Form L-1 - City Income Tax Return For Individuals - 2011 Page 2
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1
2Name(s) on return
Taxpayer’s social security number
TABLE A-1: PART-YEAR RESIDENT CALCULATION
(This table should only be used for moves within the State of Ohio - see instructions)
additional copies of this table are available at
1. Number of months lived in Lakewood
2. Divide Line 1 by 12
3. Part-Year Percentage (Multiply Line 2 by 100) - enter in Column 1 and Column 3
LOCATION WHERE EARNED
Column 1
Column 2
Column 3
Column 4
Column 5
Column 6
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)
(Lakewood W2s on Table A only)
MM DD
MM
DD
Part-Year Percentage (From Line 3)
Multiply each listing in Column 1 and
%
%
Column 3 by this percentage
(to Table A, Column 1)
(to Table A, Column 6)
TABLE B: NON-WAGE INCOME (ATTACH A COPY OF APPLICABLE FEDERAL SCHEDULES)
Column 1
Column 2
Column 3
Column 4
Column 5
additional copies of this table are available at
Earned In
Earned In
Earned In
Earned In
Totals
Lakewood
to Page 1
Taxable Non-Wage Income
1. Proprietorship Income (Loss) (From Federal Schedule(s) C)
2. Rental Income (Loss) (From Federal Schedule(s) E)
3. LLC, Partnership, S-Corporation or Trust Income (Loss) (From Federal Schedule(s) E, K-1)
(
) (
) (
) (
)
4. Loss CarryForward
5. Taxable Non-Wage Income (Add Lines 1, 2, 3, and Subtract Line 4 for each Column)
If Line 5 is equal or less than zero, enter the Loss on appropriate Table B-1 Line
6. Total Taxable Non-Wage Income (Add all applicable Columns, Line 5) - Enter on Page 1, Line 2
If Line 6 is equal or less than zero, enter zero on Page 1, Line 2
Tax Credits - (A COPY OF EACH OTHER LOCALITY TAX RETURN IS REQUIRED)
7. Tax paid to other localities outside Lakewood
8. Tax credit limit of 1% (Multiply Line 5 by 1% or .01)
9. Income limit for tax credit calculation (smaller of Line 7 and Line 8)
10. Tax credit (Multiply Line 9 by 50% or .50)
11. Total Tax Credit (Add all applicable Columns, Line 10) - Enter on Page 1, Line 8
TABLE B-1: LOSS CARRYFORWARD SCHEDULE
Column 1
Column 3
Column 3
Column 4
additional copies of this table are available at
Earned In
Earned In
Earned In
Earned In
Lakewood
2015
2010 Loss that can be carried forward until 2013
TABLE C: TAXPAYER AND/OR SPOUSE EXEMPTION (YOU MAY BE REQUIRED TO ATTACH PROOF - SEE INSTRUCTIONS)
Taxpayer
Spouse
Retired as of
/
/
Retired as of
/
/
Social Security / disability income only for all of 2011
Social Security / disability income only for all of 2011
Unemployment income for all of 2011
Unemployment income for all of 2011
No taxable income for 2011 - explain:
No taxable income for 2011 - explain:
Under 18 years of age for all of 2011 - Date of birth
/
/
Under 18 years of age for all of 2011 - Date of birth
/
/
Full time student living on campus
Full time student living on campus
Active military duty income only for all of 2011
Active military duty income only for all of 2011
Non-resident for all of 2011
Non-resident for all of 2011
Business/rental closed or sold -
/
/
Business/rental closed or sold -
/
/
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