Form R2 - 2005 Individual City Of Pickerington Income Tax Return

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FORM R2
2005 INDIVIDUAL
PLEASE CHECK ANY CHANGES IN 2005 TAX STATUS:
File with the City of Pickerington
Taxpayer
Spouse
CITY OF PICKERINGTON
Division of Taxation
100 Lockville Road
Retired–with only non-taxable income–Date Retired
INCOME TAX RETURN
Pickerington, Ohio 43147-1321
Only income was from a non-taxable source–List source
Phone: (614) 837-4116 Fax: (614) 833-2201
Due on or before April 15, 2006
E-Mail: jeichner@pickerington.net
Active Duty Military
Website:
Date Moved
into or
out of City of Pickerington
Make Checks and Money Orders Payable to
City of Pickerington
Previous Address
Other Status Change–Married, Divorced, Death, etc (List and date)
Your SS#
Spouse SS#
TO PAY BY CHARGE CARD:
Enter number and expiration date fully and accurately.
AMERICAN
R
EXPRESS
No.
AMERICAN
EXPRESS
No.
$
EXP. DATE:
AMT. CHARGED:
SIGNATURE:
PLEASE MAKE NECESSARY CORRECTIONS TO NAME/ADDRESS
ATTACH FORMS W-2, 1099 AND FEDERAL SCHEDULES C, E AND F
1. Total W-2 wages. (Use W-2 box 5 or box 18, whichever is higher) For multiple W-2’s, complete Worksheet A on reverse....
1
$
2. Other Income. From Section 1, line 5 on reverse (Schedule losses cannot be deducted from W-2 wages) ....
2
$
INCOME
3. Total Income. Add lines 1 and 2 ......................................................................................................................
3
$
4. Total Deductions. Section 2, line D on reverse ................................................................................................
4
$
5. Total Income Subject to Tax. Subtract line 4 from line 3..................................................................................
5
$
TAX
6. Pickerington Income Tax.
Multiply line 5 by 1% (.01)
......................................................................................
6
$
7.
Pickerington
income tax withheld. From W-2 or Worksheet A, column 5 on reverse. .... 7
$
DO NOT INCLUDE SCHOOL TAX SD2307
TAX
8. Prior year credits ................................................................................................ 8
$
WITHHELD,
9. Estimated payments received by Dec. 15 .......................................................... 9
$
PAYMENTS
9a. Any estimate payments made after Dec. 15 and not included in line 9 ............ 9a
$
& CREDITS
9b. Payments made by pass-through entity (name) ___________ on behalf of taxpayer 9b
$
10. 1/2% (.005) credit X wages taxed by other cities. From Section 3 on reverse ....10
$
11. Total Payments and Credits. Add lines 7 through 10
(documentation must be provided for lines 7 & 10 to be
allowed)..11
$
12. BALANCE DUE. If line 6 is more than 11, enter balance due here ..............................................................12
$
BALANCE
13. Penalty. 10% of amount owed..........................................................................................................................13
$
DUE,
13a. Late Filing Fee. $15.00 ....................................................................................................................................13a
$
REFUND
14. Interest. 1-1/2% per month ..............................................................................................................................14
$
OR
15.
Total due.
Carry to line 25 below ....................................................................................................................15
$
CREDIT
NOTE: Tax due under $1.00 – no payment required, overpayment under $1.00 – no refund or credit.
16. OVERPAYMENT. If line 6 is less than line 11, enter overpayment here ............ 16
$
17. AMOUNT FROM LINE 16 TO BE REFUNDED .................................................. 17
$
18. AMOUNT FROM LINE 16 TO BE CREDITED TO NEXT YEAR ........................ 18
$
NOTE: IF PICKERINGTON CITY TAX IS WITHHELD ON ALL INCOME, STOP HERE, CHECK THIS BOX, SIGN & DATE RETURN, ATTACH W-2‘S & MAIL TO THE CITY OF PICKERINGTON
VOUCHER NO. 1
DECLARATION OF ESTIMATED TAX FOR YEAR 2006 REQUIRED BY LAW ON ALL INCOME FROM WHICH CITY OF PICKERINGTON
TAX IS NOT WITHHELD. PENALTY FOR NON-COMPLIANCE. THE SAFE HARBOR METHOD SHALL APPLY. (See General Info. #10.)
ESTIMATE
19. Estimated income subject to tax $ ____________ Multiply by tax rate of 1% (.01) ...................................... 19
$
FOR
20. Subtract resident credit = wages taxed by another city X .005 ...................................................................... 20
$
NEXT
21. Balance of city income tax declared. Subtract line 20 from line 19 ................................................................ 21
$
YEAR
22. Less credits. Enter line 18 from above ............................................................................................................ 22
$
23. Net estimated tax due. Subtract line 22 from line 21 ...................................................................................... 23
$
24. First quarter estimate payment. Enter 1/4 of line 23 ...................................................................................... 24
$
VOUCHERS FOR REMAINING QUARTERLY PAYMENTS ARE INCLUDED ON A SEPARATE PAGE
25. Enter balance due from line 15 above ............................................................................................................ 25
$
TAX DUE
26.
TOTAL TAX DUE. ADD LINES 24 & 25. PLEASE MAKE CHECKS PAYABLE TO CITY OF PICKERINGTON
.............. 26
$
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.
WORK
HOME
SIGNATURE OF PREPARER, IF OTHER THAN TAXPAYER
TELEPHONE NUMBER
SIGNATURE OF TAXPAYER
TELEPHONE NUMBER
ADDRESS OF PREPARER
DATE
SIGNATURE OF SPOUSE
DATE

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