Individual Estimated Income Tax Payment Voucher Form - Ohio Income Tax Division - 2011
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1
2FORMS AVAILABLE ON INTERNET AT eld.oh.us
INDIVIDUAL ESTIMATED INCOME TAX PAYMENT
FOR OFFICE USE ONLY:
VOUCHER 1
CITY OF SPRINGFIELD, OHIO QUARTERLY NOTICE OF INSTALLMENT DUE ON ESTIMATED TAX DECLARED
TO PAY ONLINE OR PRINT FORMS, GO TO: eld.oh.us
ST
1
QUARTER
MAKE CHECK OR MONEY ORDER PAYABLE TO:
➙
MAKE CHECK OR MONEY ORDER PAYABLE TO AND MAIL TO:
CITY OF SPRINGFIELD, INCOME TAX DIVISION
MAIL TO
CITY OF SPRINGFIELD, INCOME TAX DIVISION
P.O. BOX 5200, SPRINGFIELD, OHIO 45501-5200
CALENDAR YEAR:
PO BOX 5200
TELEPHONE (937) 324-7357
DUE APRIL 15
DUE APRIL 18
SPRINGFIELD, OH 45501-5200
CANCELLED CHECK WILL BE YOUR RECEIPT
FISCAL YEAR:
DO NOT REMIT CASH BY MAIL
DUE 15 DAYS AFTER
PAYMENT FOR YEAR:
QUARTERLY PAYMENT ENCLOSED:
END OF QUARTER
PAYMENT FOR YEAR:
2011
TOTAL ESTIMATED TAX DECLARED:
QUARTERLY PAYMENT ENCLOSED:
$ .............................................
CANCELLED CHECK WILL BE YOUR RECEIPT - DO NOT REMIT CASH BY MAIL
$ ..........................................
$ .........................................
NAME(S) AND ADDRESS:
TELEPHONE #: ________________________________________
SOCIAL SECURITY NUMBER / FEDERAL I.D. NUMBER:
SOCIAL SECURITY NUMBER / FEDERAL I.D. NUMBER / or ACCOUNT NUMBER
Q-1
NOTIFY INCOME TAX DIVISION PROMPTLY OF ANY CHANGE IN
NOTIFY INCOME TAX DIVISION PROMPTLY OF ANY CHANGE IN OWNERSHIP, NAME OR ADDRESS
OWNERSHIP OR NAME AND ADDRESS SHOWN ABOVE
METHOD OF PAYMENT
METHOD OF PAYMENT
Check
Check
R
R
$
CREDIT CARD EXPIRATION DATE
/
/
(Amount Authorized)
PHONE NUMBER
HOME
WORK
CARDHOLDER SIGNATURE
FORMS AVAILABLE ON INTERNET AT eld.oh.us
INDIVIDUAL ESTIMATED INCOME TAX PAYMENT
FOR OFFICE USE ONLY:
VOUCHER 2
CITY OF SPRINGFIELD, OHIO QUARTERLY NOTICE OF INSTALLMENT DUE ON ESTIMATED TAX DECLARED
TO PAY ONLINE OR PRINT FORMS, GO TO: eld.oh.us
ND
2
QUARTER
MAKE CHECK OR MONEY ORDER PAYABLE TO:
➙
MAKE CHECK OR MONEY ORDER PAYABLE TO AND MAIL TO:
CITY OF SPRINGFIELD, INCOME TAX DIVISION
MAIL TO
CITY OF SPRINGFIELD, INCOME TAX DIVISION
P.O. BOX 5200, SPRINGFIELD, OHIO 45501-5200
CALENDAR YEAR:
PO BOX 5200
TELEPHONE (937) 324-7357
DUE JULY 31
SPRINGFIELD, OH 45501-5200
CANCELLED CHECK WILL BE YOUR RECEIPT
FISCAL YEAR:
DO NOT REMIT CASH BY MAIL
DUE 15 DAYS AFTER
PAYMENT FOR YEAR:
QUARTERLY PAYMENT ENCLOSED:
END OF QUARTER
PAYMENT FOR YEAR:
2011
TOTAL ESTIMATED TAX DECLARED:
QUARTERLY PAYMENT ENCLOSED:
$ .............................................
CANCELLED CHECK WILL BE YOUR RECEIPT - DO NOT REMIT CASH BY MAIL
$ ..........................................
$ .........................................
NAME(S) AND ADDRESS:
TELEPHONE #: ________________________________________
SOCIAL SECURITY NUMBER / FEDERAL I.D. NUMBER:
SOCIAL SECURITY NUMBER / FEDERAL I.D. NUMBER / or ACCOUNT NUMBER
Q-1
NOTIFY INCOME TAX DIVISION PROMPTLY OF ANY CHANGE IN
NOTIFY INCOME TAX DIVISION PROMPTLY OF ANY CHANGE IN OWNERSHIP, NAME OR ADDRESS
OWNERSHIP OR NAME AND ADDRESS SHOWN ABOVE
METHOD OF PAYMENT
METHOD OF PAYMENT
Check
Check
R
R
$
CREDIT CARD EXPIRATION DATE
/
/
(Amount Authorized)
PHONE NUMBER
HOME
WORK
CARDHOLDER SIGNATURE
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