Declaration Of Estimated Tax Form - 2004 Page 2

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CITY OF GALLIPOLIS INCOME T
CITY OF GALLIPOLIS INCOME T
AX DEPT
AX DEPT
. — DECLARA
. — DECLARA
TION OF ESTIMA
TION OF ESTIMA
TED T
TED T
AX
AX
CITY OF GALLIPOLIS INCOME T
CITY OF GALLIPOLIS INCOME T
CITY OF GALLIPOLIS INCOME TAX DEPT
AX DEPT
AX DEPT. — DECLARA
. — DECLARA
. — DECLARATION OF ESTIMA
TION OF ESTIMA
TION OF ESTIMATED T
TED T
TED TAX
AX
AX
518 SECOND A
518 SECOND A
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
VENUE; GALLIPOLIS, OH 45631-1219
SECOND QUARTER, 2004
SECOND QUARTER, 2004
SECOND QUARTER, 2004
SECOND QUARTER, 2004
SECOND 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.
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
. — DECLARATION OF ESTIMA
. — DECLARA
TION OF ESTIMA
TION OF ESTIMA
TION OF ESTIMA
TION OF ESTIMATED T
TED T
TED T
TED TAX
TED T
AX
AX
AX
AX
518 SECOND A
518 SECOND A
VENUE; GALLIPOLIS, OH 45631-1219
VENUE; GALLIPOLIS, OH 45631-1219
518 SECOND A
518 SECOND A
518 SECOND AVENUE; GALLIPOLIS, OH 45631-1219
VENUE; GALLIPOLIS, OH 45631-1219
VENUE; GALLIPOLIS, OH 45631-1219
THIRD QUARTER, 2004
THIRD QUARTER, 2004
THIRD QUARTER, 2004
THIRD QUARTER, 2004
THIRD 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.
CITY OF GALLIPOLIS INCOME T
CITY OF GALLIPOLIS INCOME T
CITY OF GALLIPOLIS INCOME TAX DEPT
AX DEPT
AX DEPT
AX DEPT. — DECLARA
. — DECLARA
. — DECLARATION OF ESTIMA
. — DECLARA
TION OF ESTIMA
TION OF ESTIMA
TION OF ESTIMATED T
TED T
TED TAX
TED T
AX
AX
AX
CITY OF GALLIPOLIS INCOME T
CITY OF GALLIPOLIS INCOME T
AX DEPT
. — DECLARA
TION OF ESTIMA
TED T
AX
518 SECOND A
518 SECOND A
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
VENUE; GALLIPOLIS, OH 45631-1219
FOURTH QUARTER, 2004
FOURTH QUARTER, 2004
FOURTH QUARTER, 2004
FOURTH QUARTER, 2004
FOURTH 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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