Form Ir-No - No Income - Individual City Income Tax Return - 2015 - City Of Englewood

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City of Englewood
2015 - No Income - 2015
Income Tax Department
333 W National Rd
Individual City Income Tax Return
Englewood, OH 45322
Phone: 937-836-5106
Fax:
937-771-2891
Return Due on or Before April 15, 2016
Email:
tax@englewood.oh.us
FORM IR-NO
Per the Englewood Tax Ordinance, all residents are required to file an income tax return
even if there is no taxable income and regardless of whether Federal or State returns are filed.
Taxpayer Name __________________________________________
SS# _____________________
Taxpayer Name ____________________________________________
SS# _____________________
Address _________________________________________________
Email ____________________
City _______________________________ State ______ Zip _________
Phone Number ____________
Check Reason for Filing as No Income:
Retired
Disabled
Unemployed
Active Military
1. DID YOU HAVE W-2 INCOME? ……………………………………………………………………..
YES
NO
(
PENSION AND SOCIAL SECURITY INCOME IS NOT W-2 INCOME)
2. DID YOU OWN RENTAL PROPERTY? …………………………………………………………….
YES
NO
3. DID YOU PARTICIPATE IN A BUSINESS, PARTNERSHIP OR PASS THRU ENTITY? …….
YES
NO
4. DID YOU HAVE GAMBLING WINNINGS (W-2G)? ………………………………………………..
YES
NO
If your answer is YES to any of the questions above, you must file the
Individual City Income Tax Return which can be found on our website .
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,
adjusted to the ordinance requirements for local tax purposes, and if an audit of the Federal return is made which
affects the tax liability shown on the return an amended return is required to be filed within three months.
____________________________________________
____________________________________________
SIGNATURE OF TAXPAYER
SIGNATURE OF TAXPAYER
_______________________________
_______________________________
DATE
DATE
____________________________________________
YES
NO
May Our Office Discuss this
TAX PREPARER SIGNATURE
Return with the Preparer?
____________________________________________
Office Use Only:
Account # _______________
TAX PREPARER PHONE

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