Form Ir-2005 - Tax Return
ADVERTISEMENT
1
2
32005
FORM: IR-2005
FOR OFFICE
FILE WITH
CITY OF LEBANON TAX DIV.
USE ONLY
50 S. BROADWAY
IF TAXPAYER AND SPOUSE ARE FULLY
LEBANON, OH 45036-1777
RETIRED WITHOUT TAXABLE INCOME,
ON OR BEFORE APRIL 17, 2006
MARK THIS BOX.
SIGN, DATE AND RETURN THIS FORM.
IF YOU ARE A NEW RESIDENT, FILING FOR
THE FIRST TIME OR HAVE MOVED SINCE
THE LAST FILING DATE, PLEASE FURNISH
PHONE (513) 932-3060 FAX (513) 932-2493
CURRENT ADDRESS AND DATE OF MOVE.
FILING REQUIRED EVEN IF NO TAX DUE
IF YOU OWN RENTAL PROPERTY,
LATE FILING WILL RESULT IN PENALTY AND INTEREST CHARGES
MOVE IN:____________________________
PLEASE MARK THIS BOX.
TAXPAYER:
EMPLOYER’S NAME: ___________________________________________________________________
CITY OF LEBANON
MOVE OUT:__________________________
CITY WHERE EMPLOYED: ___________________________________________________________________
ACCOUNT NO.
SPOUSE:
EMPLOYER’S NAME: ___________________________________________________________________
DUE APRIL 17, 2006 OR 15
th
DAY, 4
th
MONTH AFTER FISCAL YEAR END.
CITY WHERE EMPLOYED: ___________________________________________________________________
YES NO
REQUIRED:
TAXPAYER(S) NAME(S) AND ADDRESS (CORRECT IF NECESSARY)
SOCIAL SECURITY NO.(S)
ARE YOU A RESIDENT OF THE
CITY OF LEBANON?
DID YOU FILE A LEBANON
INCOME TAX RETURN LAST YEAR?
HAS THE IRS INCREASED YOUR
LOCAL TELEPHONE NO.
TAX LIABILITY FOR ANY YEAR?
IF SO, HAS AN AMENDED
CITY OF LEBANON RETURN
BEEN FILED.
OFFICE USE ONLY
SIGN LEBANON TAX RETURN ON PAGE 2
Part A
Tax Calculation
1.
Total Qualifying Wages (Attach All W-2 forms) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
$
2.
Other Taxable Income and/or Deductions from Line 19 or 21, Page 2 – See Instructions. Note Page 2 must be
completed if you have taxable rental property or business income. (Interest, Dividends, Capital Gains,
$
$
Unemployment, and Retirement Income is Not Taxable). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Taxable Income: Line 1 Plus or Minus Line 2
3.
$
$
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Lebanon Tax: 1% of Line 3
4.
$
$
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Credits
5a. Lebanon Tax Withheld Per W-2s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
5b. 2005 Estimated Tax Paid to Lebanon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
2005 Tax Paid Municipality of
5c.
______________ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
(Not to exceed 1% of portion taxed per W-2 – See Instructions)
5d. Prior Year Overpayments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
5e. Total Credits (Add Lines 5a through 5d and Enter Here) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
$
*6.
If Line 4 is Greater Than Line 5e, Payment of Balance Must Accompany This Return
$
$
PENALTY $__________ INTEREST $__________ LATE FILING FEE $25.00 . . . . . . . . . . . . . . . . . . . TAX DUE
7.
Overpayment Refunded $_____ or Credited $_____ to Next Year’s Estimate (Line 5e Greater Than Line 4). . . .
$
$
No Tax, Refund or Credit of Less than $5.00 Shall Be Collected or Refunded.
THIS SECTION IS REQUIRED TO BE COMPLETED IF NO LOCAL TAX IS WITHHELD.
Part B
Declaration of Estimated Tax for 2006
FAILURE TO PAY 70% OF YOUR 2006 ESTIMATED TAX DUE BY JANUARY 31, 2007 WILL RESULT IN A PENALTY.
8.
Total estimated income subject to tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$ ______________
$ ______________
9.
Lebanon Income Tax Declared (Multiply Line 8 by 1%) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$ ______________
$ ______________
10.
Estimated Taxes Withheld from Wages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$ ______________
$ ______________
11.
Tax due after Withholding (Line 4 less Line 10) STOP if this amount is less than $0.00 . . . . . . . . . . . . . . . . . . . .
$ ______________
$ ______________
12.
Declaration Due (25% of Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$ ______________
$ ______________
13.
Less credits (from Line 7 above) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$ ______________
$ ______________
*
14.
Net estimated tax due if Line 12 minus Line 13 is greater than zero* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$ ______________
$ ______________
15. TOTAL AMOUNT DUE –
Combine Line 6 above with Line 14
$ ______________
$ ______________
(Make check payable to the Lebanon Tax Department)
For office use:
*Subsequent estimated payments are due by the 15
th
of July, October and January.
To pay by credit card you must complete the following:
(
)
-
Name __________________________________ Check One: Visa:_______ or Mastercard ______ Daytime Phone Number________________________
Visa or Mastercard # _________ - __________ - _________ - _________ (16 digits)
Card Expiration Date ________ / ________
$
Total Amount Authorized $ __________ For 2005 $__________ For 2006 Estimate $ _________ Signature____________________________________
RETURN THIS COPY
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