2011 Estimated Tax Worksheet - City Of Gallipolis Page 2
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2CITY OF GALLIPOLIS INCOME TAX DEPT. –– ESTIMATED TAX
848 THIRD AVENUE, GALLIPOLIS, OH 45631 MAIL TO: PO BOX 339
SECOND QUARTER, 2011
TAX OFFICE USE ONLY
1. Total Estimated Tax............................................................................................. $_________________
TOTAL PAID $ ________________________________
2. Amount Enclosed (1/4 of line 1) ......................................................................... $_________________
❑ CASH ❑ CHECK __________________________
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 TAX DEPT. –– ESTIMATED TAX
848 THIRD AVENUE, GALLIPOLIS, OH 45631 MAIL TO: PO BOX 339
THIRD QUARTER, 2011
TAX OFFICE USE ONLY
1. Total Estimated Tax............................................................................................. $_________________
TOTAL PAID $ ________________________________
2. Amount Enclosed (1/4 of line 1) ......................................................................... $_________________
❑ CASH ❑ CHECK __________________________
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 TAX DEPT. –– ESTIMATED TAX
848 THIRD AVENUE, GALLIPOLIS, OH 45631 MAIL TO: PO BOX 339
FOURTH QUARTER, 2011
TAX OFFICE USE ONLY
1. Total Estimated Tax............................................................................................. $_________________
TOTAL PAID $ ________________________________
2. Amount Enclosed (1/4 of line 1) ......................................................................... $_________________
❑ CASH ❑ CHECK __________________________
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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