Form Ir - Individual Income Tax Return - City Of Fairfield
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1
2File with Fairfield Income Tax
City of Fairfield
5350 Pleasant Ave
FORM IR
2005
Individual Income Tax Return 2005
Fairfield OH 45014-3597
(513) 867-5327
or
Your social security number
Fax (513) 867-5325
Fiscal Period _________ to __________
(Enter without dashes)
Forms available on Internet at
Calendar year taxpayers file on or before April 17
Spouse’s social security number
th
and fiscal year taxpayers file by the 17
day of the
th
(Enter without dashes)
fourth month after the close of the period.
Provide Name and Address in space below
Resident
Date moved in ____________
Non Resident
Name:
Sole Proprietor
Date moved out ___________
Address:
Payment by Check:
Payable to Fairfield Income Tax
City, State, Zip:
Payment by Charge Card
MasterCard / Visa
(Enter without dashes)
No. _____________________________________________
Exp Date ________________
**
denotes auto calculating field.
If taxpayer and spouse are fully retired and without taxable income, place an x in the box, sign, date and return this form by the due date listed above.
FILING
Single
STATUS
Married filing joint return (even if only one had income). Did you file joint or separately last year?
Joint
Separate
Married filing separate return. Enter spouse’s social security number above and full name here:
____________________
INCOME
1.
Total W-2 wages. W-2s MUST BE ATTACHED ………………………………….……….……………… 1
$ ____________________
0.00
**
2.
Other Taxable Income or Deductions from Line 20 from side two (back) of this form ….…… 2
$ ____________________
**
3.
Total Taxable Income …………………………………………………………………………………….. 3
$ ____________________
0.00
**
TAX
4.
Fairfield Tax is 1.5% (.015) of Line 3 ……………………………………………………………………… 4
$ ____________________
0.00
TAX
5.
Tax Credits: Credit will only be given with proper documentation.
WITHHELD,
A.
Fairfield income tax withheld ………………………………… 5A $ ___________________
PAYMENTS
B.
Credit for income tax withheld/paid to other cities ……..
5B
$ ___________________
AND
C.
Prior year overpayments ………………………………………
5C $ ___________________
CREDITS
D.
Estimated payments …………………………………………… 5D $ ___________________
**
0.00
E.
Total tax credits (Lines 5A through 5D) ………………………………………………………….. 5E
$ ____________________
BALANCE
6.
Balance Due, if Line 4 is greater than Line 5E. No tax due if less than $1.00 ………………….. 6
$ ____________________
DUE,
A.
Penalty …………………………………………………………….. 6A $ ___________________
REFUND,
B.
Interest …………………………………………………………….. 6B
$ ___________________
AND/OR
C.
Total Penalty and Interest (Line 6A and Line 6B) ………….. 6C $ ___________________
CREDIT
D.
Total Balance Due (Line 6 and Line 6C)………………………………………….……………… 6D $ ___________________
7.
Overpayment, if Line 4 is less than Line 5E. No refund/credit if less than $1.00 ....……………. 7
$ ___________________
A.
REFUND amount ..…………………………………..……………. 7A $ ___________________
B.
CREDIT amount …………………………………………………... 7B
$ ___________________
DECLARATION OF ESTIMATED TAX FOR 2006
**
0.00
ESTIMATE
8.
Total income subject to tax $ __________________ multiply by tax rate of 1.5% (.015) ……….. 8
$ ___________________
FOR
9.
Estimated income tax to be withheld or paid to other cities ……………………..……..……….. 9
$ ___________________
**
0.00
NEXT
10. Estimated tax due (Line 8 less Line 9).
…… 10
$ ___________________
If less than $200, estimated payments are not required
YEAR
11. Prior year tax credit from Line 7B above ……………………………………………………………… 11
$ ___________________
**
0.00
12. First quarter estimated tax payment (minimum of 22.5% (.225) of Line 10)* …………………… 12
$ ___________________
*First quarter estimated tax payment should be paid with this return. Use enclosed estimate forms for 2
, 3
and 4
quarters.
nd
rd
th
0.00
13. If Line 11 is greater than Line 12, enter 0 ……………………………………………………………… 13
$ ___________________
**
TAX DUE
14. TOTAL TAX DUE (Lines 6D and 13) Make checks payable to FAIRFIELD INCOME TAX ….
14
$ ___________________
0.00
The undersigned declares that this return (and accompanying schedules) is true, correct and complete for the taxable period stated and that the figures used herein are the same as
used for Federal Income Tax purposes.
____________________________________________________________________________
May we discuss the return with the tax practitioner below?
Yes
No
(Required)
Signature of Taxpayer
Date
____________________________________________________________________________
For Tax Division Use Only
(Required)
Signature of Taxpayer
Date
____________________________________________________________________________
Signature of Preparer, if other than taxpayer
Date
____________________________________________________________________________
Name and Address of Preparer
Telephone Number
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