Quarterly Statement Of Estimated Income Tax Form

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MAKE REMITTANCE PAYABLE TO: CITY OF BELLEFONTAINE
Note: For declaration of
QUARTERLY STATEMENT
VISA/MasterCard/Am Exp Accepted
SEND TO: CITY OF BELLEFONTAINE INCOME TAX
estimated taxes, you will
OF ESTIMATED INCOME TAX DUE
135 N. DETROIT ST.
receive no further notice.
Account # ____________________
D-1/B
BELLEFONTAINE, OH 43311-1462
Expiration Date ________________
Signature ____________________
VOUCHER 2
(CALENDAR YEAR-DUE JUNE 15)
If fiscal year taxpayer, see instruction
B. Overpayment for last
A. Estimated tax (or amended estimated
year credited to estimated
tax) for the
tax for this year.
year ending
(month and year)
$
$
$
1. Amount of this installment .....................
2. Amount of unused overpayment credit
NOTE: DO NOT SEND CASH THROUGH U.S. MAIL
$
if any applied to this installment ...........
3. Amount of this installment payment
$
(line 1 less line 2) ....................................
2nd QUARTER PAYMENT DUE JUN. 15
BE SURE YOUR NAME, FEDERAL I.D. NUMBER AND TAX ACCOUNT NUMBER APPEARS ON EACH VOUCHER BEFORE MAILING TO: CITY OF BELLEFONTAINE, INCOME TAX DEPT, 135 N. DETROIT ST, BELLEFONTAINE OH 43311
MAKE REMITTANCE PAYABLE TO: CITY OF BELLEFONTAINE
Note: For declaration of
QUARTERLY STATEMENT
VISA/MasterCard/Am Exp Accepted
SEND TO: CITY OF BELLEFONTAINE INCOME TAX
estimated taxes, you will
OF ESTIMATED INCOME TAX DUE
135 N. DETROIT ST.
receive no further notice.
Account # ____________________
D-1/B
BELLEFONTAINE, OH 43311-1462
Expiration Date ________________
Signature ____________________
VOUCHER 3
(CALENDAR YEAR-DUE SEPTEMBER 15)
If fiscal year taxpayer, see instruction
B. Overpayment for last
A. Estimated tax (or amended estimated
year credited to estimated
tax) for the
tax for this year.
year ending
(month and year)
$
$
$
1. Amount of this installment .....................
2. Amount of unused overpayment credit
NOTE: DO NOT SEND CASH THROUGH U.S. MAIL
$
if any applied to this installment ...........
3. Amount of this installment payment
$
(line 1 less line 2) ....................................
3rd QUARTER PAYMENT DUE SEPT. 15
BE SURE YOUR NAME, FEDERAL I.D. NUMBER AND TAX ACCOUNT NUMBER APPEARS ON EACH VOUCHER BEFORE MAILING TO: CITY OF BELLEFONTAINE, INCOME TAX DEPT, 135 N. DETROIT ST, BELLEFONTAINE OH 43311
MAKE REMITTANCE PAYABLE TO: CITY OF BELLEFONTAINE
Note: For declaration of
QUARTERLY STATEMENT
VISA/MasterCard/Am Exp Accepted
SEND TO: CITY OF BELLEFONTAINE INCOME TAX
estimated taxes, you will
OF ESTIMATED INCOME TAX DUE
135 N. DETROIT ST.
receive no further notice.
Account # ____________________
D-1/B
BELLEFONTAINE, OH 43311-1462
Expiration Date ________________
Signature ____________________
VOUCHER 4
(CALENDAR YEAR-DUE DECEMBER 15)
If fiscal year taxpayer, see instruction
B. Overpayment for last
A. Estimated tax (or amended estimated
year credited to estimated
tax) for the
tax for this year.
year ending
(month and year)
$
$
$
1. Amount of this installment .....................
2. Amount of unused overpayment credit
NOTE: DO NOT SEND CASH THROUGH U.S. MAIL
$
if any applied to this installment ...........
3. Amount of this installment payment
$
(line 1 less line 2) ....................................
4th QUARTER PAYMENT DUE DEC. 15
BE SURE YOUR NAME, FEDERAL I.D. NUMBER AND TAX ACCOUNT NUMBER APPEARS ON EACH VOUCHER BEFORE MAILING TO: CITY OF BELLEFONTAINE, INCOME TAX DEPT, 135 N. DETROIT ST, BELLEFONTAINE OH 43311

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