Declaration Of Estimated Tax Form - 2004
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1
2IMPOSITION OF T
IMPOSITION OF T
AX FOR DECLARA
AX FOR DECLARA
TIONS
TIONS
IMPOSITION OF T
IMPOSITION OF T
IMPOSITION OF TAX FOR DECLARA
AX FOR DECLARA
AX FOR DECLARATIONS
TIONS
TIONS
THIS IS THE ONL
THIS IS THE ONL
Y TIME THESE VOUCHERS WILL BE SENT
Y TIME THESE VOUCHERS WILL BE SENT
THIS IS THE ONL
THIS IS THE ONL
THIS IS THE ONLY TIME THESE VOUCHERS WILL BE SENT
Y TIME THESE VOUCHERS WILL BE SENT
Y TIME THESE VOUCHERS WILL BE SENT
This is your 2004 declaration of estimated tax package. Included are four quarterly installment forms to be
filed by:
INDIVIDUALS: April 15, July 31, October 31, and January 31.
CORPORATIONS: April 15, June 15, September 15, December 15.
A worksheet to determine if you are required to file a declaration of estimated tax is listed below for your
convenience.
2004 DECLARA
2004 DECLARA
TION OF ESTIMA
TION OF ESTIMA
TED T
TED T
AX WORKSHEET
AX WORKSHEET
2004 DECLARA
2004 DECLARA
2004 DECLARATION OF ESTIMA
TION OF ESTIMA
TION OF ESTIMATED T
TED T
TED TAX WORKSHEET
AX WORKSHEET
AX WORKSHEET
1. Total income subject to Gallipolis Tax ............................................................................................................$
2. Gallipolis income tax — 1% of line 1 amount ................................................................................................$
3. Less: Gallipolis tax withheld by employers ...................................................................... $(
)
4. Less: Overpayment on previous year’s return ................................................................. $(
)
5. Less: Income taxes paid to City of________________
$(
)
Not to exceed 1% of that city’s income .
6. Net estimated tax due (line 2 minus lines 3, 4 and 5 .....................................................................................$
P P P P P A A A A A YMENT RECORD
YMENT RECORD
YMENT RECORD
YMENT RECORD
YMENT RECORD
Date
Check #
Amount Paid
Quarter 1
$
NO NOTICE OF
NO NOTICE OF
NO NOTICE OF
NO NOTICE OF
NO NOTICE OF
Quarter 2
$
TOT
TOT
TOT
TOT
TOTAL P
AL P
AL P
AL PA A A A A YMENTS
AL P
YMENTS
YMENTS
YMENTS
YMENTS
WILL BE SENT TO Y
WILL BE SENT TO Y
OU
OU
Quarter 3
$
WILL BE SENT TO Y
WILL BE SENT TO Y
WILL BE SENT TO YOU
OU
OU
Quarter 4
$
Credit from prior year ...................................... $
Enter this amount on line 8 of your 2004 City T
Enter this amount on line 8 of your 2004 City Tax Return.
Enter this amount on line 8 of your 2004 City T
ax Return.
ax Return.
ax Return.
Enter this amount on line 8 of your 2004 City T
Enter this amount on line 8 of your 2004 City T
ax Return.
To avoid a penalty, each installment must equal at least 25% of the lesser of 90% of the tax shown on the
current year’s tax return or 100% of the tax shown on the return for the preceding tax year, the amount of
tax for the current year would be less than fifty dollars ($50.00).
Page 8
CITY OF GALLIPOLIS INCOME T
CITY OF GALLIPOLIS INCOME T
CITY OF GALLIPOLIS INCOME T
CITY OF GALLIPOLIS INCOME T
CITY OF GALLIPOLIS INCOME TAX DEPT
AX DEPT
AX DEPT
AX DEPT
AX DEPT. — DECLARA
. — DECLARA
. — DECLARA
. — DECLARA
. — DECLARATION OF ESTIMA
TION OF ESTIMA
TION OF ESTIMA
TION OF ESTIMA
TION OF ESTIMATED T
TED T
TED T
TED T
TED TAX
AX
AX
AX
AX
518 SECOND A
518 SECOND A
518 SECOND AVENUE; GALLIPOLIS, OH 45631-1219
VENUE; GALLIPOLIS, OH 45631-1219
VENUE; GALLIPOLIS, OH 45631-1219
VENUE; GALLIPOLIS, OH 45631-1219
518 SECOND A
518 SECOND A
VENUE; GALLIPOLIS, OH 45631-1219
FIRST QUARTER, 2004
FIRST QUARTER, 2004
FIRST QUARTER, 2004
FIRST QUARTER, 2004
FIRST QUARTER, 2004
TAX OFFICE USE ONLY
TOTAL PAID $ _______________________
1. Total Estimated Tax
.................................... $
(Line 6 from worksheet)
❐
❐
CASH
CHECK _________________
2. Amount Enclosed (¼ of line 1) .................................................. $
RECEIPT # __________________________
Account # ______________ SS# or FID# ______________________________________
Name ________________________________________________________________
Address ________________________________________________________________
City, State, Zip ________________________________________________________________
Date ______________ Telephone # ______________________________________
PLEASE RETURN THIS COPY AND MAKE CHECKS PAYABLE TO THE CITY OF GALLIPOLIS INCOME TAX DEPT.
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