Form Q-1 - Quarterly Notice Of Installment Due On Estimated Tax Declared - Statement Of Ansonia, Ohio, Income Tax

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STATEMENT OF ANSONIA, OHIO, INCOME TAX
FORM Q-1
Village of Ansonia
Quarterly Notice of Installment Due On Estimated Tax Declared
Return Part 1 - Keep Part 2
MAKE CHECK OR MONEY ORDER TO
This Statement MUST Accompany Your
Department of Taxation, Ansonia
Remittance To:
VILLAGE OF ANSONIA
AMOUNT
If receipt is desired, return this statement with a
self-addressed, stamped envelope.
DEPARTMENT OF TAXATION
ENCLOSED
DO NOT REMIT CASH BY MAIL
P.O. Box 607
$
Postage Will Not Be Accepted For Payment
Ansonia, Ohio 45303-0607
CREDIT AND/OR PAYMENTS
AMOUNT OF
QUARTERLY
ESTIMATED TAX
UNPAID BALANCE
INSTALLMENT DUE
DECLARED
Date of Last Credit
Total Amount Credited
DUE ON OR BEFORE
NOTIFY DEPT. OF TAXATION PROMPTLY OF ANY CHANGE IN NAME OR ADDRESS SHOWN ABOVE

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