Form 1040-R - Springboro Individual Income Tax Return - 2003

1040-R

2003

2003

FOR ASSISTANCE

SPRINGBORO INDIVIDUAL INCOME TAX RETURN

CALL (937) 748-9701

320 W. Central Ave., Springboro, OH 45066 – DUE ON OR BEFORE APRIL 30, 2004

FOR FAILURE TO FILE BY APRIL 30, 2004, A $25.00 PENALTY WILL BE ASSESSED

IF NAME OR ADDRESS INCORRECT, MAKE NECESSARY CHANGES

TAXPAYER SSN: ______________________________________________

(LIST BOTH NAMES AND SOCIAL SECURITY NUMBERS IF FILING A JOINT RETURN)

SPOUSE SSN: _________________________________________________

HOME PHONE NUMBER:_______________________________________

IF YOU MOVED DURING THE YEAR, COMPLETE THIS SECTION:

DATE OF MOVE: ______________________________________________

FORMER ADDRESS: ___________________________________________

I AM NOT REQUIRED TO COMPLETE SECTION 8 OF THIS RETURN BECAUSE:

A

_____ACTIVE DUTY MILITARY

_______ONLY INCOME IS FROM A NON-TAXABLE SOURCE – LIST SOURCE:_______________________________________

(INTEREST, DIVIDENDS, STOCKS, BONDS, CAPITOL GAINS, UNEMPLOYMENT, RETIREMENT INCOME, ETC. IS NOT TAXABLE)

1.

Total from Worksheet A column 2 . . . . .Number of W-2s attached . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1. ____________________

B

2.

Total from Worksheet B (attach Federal Schedules) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2. ____________________

3.

Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3. ____________________

4.

Total From Worksheet C (attach Federal Schedules) . . . . . . . . . . . .4A. (__________________) . . . . . . .4B. ____________________

5.

Total Income (Add Lines 3 and 4B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5. ____________________

6.

Tax liability – Multiply line 5 by 1.5% (0.015) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6. ____________________

7.

A. Springboro Tax Withheld . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7A. ___________________

B. Credit for other city tax withheld (Max. credit 1.5% see worksheet A column 5) . . . . . .B. ___________________

C. Estimated taxes paid for 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C. ___________________

D. Prior year credit carried forward . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .D. ___________________

7E. Total of credits. Add 7A, 7B, 7C and 7D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7E. ____________________

8.

If line 6 is greater than box 7E, enter your balance due here (not less than $10.00) . . . . . . . . . . . . . . . . . . . .8. ____________________

9.

If line 7E is greater than line 6, enter your overpayment here (not less than $10.00) . . . . . . . . . . . . . . . . . . .9. ____________________

Amount to be: REFUNDED:____________________

or CREDITED TO 2004___________________

10. Late filing penalty:_____________

Penalty:______________ Interest:____________ . . . . . . . . . . . . . . .10. ____________________

11. BALANCE DUE Add line 8 and line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11. ____________________

DECLARATION OF ESTIMATED TAX DUE FOR TAX YEAR 2004

MANDATORY IF LIABILITY

$25.00 FAILURE TO FILE FEE IF NOT COMPLETED AND

IS $100.00 OR MORE

$25.00 FAILURE TO PAY ACCORDING TO PAY SCHEDULES

12. Total estimated tax due for tax year 2004 (gross taxable income multiplied by 1.5% . . . . . . . . . . . . . . . . . . . . .12. _____________________

13. Less credits (including prior year credit from line 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13. _____________________

14. Net taxes owned for tax year 2004 estimated tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14. _____________________

15. Amount paid with this declaration (1/4 of amount in box 14) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15. _____________________

16. TOTAL DUE – ADD BOXES 11 and 15 to arrive at total due with this return . . . . . . . . . . . . . . . . . . . . . . . . .16. _____________________

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 and correct.

FOR OFFICE USE ONLY

Your Signature

DATE

C

Spouse’s Signature

DATE

Signature and address of preparer (if other than taxpayer)

DATE