Income Tax Return Mandatory Filing Form - City Of Brooklyn - 2004

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Income Tax Division
CITY OF BROOKLYN
CALENDAR YEAR 2004 OR
7619 Memphis Avenue
FISCAL YEAR ______ TO ______
Brooklyn, OH 44144-2197
INCOME TAX RETURN
(216) 351-2133
MANDATORY FILING
Your Social Security
(216) 635-4211 Fax
DUE BY APRIL 15, 2005
Number or Federal I.D.
Spouse’s Social
Our tax records indicate a tax return was not filed for the following years:
Security Number
❑
❑
THIS YEAR’S FILING STATUS:
JOINT
SEPARATE
❑
❑
LAST YEAR’S FILING STATUS:
JOINT
SEPARATE
RECENT MOVE DATE:
/
/
❑
❑
From Brooklyn
To Brooklyn
Previous or New Address (circle one)
City, State, Zip
Note: If your total income is reported on W-2 wages and local tax was correctly withheld at the
rate of 2.0%, complete the shaded areas only, sign return at the bottom and attach the W-2 forms.
All others, see instructions and complete form in its entirety.
Work Phone (
) ________-_____________ Home Phone (
) ________-_____________
If you have previously filed a Brooklyn Tax Return under a different name, please indicate former name:
INCOME
1. Wages and salaries
1
(Required: Attach W-2 and/or 1099 forms and complete Worksheet Table on back of return)
2. Other Taxable Income
2a. Business Income
_________% allocable to Brooklyn
2a
(attach schedule[s])
2b. Rental or Supplemental Income
2b
(attach Schedule E)
2c. Other income
2c
(please provide documentation)
2d. Loss carried forward from previous years
2d
(include schedule)
3. Total other taxable income
3
(add lines 2a, 2b, 2c, subtract line 2d; if amount is less than zero, enter zero)
4. Total taxable income before deductions
4
(add lines 1 and 3)
5. Deductions
5
(from line 32 on back of this return)
6. Brooklyn taxable income
6
(subtract line 5 from line 4)
TAX AND CREDITS
7. Brooklyn tax due before credits
7
(multiply line 6 by 2.0%)
8. Refunds or credits received in 2004 from other localities
8
(individuals only)
9. Current year tax due before credits
9
(add lines 7 and 8)
10. Taxes withheld and paid to Brooklyn
10
(total of column 2 from Worksheet Table)
11. Taxes withheld and paid to other localities
11
(total of column 3 from Worksheet Table)
12a. 2004 estimated tax payments made to Brooklyn…...As of 12/31/04
$___________________
12a
12b. 2004 estimated tax payments made to Brooklyn…...After above date $___________________
12b
13. Income tax credit carried forward from prior years
13
14. Total credits
14
(add lines 10, 11, 12 and 13)
15. If difference between line 9 and line 14 is less than $1.00, enter zero and proceed to line 21
15
REFUND
16. If line 14 is greater than line 9, and not less than $1.00, enter the difference, which is amount of overpayment
16
17. Amount of line 16 to be credited to 2005 estimated tax liability
17
(enter here and on line 26)
18. Amount to be refunded
Proceed to line 21
18
(subtract line 17 from line 16)
(no refunds of $1.00 or less)
AMOUNT PAYABLE TO CITY
19. If line 9 is greater than line 14, and not less than $1.00, enter the difference, which is the balance due for 2004
19
20. Penalty and Interest
20
(from line 36 on back of return)
DECLARATION OF 2005 PERSONAL OR BUSINESS ESTIMATED INCOME TAX
21. Estimated taxable income for 2005 tax year
21
22. Estimated tax due
22
(multiply line 21 by 2.0%)
23. Taxes to be withheld and paid to Brooklyn and other localities
23
24. Estimated tax due for 2005 tax year
24
(subtract line 23 from line 22)
25. First quarter of estimated tax payable to City
25
(multiply line 24 by 25%)
26. 2004 credit applied to 2005 estimated tax payments
26
(line 17)
27. Net amount due for initial quarterly payment
27
(subtract line 26 from line 25)
28. Total amount due by April 15, 2005
Make check payable to CITY OF BROOKLYN
28
(add lines 19, 20 and 27)
The undersigned declares this to be a true, correct, and complete return of Brooklyn Income Tax for the period stated
Signature
Date
/
/
For Departmental Use
Spouse’s Signature
Date
/
/
Tax Preparer’s Signature
Phone #
Date
/
/
(If other than taxpayer)
(
)
-
I authorize the Brooklyn Income Tax Division to discuss my account and enclosures with my preparer (above)
Initials

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