Form L-1 - City Income Tax Return For Individuals - 2011
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2L-1
CITY OF LAKEWOOD – DIVISION OF MUNICIPAL INCOME TAX
2011
City Income Tax Return For Individuals
Due By: April 17, 2012
DATE OF MOVE DURING 2011:
REFUND
Into Lakewood
/
/
Previous Address:
EXTENSION attached
Out of Lakewood
/
/
Current Address:
AMENDED Year
Name(s) and Current Address
Taxpayer’s Social Security Number
E-FILE PIN#:
Spouse’s Social Security Number (if joint)
Make checks payable and mail to:
City of Lakewood - Division of Tax
PO Box 77047 Cleveland, OH 44194
Phone: (216) 529-6620 Fax: (216) 529-6099
Filing Status – CHECK ONLY ONE
Website:
Single
IF RENTING:
Married - Filing Joint
Landlord:
Married - Filing Separately
Mailing Address:
Telephone (
)
TABLE A: WAGES AND COMPENSATION
(ATTACH FEDERAL FORMS W-2, 1099-MISC, AND A COPY OF PAGE 1 OF YOUR 2011 FEDERAL RETURN)
additional copies of this table are available at
Column 1
Column 2
Column 3
Column 4
Column 5
Column 6
LOCATION WHERE EARNED
Dates wages
were earned
List each W2 separately
Total Wages
Withheld for
Withheld for
Tax Credit Limit
Smaller of
Tax Credit
or Compensation
Lakewood
other localities
(Column 1 x .01)
Column 3 or 4
(Column 5 x .50)
MM DD
MM
DD
LAKEWOOD
LAKEWOOD
Total from supplementary page(s)
Total
(to Line 1)
(to Line 6)
(to Line 7)
If you want Lakewood to calculate your tax - STOP, check the box, sign and date the return. Submit with W-2s before March 15, 2012.
INCOME
1. Wages and compensation (from Table A, Column 1)
1.
2. Non – Wage Income (from Table B, Column 5, Line 6) – DO NOT enter an amount less than zero
2.
3.
3. Non – Wage Income not reported on Table B (ie. Gambling winnings)
4. Total taxable income (add Lines 1, 2, and 3)
4.
TAX AND CREDITS
5. Total Lakewood tax due before credits (multiply Line 4 by 1.5% or .015)
5.
6. Taxes withheld and paid to Lakewood (from Table A, Column 2)
6.
7. Wage income tax credit (from Table A, Column 6)
7.
8. Non-wage income tax credit (from Table B, Column 5, Line 11)
8.
9. Income Tax paid by a Lakewood based LLC, Partnership, or S-Corp.
9.
10. Total credits (add Lines 6, 7, 8, and 9)
10.
11.
Tax due before estimate payments (subtract Line 10 from Line 5)
11.
12. 2011 estimated tax payment(s) and unused prior year credits - up-to-date amounts available at
12.
13.
13. Total net tax – Subtract Line 12 from Line 11 and proceed to Line 16. If less than $5.00, enter zero and proceed to Line 14
OVERPAYMENT
14. Overpayment - If Line 12 is greater than Line 11, and not less than $5.00, subtract Line 11 from Line 12
14.
Amount to be refunded - $
(Proceed to Line 17)
15. From Line 14 - Amount to be credited to 2012 - $
BALANCE DUE
16. Balance due – If Line 11 is greater than Line 12, and not less than $5.00, subtract Line 12 from Line 11
16.
ESTIMATED INCOME TAX FOR 2012
17. Estimated income tax for 2012 (from Line 11)
17.
18.
18. First quarter payment (multiply Line 17 by 25% or .25)
19..
19. 2011 credit applied to first quarter estimate (from Line 15)
20. Total amount due by April 17, 2012 (add Line 16, 18, and subtract Line 19)
20.
The undersigned declares this to be a true, correct, and complete return of Lakewood Income Tax for the period stated.
Pay by Credit Card-Mastercard / Visa / Discover
Taxpayer’s Signature
Date
Account Number
Spouse’s Signature
Date
Exp. Date
Amount Paid $
Tax Preparer’s Signature (If other than taxpayer)
Phone #
Date
Signature
I authorize the City of Lakewood - Division of Municipal Income Tax to discuss my account and enclosures with my preparer (above)
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