Ohio Tax Form - City Of Louisville - Tax Dept printable pdf download

Taxpayer’s S.S. # or

CALENDAR YR

FISCAL YEAR

Federal ID #

MAKE CHECK OR MONEY ORDER TO:

CITY OF LOUISVILLE – TAX DEPT

Home Telephone No.

Business Telephone No.

DUE DATE APRIL 15TH

215 SOUTH MILL STREET

LOUISVILLE OH 44641

Spouse’s Social

TAX OFFICE USE

Security No.

Phone: (330) 875-3434 Fax: (330) 875-9091

Email:

Spouse’s

Name

Filing Status

Single

Other

Married filing joint

MOVE IN OR OUR (circle)

DATE:

FORWARDING ADDRESS:

1. WAGES – W-2 COPIES MUST BE ATTACHED – USE HIGHEST AMOUNT ON W-2 (Box 5)

EMPLOYER NAME

WORK CITY

CITY WAGES

Louisville Tax Withheld

Other Cities Tax Withheld

TOTALS

1. Wages, salaries, tips, etc. (Box 5 of W-2) ATTACH ALL

2. Federal Form 2106 Deduction (if applicable)

3. Adjustments from Page 2, Line 21, 22, or 23 (see instructions)

4. Taxable Income (Sum of Lines 1 through Line 3)

5. Louisville Income Tax 2% of Line 4 (Line 4 x .02)

6. Credits **Read instructions as there are changes**

(A) Louisville Income Tax withheld by Employer (s)

(B) Municipal tax paid to other cities $

(2% maximum) Less: withholding

on pay stub(s) (Jan 1 - Jan 19, 2008 $

x 60%

(B1)

Other cities tax withheld on paystub Jan 1 - Jan 19, 2008

x 100%

Pay stub must be attached for the credit to be allowed

(D) Prior year Overpayment Applied

(E) Total Credits (Add 6A - 6D)

7. Tax Due (line 5 less 6E)

8. (A) Overpayment Claimed

(B) Enter Amount of Line (8A) Applied to 2009

9. Late Filing Fee

10. Other Penalties & Interest

11.

Total Amount Due – Pay in Full With This Return

MANDATORY DECLARATION OF ESTIMATED TAX – Taxpayer’s owing more than $100.00 are required by law to be set up and pay

12. Total Income subject to Louisville Tax $

x Louisville tax 2%

(12B)

(A) Louisville Tax Withheld

13. Estimate Credits:

(B) 60% of other tax withheld

(D) Total Line (13A-13C)

(E) Estimated Tax (13D less 12B)

14. Calculation of 1st Quarter Estimate

(A) Multiply line 13E x .25

(B) Less: Line 8B

15. Balance of estimate to be billed quarterly Line 14A x 3

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CREDIT CARD INFORMATION FOR PAYMENT– Visa/Mastercard

ACCOUNT NUMBER

SECURITY PIN

CARD EXPIRATION

AMOUNT PAID $

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Taxpayer’s Signature

Date

Spouse’s Signature

Date

Tax Preparer’s Signature

Date

Tax Preparer’s Phone:

I (We) authorize the Income Tax Dept to discuss my/our return and enclosures with the preparer above. Initial here.