Form R2 - 2003 Individual City Of Pickerington Income Tax Return printable pdf download

FORM R2

2003 INDIVIDUAL

PLEASE CHECK ANY CHANGES IN 2003 TAX STATUS:

File with the City of Pickerington

CITY OF PICKERINGTON

Taxpayer

Spouse

Division of Taxation

100 Lockville Road

Retired–with only non-taxable income–Date Retired

INCOME TAX RETURN

Pickerington, Ohio 43147-1321

Phone: (614) 837-4116 Fax: (614) 833-2201

Only income was from a non-taxable source–List source

Due on or before April 15, 2004

E-Mail: jeichner@pickerington.net

Active Duty Military

Website:

Make Checks and Money Orders Payable to

Date Moved

into or

out of City of Pickerington

City of Pickerington

Previous Address

Other Status Change–Married, Divorced, Death, etc (List and date)

Your SS#

Spouse SS#

TO PAY BY CHARGE CARD:

Enter number and expiration date fully and accurately.

AMERICAN

EXPRESS

No.

AMERICAN

EXPRESS

No.

EXP. DATE:

AMT. CHARGED:

SIGNATURE:

PLEASE MAKE NECESSARY CORRECTIONS TO NAME/ADDRESS

ATTACH FORMS W-2, 1099 AND FEDERAL SCHEDULES C, E AND F

1. Total W-2 wages. (Always use highest gross on all W-2’s) For multiple W-2’s, complete Worksheet A on reverse ....

2. Other Income. From Section 1, line 5 on reverse (Schedule losses cannot be deducted from W-2 wages) ....

INCOME

3. Total Income. Add lines 1 and 2 ......................................................................................................................

4. Total Deductions. Section 2, line D on reverse ................................................................................................

5. Total Income Subject to Tax. Subtract line 4 from line 3..................................................................................

TAX

6. Pickerington Income Tax.

Multiply line 5 by 1% (.01)

......................................................................................

Pickerington

income tax withheld. From W-2 or Worksheet A, column 5 on reverse. .... 7

DO NOT INCLUDE SCHOOL TAX SD2307

TAX

8. Prior year credits ................................................................................................ 8

WITHHELD,

9. Estimated payments received by Dec. 15 .......................................................... 9

PAYMENTS

9a. Any estimate payments made after Dec. 15 and not included in line 9 ............ 9a

& CREDITS

10. 1/2% (.005) credit X wages taxed by other cities. From Section 3 on reverse ....10

11. Total Payments and Credits. Add lines 7 through 10 (documentation must be provided for lines 7 & 10 to be allowed)..11

12. BALANCE DUE. If line 6 is more than 11, enter balance due here ..............................................................12

13. Penalty. 10% of amount owed..........................................................................................................................13

BALANCE

13a. Late Filing Fee. $15.00 ....................................................................................................................................13a

DUE,

14. Interest. 1-1/2% per month ..............................................................................................................................14

REFUND

15.

Total due.

Carry to line 25 below ....................................................................................................................15

NOTE: Tax due under $1.00 – no payment required, overpayment under $1.00 – no refund or credit.

16. OVERPAYMENT. If line 6 is less than line 11, enter overpayment here ............ 16

CREDIT

17. AMOUNT FROM LINE 16 TO BE REFUNDED .................................................. 17

18. AMOUNT FROM LINE 16 TO BE CREDITED TO NEXT YEAR ........................ 18

NOTE: IF PICKERINGTON CITY TAX IS WITHHELD ON ALL INCOME, STOP HERE, CHECK THIS BOX, SIGN & DATE RETURN, ATTACH W-2‘S & MAIL TO THE CITY OF PICKERINGTON

VOUCHER NO. 1

DECLARATION OF ESTIMATED TAX FOR YEAR 2004 REQUIRED BY LAW ON ALL INCOME FROM WHICH CITY OF PICKERINGTON

TAX IS NOT WITHHELD. PENALTY FOR NON-COMPLIANCE. THE SAFE HARBOR METHOD SHALL APPLY. (See General Info. #10.)

ESTIMATE

19. Estimated income subject to tax $ ____________ Multiply by tax rate of 1% (.01) ...................................... 19

FOR

20. Subtract resident credit = wages taxed by another city X .005 ...................................................................... 20

21. Balance of city income tax declared. Subtract line 20 from line 19 ................................................................ 21

YEAR

22. Less credits. Enter line 18 from above ............................................................................................................ 22

23. Net estimated tax due. Subtract line 22 from line 21 ...................................................................................... 23

24. First quarter estimate payment. Enter 1/4 of line 23 ...................................................................................... 24

VOUCHERS FOR REMAINING QUARTERLY PAYMENTS ARE INCLUDED ON A SEPARATE PAGE

25. Enter balance due from line 15 above ............................................................................................................ 25

TAX DUE

26.

TOTAL TAX DUE. ADD LINES 24 & 25. PLEASE MAKE CHECKS PAYABLE TO CITY OF PICKERINGTON

.............. 26

The undersigned declares that this return (and accompanying schedules) is a true, correct and complete return for the taxable period stated and that the figures

used herein are the same as used for Federal Income Tax purposes.

WORK

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SIGNATURE OF PREPARER, IF OTHER THAN TAXPAYER

TELEPHONE NUMBER

SIGNATURE OF TAXPAYER

TELEPHONE NUMBER

ADDRESS OF PREPARER

DATE

SIGNATURE OF SPOUSE

DATE