Form Ir - Income Tax Return 2003 (Page 2 of 3) in pdf

DECLARATION OF ESTIMATED TAX FOR YEAR 2004

Was a declaration of estimated tax for 2004 made with a request

for extension of time to file the 2003 tax return?

YES

If a declaration has been made, the declaration below need only

be completed if you wish to amend what was filed previously

10. TOTAL ESTIMATED 2004 INCOME $

MULTIPLY BY TAX RATE 1% = TOTAL 2004 ESTIMATED TAX

11. ESTIMATED TAX CREDITS:

A . ESTIMATED TOTAL TAXES TO BE WITHHELD BY EMPLOYER(S)

FOR CITY OF FOREST PARK

B. ESTIMATED 2004 FOREST PARK TAX CREDIT (PER WORKSHEET)

C. PAYMENT MADE WITH REQUEST FOR EXTENSION

D. TOTAL ESTIMATED TAX PAYMENTS AND CREDITS (Total Lines 11A, 11B and 11C)

12. TOTAL ESTIMATED TAX DUE AND PAYABLE TO FOREST PARK DURING 2004

(Subtract Line 11D from Line 10)

13. AMOUNT TO BE PAID WITH THIS DECLARATION (1/4 of Line 12 due by 4/30/2004)

14. TAX OVERPAYMENT FROM PREVIOUS TAX YEAR: ENTER AMOUNT FROM LINE 9

15. CONTRIBUTION TO ENVIRONMENTAL AWARENESS

$ 2

$ 5

$10

$ OTHER

AND/OR HOME IMPROVEMENT PROGRAMS:

$ 2

$ 5

$10

$ OTHER

16. TOTAL: LINE 8 $

PLUS LINE 13 $

MINUS LINE 14 $

PLUS LINE 15 $

= AMOUNT ENCLOSED $

17. IF OVERPAYMENT - REFUND $

OR APPLY TO NEXT YEAR'S ESTIMATE $

PAYING TAX DUE BY CREDIT CARD

Circle One:

MasterCard

Visa

Account Number (16 Digits):

Expiration Date:

Amount To Be Paid:

Your Signature For Authorization:

DECLARATION AND RETURN PAYMENT CALENDAR

APRIL 30, 2004

JULY 31, 2004

OCT. 31, 2004

JAN. 31, 2005

APRIL 30, 2005

File 2003 Return,

Make 2nd

Make 3rd

Make 4th

File 2004 return,

File 2004 Declaration,

quarter 2004 payment

File 2005 Declaration

and make 1st

quarter payment

I CERTIFY THAT I HAVE EXAMINED THIS RETURN (INCLUDING ACCOMPANYING SCHEDULES AND STATEMENTS) AND TO THE BEST OF MY KNOWLEDGE

AND BELIEF IT IS TRUE, CORRECT AND COMPLETE. IF PREPARED BY A PERSON OTHER THAN TAXPAYER, THE DECLARATION IS BASED ON ALL

INFORMATION OF WHICH PREPARER HAS ANY KNOWLEDGE.

May we discuss your taxes with your preparer? YES

Signature of Person Preparing if Other Than Taxpayer

Date

Signature of Taxpayer or Agent (Required)

Date

Address

Signature of Taxpayer or Agent (Required)

Date

Telephone Number

and

e-mail address

Telephone Number

and

e-mail address

Note: Unless this tax form is signed and accompanied by payment of the tax due (Line 16), it is not a legal FINAL return.

FOR ADDITIONAL ASSISTANCE CALL (513) 595-5211

Form Ir - Income Tax Return 2003 Page 2

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