Fillable Form Rd-109 - Wage Earner Return Earnings Tax printable pdf download

Form Rd-109 - Wage Earner Return Earnings Tax

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W AGE EARNER RETURN EARNINGS TAX

RD-109

DO NOT INCLUDE BUSINESS INCOME ON THIS FORM

(09/09)

City of Kansas City, Missouri

Phone

Revenue Division

(816) 513-1120

Free E-filing:

Period From:

Period To:

Social Security Number:

Name:

Mailing Address:

"X" this box if change made to name, address, or SSN Number

Do not file this form if your 1% earnings tax is fully withheld by your employer.

Employer Name and Address

The Revenue Division and the IRS routinely share computer tapes and

1. X box if amended return

audit results. Differences, other than those allowed under City ordinance,

will be identified and may result in an audit or further investigation.

DOLLARS

CENTS

2. Salaries, wages, commissions

ATTACH COPY OF W-2 AND 1099

3. Amount of nonresident adjustment (Enter amount from RD-109 NR line 5)

4. Total taxable wages (line 2 less line 3)

Write your SSN on check,

Make payable to City Treasurer

Mail to : Revenue Division P.O. Box

5. Earnings Tax (1% of line 4)

842707, Kansas City MO 64184-2707

6. Earnings tax paid with extension RD-112

File this return on

or before April 15

7. Local tax withheld by employer as shown on W-2

8. Earnings tax paid to other city (residents only), not to exceed line 5

9. Amount Due (line 5 less lines 6, 7, and 8, not less than 0)

10. Penalty (5% per month, not to exceed 25%)

11. Interest (1% per month until tax is paid in full)

12. Total amount due (sum of lines 9, 10, and 11)

13. Overpayment to be refunded (lines 6 + 7 + 8 less 5)

(No refunds less than $1.00)

14. Amount of payment DO NOT SEND CASH

Under penalties of perjury, I declare this return (and accompanying schedules) to be a true, correct, and complete accounting for the taxable year stated.

Yes

I authorize the Com missioner of Revenue or delegate to discuss my return and attachm ents with my preparer.

Taxpayer Signature

Print Name

Title

Date

Phone

Preparer's Signature (if other than taxpayer)

Print Name

Title

Date

Phone