Subsequent Receipt Of Taxable Income Voids This Exemption Form - City Of North Canton. Ohio Income Tax Department

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CITY OF NORTH CANTON
INCOME TAX DEPARTMENT
EXEMPTION FORM
TELEPHONE (330) 499-3467
YOU MAY NOT BE REQUIRED TO FILE A CITY INCOME TAX RETURN NOW OR IN THE FUTURE.
COMPLETE THE FOLLOWING FORM AND RETURN IT TO OUR OFFICE BY APRIL 15, AND YOU
WILL NOT BE CONSIDERED A DELINQUENT TAXPAYER.
SUBSEQUENT RECEIPT OF TAXABLE INCOME VOIDS THIS EXEMPTION FORM.
WRITE NAME AND ADDRESS
SOCIAL SECURITY NUMBERS
Yours
Spouse
Phone
(
)
I AM NOT REQUIRED TO FILE A RETURN BECAUSE:
1.
I DO NOT HAVE TAXABLE INCOME FOR THE FOLLOWING REASON (S):
A.
RETIREMENT INCOME
B.
INTEREST INCOME
C.
DIVIDEND INCOME
D.
ACTIVE MILITARY INCOME
2.
I MOVED OUT OF THE CITY IN PREVIOUS TAX YEAR
DATE
3.
TAXPAYER WAS DECEASED IN PREVIOUS TAX YEAR
DATE
4.
UNDER 18 YEARS OLD
DATE OF BIRTH
5.
OTHER
EXPLAIN
SIGNATURE
DATE
SIGNATURE
DATE

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