Individual Tax Return Form - City Of Huber Heights - 2014
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1
2City of Huber Heights
Individual Tax Return
Account Number ___________________
Division of Taxation
2014
P. O. Box 24309
OR
Huber Heights, Ohio 45424
FISCAL PERIOD _______ TO _______
Phone: (937) 237-2976
Fax: (937) 237-2983
Calendar Year Taxpayers file on or before April 15
th
th
Fiscal Year Due on 15
Day of 4
Month After Year End
Website:
THIS SPACE IS FOR OFFICIAL USE ONLY
Check One
□
Single
Name
SSN
□
Married Filing Joint
□
Married Filing Separate
Spouse Name
SSN
Part Year Resident From _______to______
Address
City/State/Zip
Previous Address _____________________
Part A
I am not required to complete Part B because: Check One
□ All Income from non-taxable source (list source) ______________________________
E-Mail ______________________________
□ Active Duty Military and no other non-military income
□ Retired with only non-taxable income Date Retired ____________DOB ___________
Phone No.___________________________
Part B
Tax Calculation
(Attach front page of Federal Form 1040)
Total Qualifying Wages (Attach W-2 Forms) For multiple W-2s complete Worksheet A on page 2………………
1.
$
Less Employee Deductions (Attach Form 2106, 2% ALLOWANCE)……..………………………………………...…
2.
$
Taxable Wages Before Adjustment. (Line 1 minus Line 2)………………………………………………………………
3.
$
Less Nontaxable Income (part-year or non-residents only) (provide calculations)…………………………………….
4.
$
Taxable Qualified Wages (Line 3 minus Line 4)………………………………………………………...…………………
5.
$
Other Income or (Loss) From Federal Schedules C, E, F, K-1, 1099-MISC (See Worksheet B Line 6)
6.
$
(Attach copies of all Federal Schedules)………………………………………………………………………………..
Huber Taxable Income (Line 5 plus Line 6) Losses on Line 6 do not offset W-2 Income from Line 5………...
7.
$
Huber Heights Income Tax (Multiply Line 7 by 2% [.0200]….…………………………………………………………...
8.
$
9 a.
Huber Heights Tax Withheld (per W-2s)…………………………………...
$
Estimates Paid (including credit from previous year)……………………..
9 b.
$
9 c.
Other Local Taxes Paid (Allowed up to 2% credit)…………………..……
$
Total Payments and Credits (Lines 9a + 9b + 9c)…….…………………………………………………………………..
10.
$
Tax Due (Subtract Line 10 from Line 8)…………………………………………………………………………………….
11.
$
12.
Penalty $__________ Under Pay Penalty $__________ Interest $__________
Total Penalty & Interest Due
$
Total Amount Due (Add Line 11 and Line 12) (Amounts less than $5.00 not payable)…..…………………………...
13.
$
Overpayment – Credit to 2015 (Line 10 greater than Line 8)…………….
14.
$
Refunded (Amounts less than $5.00 will not be refunded)……………….
15.
$
Part C
Declaration of Estimated Tax for 2015
Total estimated income subject to tax………………………………………………………………………………………
16.
$______________________
17.
Huber Heights Tax Declared (Multiply Line 16 by 2.25% [.0225])…………….……...…………………………….……
$______________________
Estimated Taxes Withheld from Wages…………………………………………………………………………………….
18.
$______________________
Tax due after Withholding (Line 17 less Line 18) STOP if this amount is less than $0.00..…………………………..
19.
$______________________
Declaration Due (25% of Line 19)…………………………………………………………………………………………...
20.
$______________________
Less credits (from Line 14 above)…………………………………………………………………………………………...
21.
$______________________
Net estimated tax due if Line 20 minus Line 21 is greater than zero*…………………………………………………...
22.
$______________________
23.
TOTAL AMOUNT DUE—Combine Line 13 above with Line 22 (
)
$______________________
Make checks payable to the City of Huber Heights
*Subsequent estimated payments are due by the 31st of July, October, and January.
The undersigned declares that this return (and accompanying schedules) is a true, correct and complete return for the taxable period stated
and that the figures used herein are the same as used for Federal Income Tax purposes.
SIGNATURE OF TAXPAYER
SIGNATURE OF PERSON PREPARING IF OTHER THAN TAXPAYER
DATE
DATE
SIGNATURE OF SPOUSE
NAME AND ADDRESS OF PREPARER
PHONE NUMBER
DATE
Check here if we may contact the above preparer with questions regarding the preparation of this return.
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