Declaration Of Estimated Tax - Ohio Income Tax Division - 2006

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2006 Declaration of Estimated Tax – 2
Quarter Statement Due By 7/31/2006
nd
City of Fairfield
Income Tax Division
Account, Social Security or Federal ID #:___________________________
5350 Pleasant Avenue
Fairfield, OH 45014-3597
(513) 867-5327
Annual Estimate: $ __________________
Amount Paid this Quarter: $ __________________
Name _____________________________________
Address ____________________________________
If paying by charge card, please circle one:
MASTERCARD VISA
____________________________________________
ACCT NO. _______________________________ EXPIRATION DATE _____/______
____________________________________________
SIGNATURE _____________________________________
Please indicate any name or address changes
To determine if this transaction will be treated as a cash advance when paid to
CITY OF FAIRFIELD TAX, please check with your credit card issuing company.
____________________________________________
____________________________________________
Amended Annual Estimate: $ __________________
2006 Declaration of Estimated Tax – 3
Quarter Statement Due By 10/31/2006
rd
City of Fairfield
Income Tax Division
Account, Social Security or Federal ID #:___________________________
5350 Pleasant Avenue
Fairfield, OH 45014-3597
(513) 867-5327
Annual Estimate: $ __________________
Amount Paid this Quarter: $ __________________
Name _____________________________________
Address ____________________________________
If paying by charge card, please circle one:
MASTERCARD VISA
____________________________________________
ACCT NO. _______________________________ EXPIRATION DATE _____/______
____________________________________________
SIGNATURE _____________________________________
Please indicate any name or address changes
To determine if this transaction will be treated as a cash advance when paid to
CITY OF FAIRFIELD TAX, please check with your credit card issuing company.
____________________________________________
____________________________________________
Amended Annual Estimate: $ __________________
2006 Declaration of Estimated Tax – 4
Quarter Statement Due By 1/31/2007
th
City of Fairfield
Income Tax Division
Account, Social Security or Federal ID #:___________________________
5350 Pleasant Avenue
Fairfield, OH 45014-3597
(513) 867-5327
Annual Estimate: $ __________________
Amount Paid this Quarter: $ __________________
Name _____________________________________
Address ____________________________________
If paying by charge card, please circle one:
MASTERCARD VISA
____________________________________________
ACCT NO. _______________________________ EXPIRATION DATE _____/______
____________________________________________
SIGNATURE _____________________________________
Please indicate any name or address changes
To determine if this transaction will be treated as a cash advance when paid to
CITY OF FAIRFIELD TAX, please check with your credit card issuing company.
____________________________________________
____________________________________________
Amended Annual Estimate: $ __________________

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