Declaration Of Estimated Tax - Ohio Income Tax Division - 2005

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nd
2005 Declaration of Estimated Tax – 2
Quarter Statement Due By 7/31/2005
City of Fairfield
Income Tax Division
Account, Social Security or Federal ID #:___________________________
5350 Pleasant Avenue
Fairfield, OH 45014-3597
(513) 867-5327
Annual Estimate: $ __________________
Amount Paid this Quarter: $ __________________
Name _____________________________________
Address ___________________________________
If paying by charge card, please circle one:
MASTERCARD VISA
and fill in below.
__________________________________________
ACCT NO. _______________________________ EXPIRATION DATE _____/______
__________________________________________
SIGNATURE _____________________________________
Please indicate any name or address changes
To determine if this transaction will be treated as a cash advance when paid to CITY
OF FAIRFIELD TAX, please check with your credit card issuing company.
_____________________________________
_____________________________________
Amended Annual Estimate: $ __________________
rd
2005 Declaration of Estimated Tax – 3
Quarter Statement Due By 10/31/2005
City of Fairfield
Income Tax Division
Account, Social Security or Federal ID #:___________________________
5350 Pleasant Avenue
Fairfield, OH 45014-3597
(513) 867-5327
Annual Estimate: $ __________________
Amount Paid this Quarter: $ __________________
Name _____________________________________
Address ___________________________________
If paying by charge card, please circle one:
MASTERCARD VISA
and fill in below.
__________________________________________
ACCT NO. _______________________________ EXPIRATION DATE _____/______
__________________________________________
SIGNATURE _____________________________________
Please indicate any name or address changes
To determine if this transaction will be treated as a cash advance when paid to CITY
OF FAIRFIELD TAX, please check with your credit card issuing company.
_____________________________________
_____________________________________
Amended Annual Estimate: $ __________________
th
2005 Declaration of Estimated Tax – 4
Quarter Statement Due By 1/31/2006
City of Fairfield
Income Tax Division
Account, Social Security or Federal ID #:___________________________
5350 Pleasant Avenue
Fairfield, OH 45014-3597
(513) 867-5327
Annual Estimate: $ __________________
Amount Paid this Quarter: $ __________________
Name _____________________________________
Address ___________________________________
If paying by charge card, please circle one:
MASTERCARD VISA
and fill in below.
__________________________________________
ACCT NO. _______________________________ EXPIRATION DATE _____/______
__________________________________________
SIGNATURE _____________________________________
Please indicate any name or address changes
To determine if this transaction will be treated as a cash advance when paid to CITY
OF FAIRFIELD TAX, please check with your credit card issuing company.
_____________________________________
_____________________________________
Amended Annual Estimate: $ __________________

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