Ashland City Income Tax Return Form 2015 - State Of Ohio
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22015
ASHLAND CITY INCOME TAX RETURN
INDIVIDUAL
TAX OFFICE USE ONLY
TOTAL TAX
FILING IS REQUIRED, EVEN IF NO TAX IS DUE
IF YOU RENT, PLEASE GIVE
LIABILITY
____________
EXTENSIONS DUE APRIL 18TH ALONG WITH PAYMENT
LANDLORD INFORMATION:
TOTAL TAX
NAME:_____________________________________
PAID W/RETURN _____________
____ RESIDENT
____ NON-RESIDENT
IF YOU MOVED DURING THE TAX YEAR GIVE DATES
ADDRESS:_________________________________
CHECK #
______________
INTO
/
/
OUT OF
/
/
___________________________________________
___________________________________
NAME(S):
TAXPAYER SOCIAL SEC. NO. _____________________________________
ADDRESS:
SPOUSE SOCIAL SEC. NO.
_____________________________________
E-MAIL ADDRESS:
_____________________ACCOUNT NO.
PHONE NO.
EXEMPTION FORM:
IF EXEMPT- STOP HERE, SIGN, DATE AND MAIL
UNEMPLOYED
RETIRED
ACTIVE MILITARY
UNDER 18 YRS OF AGE- BIRTHDATE:_______________
OTHER:___________________________________
1. WAGES, SALARIES & TIPS (BOX 5 OF W-2 OR HIGHEST WAGE ON W-2)
1. $____________________
(ATTACH ALL W-2S)
2. FEDERAL FORM 2106 DEDUCTIONS (USE LINE 27 FROM FEDERAL SCHEDULE A)
2. $ -___________________
(BOTH THE FORM 2106 AND FEDERAL SCHEDULE A MUST BE ATTACHED TO RECEIVE DEDUCTION)
3. OTHER INCOME: Fed. Schedule C, E, K-1, 1099'S, FEES, COMMISSIONS, GAMBLING & MISCELLANEOUS
3. $____________________
(ATTACH ALL SCHEDULES AND TENANT ROSTERS) (1099RS ARE NOT TAXABLE TO THE CITY)
0.00
4. TOTAL INCOME LINE 1 MINUS LINE 2 PLUS LINE 3
4. $____________________
0.00
5. ASHLAND INCOME TAX 1.5% OF LINE 4
5. $____________________
(LINE 4 X .015)
6. A. ASHLAND INCOME TAX WITHHELD BY EMPLOYERS
6A. $____________________
B. TAXES PAID TO OTHER CITIES
B. TAXES PAID TO OTHER CITIES
(Limit 1% of W-2 Wages)
6B. $____________________
(LIMIT 1% OF BOX 18)
C. ESTIMATED TAXES PAID / PRIOR YRS OVERPAYMENT
C. ESTIMATED TAX PAYMENTS PAID TO ASHLAND
6C. $____________________
0.00
D. TOTAL CREDITS
E. TOTAL CREDITS (ADD A, B, C AND D)
- 6D. $____________________
(ADD A, B AND C)
0.00
7. TAX DUE
7. $____________________
(LINE 5 MINUS 6D)
8. A. OVERPAYMENT CLAIMED IF LINE 7 IS NEGATIVE
8A. $____________________
B. ENTER AMT OF LINE 7 YOU WANT APPLIED TO NEXT YR
B. ENTER AMT OF LINE 7 YOU WANT APPLIED TO NEXT YR.
8B. $____________________
C. ENTER AMT OF LINE 7 YOU WANT REFUNDED
C. ENTER AMT OF LINE 7 YOU WANT TO BE REFUNDED
8C. $____________________
9. INTEREST
9. $___________________
(1.5% OF TAX PER MONTH OR PORTION OF A MONTH ON LINE 7)
10. LATE FILING PENALTY
10. $___________________
($25.00)
No payment or refund for amount under $5.00
0.00
11. AMOUNT DUE
11. $___________________
DECLARATION OF ESTIMATED TAX FOR 2016 TAX YEAR
THIS SECTION MUST BE COMPLETED IF AMOUNT DUE IN 2015 IS OVER $200.00
12. ESTIMATED TAXABLE INCOME
12. $___________________
0.00
13. ESTIMATED TAX DUE
13. $_________________
(Multiply line 12 by .015)
14. TAXES TO BE WITHHELD AND PAID TO ASHLAND
14. $___________________
15. TAXES PAID TO OTHER CITIES
15. $___________________
(Limit of 1%)
0.00
16. LESS OVERPAYMENT FROM 8B
16. $___________________
0.00
17. TOTAL OF LINES 14, 15 AND 16
17. $___________________
0.00
18. NET ESTIMATED TAX DUE
18. $_________________
(Subtract line 17 from line 13)
0.00
19. AMOUNT DUE FOR FIRST QTR
19. $_________________
(Multiply line 18 by .225)
0.00
20. TOTAL AMOUNT DUE (Add lines 11 and 19) -
20. $ ____________
PAY IN FULL WITH RETURN
(DUE APRIL 18TH)
*** FOR YOUR CONVENIENCE, PLEASE USE OUR WEBSITE: ***
I CERTIFY, TO THE BEST OF MY KNOWLEDGE, THAT THIS RETURN, SCHEDULES AND STATEMENTS ARE TRUE AND CORRECT. (Signature Required)
Taxpayer's Signature _______________________________________________________
Date _____________________
Spouse's Signature _________________________________________________________
Date _____________________
Preparer's Signature ________________________________ Date __________
Company Name_________________________Phone No _____________________
* I (WE) AUTHORIZE THE INCOME TAX DEPT TO DISCUSS THIS RETURN AND ENCLOSURES WITH THE PREPARER ABOVE
Check here ______
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