Form Fr 1098 - Individual Income Tax Return - City Of Ravenna Income Tax Dept Page 2
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2Worksheet I: Wage Income (MUST attach W-2's and/or 1099 forms)
Column 1
Column 2
Column 3
(a) Date wages were earned
Taxable Income (If 2106
Tax paid to other cities
(Month, Day)
is applicable, complete
(not to exceed 2.00% of
Print Employer's Name
Locality Where Employed:
From:
To:
worksheet II first)
Ravenna Tax Withheld
column 1)
Total:
Number of W-2's and 1099's attached:
*Use on page 1, line 1
*Use on page 1, line 6
*Use on page 1, line 8
Tax credit on non-wage income from Worksheet III, Line 6 (add to W-2 wage credit):
Total:
Worksheet II: 2106 Business Expense Deduction (MUST attach Federal Form 2106 to receive credit)
Wages earned IN Ravenna: For RESIDENTS or NON-RESIDENTS
Column A
Column B
Column C
Column D
Column E
Column F
Column G
Adjusted Taxable Income
Ravenna Tax withheld.
(subtract Column F from
Multiply Total Wage by
Place this figure on
% of 2106 Business Expense
Amount of expenses from
Column A). PLace this on
Total Wage
Difference between
Worksheet I, Column 2
2.00%
applicable to Ravenna
Federal Form 2106
Worksheet I, Column 1
(Largest figure on W-2)
Column B & Column C
%
Not applicable
100
%
Not applicable
100
Wages earned OUTSIDE Ravenna: For RESIDENTS Only.
Column A
Column B
Column C
Column D
Column E
Column F
Column G
Adjusted Taxable Income
2106 Allowance. (Multiply
Other City tax withheld.
(subtract Column F from
Amount of Federal Form
Multiply Total Wage by
Place this figure on
% of 2106 Business Expense
Column A). PLace this on
Total Wage
Difference between
2106 by the percentage
Worksheet I, Column 3
2.00%
applicable to Ravenna
Worksheet I, Column 1
(Largest figure on W-2)
Column B & Column C
in Column E).
%
%
Worksheet III: Non-Wage Income (MUST attach Federal Schedules from IRS, 1040 Form, Schedules C and/or E)
Column A
Column B
Column B
Income:
Net Profit / (Loss)
Allocation Percentage
Amount subject to Tax
%
1. Federal Schedule C (Business)
%
2. Federal Schedule E (Supplemental)
%
3. Other INCOME or LOSS (Attach Schedule)
4. Loss carry forward (Attach worksheet) Losses can be carried forward up to five years.
5. TOTAL of ALL taxable Non-Wage Income (Add lines 1,2,3 and subtract line 4)
*Use on front, line 2
Tax Credits:
6. Tax paid to OTHER Cities (Not to exceed the 2.00% allowance) Attach a copy of other City's return)
*Place this figure on Worksheet I
EXEMPTION: (Check appropriate box and sign on front)
I am required to file a return since I am a resident of Ravenna, but I have no taxable income because:
Under 16 years of age for entire year (Documentation of age required)
Date of Birth:
Retired or disabled, receiving only pension, Social Security, interest or dividends
On public assistance with no taxable income.
An active member of the Armed Forces of the United States for the entire year.
(This does not include civilians employed by the military or National Guard)
Other (Explain)
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