Form Q-1 - Tax Payment Vouchers Form - City Of Springfield
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1FORMS AVAILABLE ON INTERNET AT eld.oh.us
FORMS AVAILABLE ON INTERNET AT eld.oh.us
CITY OF SPRINGFIELD, OHIO QUARTERLY NOTICE OF INSTALLMENT DUE ON ESTIMATED TAX DECLARED
CITY OF SPRINGFIELD, OHIO QUARTERLY NOTICE OF INSTALLMENT DUE ON ESTIMATED TAX DECLARED
VOUCHER 3
VOUCHER 4
CALENDAR YEAR - DUE OCTOBER 31
CALENDAR YEAR - DUE JANUARY 31
FISCAL YEAR - DUE 15 DAYS AFTER
FISCAL YEAR - DUE 15 DAYS AFTER
END OF QUARTER
END OF QUARTER
MAKE CHECK OR MONEY ORDER PAYABLE TO:
MAKE CHECK OR MONEY ORDER PAYABLE TO:
MAIL
MAIL
CITY OF SPRINGFIELD, INCOME TAX DIVISION
CITY OF SPRINGFIELD, INCOME TAX DIVISION
➙
➙
P.O. BOX 5200, SPRINGFIELD, OHIO 45501-5200
P.O. BOX 5200, SPRINGFIELD, OHIO 45501-5200
TO
TO
TELEPHONE (937) 324-7357
TELEPHONE (937) 324-7357
CANCELLED CHECK WILL BE YOUR RECEIPT
CANCELLED CHECK WILL BE YOUR RECEIPT
DO NOT REMIT CASH BY MAIL
DO NOT REMIT CASH BY MAIL
TOTAL ESTIMATED TAX DECLARED:
QUARTERLY PAYMENT ENCLOSED:
TOTAL ESTIMATED TAX DECLARED:
QUARTERLY PAYMENT ENCLOSED:
$ ..........................................
$ .........................................
$ ..........................................
$ .........................................
NAME(S) AND ADDRESS:
NAME(S) AND ADDRESS:
SOCIAL SECURITY NUMBER/FEDERAL I.D. NUMBER:
SOCIAL SECURITY NUMBER/FEDERAL I.D. NUMBER:
Q-1
Q-1
NOTIFY INCOME TAX DIVISION PROMPTLY OF ANY CHANGE IN
NOTIFY INCOME TAX DIVISION PROMPTLY OF ANY CHANGE IN
OWNERSHIP OR NAME AND ADDRESS SHOWN ABOVE
OWNERSHIP OR NAME AND ADDRESS SHOWN ABOVE
METHOD OF PAYMENT
METHOD OF PAYMENT
Check
Check
R
R
$
CREDIT CARD EXPIRATION DATE
/
/
$
CREDIT CARD EXPIRATION DATE
/
/
(Amount Authorized)
(Amount Authorized)
PHONE NUMBER
HOME
WORK
PHONE NUMBER
HOME
WORK
CARDHOLDER SIGNATURE
CARDHOLDER SIGNATURE
FORMS AVAILABLE ON INTERNET AT eld.oh.us
FORMS AVAILABLE ON INTERNET AT eld.oh.us
CITY OF SPRINGFIELD, OHIO QUARTERLY NOTICE OF INSTALLMENT DUE ON ESTIMATED TAX DECLARED
CITY OF SPRINGFIELD, OHIO QUARTERLY NOTICE OF INSTALLMENT DUE ON ESTIMATED TAX DECLARED
VOUCHER 2
VOUCHER 1
CALENDAR YEAR - DUE JULY 31
CALENDAR YEAR - DUE APRIL 15
FISCAL YEAR - DUE 15 DAYS AFTER
FISCAL YEAR - DUE 15 DAYS AFTER
END OF QUARTER
END OF QUARTER
MAKE CHECK OR MONEY ORDER PAYABLE TO:
MAKE CHECK OR MONEY ORDER PAYABLE TO:
MAIL
MAIL
CITY OF SPRINGFIELD, INCOME TAX DIVISION
CITY OF SPRINGFIELD, INCOME TAX DIVISION
➙
➙
P.O. BOX 5200, SPRINGFIELD, OHIO 45501-5200
P.O. BOX 5200, SPRINGFIELD, OHIO 45501-5200
TO
TO
TELEPHONE (937) 324-7357
TELEPHONE (937) 324-7357
CANCELLED CHECK WILL BE YOUR RECEIPT
CANCELLED CHECK WILL BE YOUR RECEIPT
DO NOT REMIT CASH BY MAIL
DO NOT REMIT CASH BY MAIL
TOTAL ESTIMATED TAX DECLARED:
QUARTERLY PAYMENT ENCLOSED:
TOTAL ESTIMATED TAX DECLARED:
QUARTERLY PAYMENT ENCLOSED:
$ ..........................................
$ .........................................
$ ..........................................
$ .........................................
NAME(S) AND ADDRESS:
NAME(S) AND ADDRESS:
SOCIAL SECURITY NUMBER/FEDERAL I.D. NUMBER:
SOCIAL SECURITY NUMBER/FEDERAL I.D. NUMBER:
Q-1
Q-1
NOTIFY INCOME TAX DIVISION PROMPTLY OF ANY CHANGE IN
NOTIFY INCOME TAX DIVISION PROMPTLY OF ANY CHANGE IN
OWNERSHIP OR NAME AND ADDRESS SHOWN ABOVE
OWNERSHIP OR NAME AND ADDRESS SHOWN ABOVE
METHOD OF PAYMENT
METHOD OF PAYMENT
Check
Check
R
R
$
CREDIT CARD EXPIRATION DATE
/
/
$
CREDIT CARD EXPIRATION DATE
/
/
(Amount Authorized)
(Amount Authorized)
PHONE NUMBER
HOME
WORK
PHONE NUMBER
HOME
WORK
CARDHOLDER SIGNATURE
CARDHOLDER SIGNATURE
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