Individual Income Tax Return Form City Of Fairlawn, Ohio
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CITY OF FAIRLAWN, OHIO
Individual Income Tax Return
Tax Office Use Only
Year Ending December 31, ______
PO Box 5433 Fairlawn OH 44334
Due on or before April 15, ______
(330) 668-9525 Fax (330) 668-9565
Social Security # ________-_______-__________
Acct #
Spouse # ________-_______-__________
Name:
Check box if first time filing.
Address:
Check box if all income is non-taxable. Such as
City/St/Zip:
Social Security, Unemployment, Interest, Disability.
Check box if moved during the year.
______
Date Moved In: _______ Date Moved Out:
If pre-printed information is incorrect, please make necessary changes.
1. Enter Total Compensation Received, Including All Deferred Income
Employed
Taxable Wage
Fairlawn
Other City/JEDD
Print Employers Name
City Where Employed
From
To
Largest Figure on W-2
Tax Withheld
Tax Withheld
Not To Exceed 2% per W-2
Attach W-2’s on Back
1a $
1b $
1c $
Column Totals
2. Other Taxable Income:
2a. Business Income (attach Schedule C) …………………………………………………….……_____________
2b. Rental Income (attach Schedule E & copy of other city return if outside Fairlawn) .…………._____________
2c. Other Income (attach documentation) …………………………………………………………._____________
2d. Loss Carry Forward from Previous Years …………………………………………………….._____________
3. TOTAL OTHER TAXABLE INCOME (add lines 2a, 2b, 2c, subtract 2d; if amount is less than zero, enter zero)………_____________
4. Total Taxable Income Before Deductions (add lines 1a and 3) …………………………………………_____________
5. Deductions for Unreimbursed Expenses (see instructions & attach Form 2106) ………………………._____________
6. FAIRLAWN TAXABLE INCOME (subtract line 5 from line 4) ……………………………………………………….…._____________
7. Fairlawn Tax Due Before Credits (multiply line 6 by 2%) ……………………………………………..._____________
8. Refunds Received from Other City/JEDD …………..………………………………………………….._____________
9. TOTAL INCOME TAX DUE BEFORE CREDITS (add lines 7 and 8) …………………………………………………._____________
10. Credits:
10a. Fairlawn Income Tax Withheld by Employer (line 1b) …………………………………….._____________
10b. Other City/JEDD Tax Withheld by Employer (line 1c, not to exceed 2% per W-2) ……….._____________
10c. Payments Made to Another City (attach documentation) ……………………………………_____________
10d. Fairlawn Estimated Tax Payments…………………………………………………………..._____________
10e. Prior Year Overpayment …………………………………………………………………….._____________
11. TOTAL CREDITS PAID (add lines 10a thru 10e) ………………………………………………………………………..._____________
12. BALANCE OF TAX DUE (subtract line 11 from line 9) ………………………………………………………………….._____________
13. Late Fee, if return is received after due date ($50 first offense, $100 subsequent offenses) … ………._____________
14. Interest, if tax is received after due date (1.5% of balance of tax due per month) …………..…………_____________
15. Penalty, if tax is received after due date (1.5% of balance of tax due per month) …………..…………_____________
16. BALANCE OF TAX AND FEES DUE (add lines 12 thru 15) …………………………………………………................._____________
17. Overpayment (if line 16 is less than zero): Credit to Next Year _____________Refund _____________
Amounts Less Than $1.00 Will Not Be Collected, Credited or Refunded
DECLARATION OF ESTIMATED TAX FOR YEAR ________
18. Estimated Taxable Income for Current Year ………………………………… _____________
19. Estimated Tax Due (2% of line 18) …………………………………………..._____________
20. Tax Withheld or Paid to Another City ……………………………………….._____________
21. Total Estimated Tax Due (subtract line 20 from line 19) ……………………………………….._____________
22. First Quarter Estimated Payment (not less than ¼ of line 21)…………………_____________
23. First Quarter Estimated Balance Due (subtract line 17 credit from line 22) ……………………. _____________
24. AMOUNT PAID WITH THIS RETURN (add lines 16 and 23)
Make Check Payable to City of Fairlawn ………_____________
I certify I have examined this return including accompanying schedules and statements and to the best of my knowledge believe it is true, correct and complete.
________________________________________
_____________________________________________
Printed name & number of person preparing, if other than taxpayer.
Phone Number
Signature of Taxpayer
Date
__________________________________________________________________________________________
Signature of Spouse
Date
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