT NUMBER
amended at any time. NOTE: FISCAL YEAR TAXPA YERS WILL SUBSTITUTE
AMENDED ESTIMATED TAX DUE
THEIR CORRESPONDING DATES.
IF YOUR RECORD DOES NOT AGREE WITH
ACCOUNT NUMBER
DUE ON OR BEFORE
TAX RATE
TOTAL AMOUNT
$
1
THIS, PLEASE NOTIFY TAX DEPARTMENT
DUE
IMMEDIATELY . 216 433-1533 / 433-1300
PRIOR YEAR
$
NOTIFY OFFICE OF ANY CHANGE IN NAME OR
2
CREDIT
ADDRESS.
MAKE CHECK OR MONEY ORDER PAYABLE
PAYMENTS
$
3
TO DATE
TO: CITY OF BROOK PARK • DEPT. OF
TA XATION • 6161 ENGLE RD. • BROOK PARK,
OH 44142
UNPAID
$
4
BALANCE
FAILURE TO PAY ESTIMATED TAX
PAYMENTS WILL BE SUBJECT TAXPAYER
AMOUNT
$
TO AN ASSESSMENT.
5
NOW DUE
RETURN THIS PART
AMOUNT PAID
$
6
HEREWITH
WITH PAYMENT
SIGNATURE
DATE

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