Form Kr-1040 - Individual Income Tax Form - 2004
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1
2INDIVIDUAL
File with the City of Kettering
INCOME TAX RETURN (Form KR-1040)
Tax Division
P. O. Box 293100
________
FOR TAX DIVISION USE ONLY
Kettering, Ohio 45429-9100
year
Telephone (937) 296-2502
OR
Fiscal Period _________________ to __________________
Fax (937) 296-3242
CALENDAR YEAR TAXPAYERS FILE ON OR BEFORE APRIL 15.
Forms available on the internet
FISCAL YEARS FILE BY 15TH DAY OF THE FOURTH MONTH AFTER
at
THE CLOSE OF THE PERIOD.
Social Security #
Spouse’s Social Security #
ACCOUNT NUMBER:_________________________________________
Your Occupation
Spouse's Occupation
________________________________ _________________________________
Name _____________________________________________________
City of Residence ___________________________________________________
Cities of Income ____________________________________________________
Address ___________________________________________________
Phone ____________________________________________________________
Did you file a City of Kettering Income Tax Return last year?
Yes
No
If no, please explain: ________________________________________________
City/State/Postal Code _______________________________________
Did you move
Into or
Out of Kettering during the year?
If so, complete the following: Date Moved ____________________________________
Old Address_______________________________________________________
ALL APPROPRIATE W-2’S, FEDERAL SCHEDULES, EXPLANATIONS MUST BE ATTACHED
INCOME
1. Total W-2 wages. For multiple W-2’s, complete Worksheet A on reverse W-2’s MUST BE ATTACHED ........................... 1 $
2. 2106 Expenses. Complete worksheet A on reverse. See instructions. MUST BE ATTACHED .......................................... 2 $
3. TAXABLE WAGES. SUBTRACT LINE 2 FROM LINE 1 .................................................................................................. 3 $
4. Other income — From Line F, Section 5, Summary of Other Income (on Reverse) .......................................................... 4 $
5. KETTERING TAXABLE INCOME. ADD LINES 3 AND 4 ................................................................................................. 5 $
TAX
6. KETTERING INCOME TAX. MULTIPLY LINE 5 BY 1.75% (.0175) .................................................................................. 6 $
7. Kettering Tax Withheld ............................................................................................................... 7 $
TAX
WITHHELD,
8. Credit for Taxes Paid to Other Cities (Limited to 1.75%) ............................................................. 8 $
PAYMENTS
9. Estimated Payments/Extension Payments .................................................................................. 9 $
AND
10. Prior Year Credit ....................................................................................................................... 10 $
CREDITS
11. TOTAL PAYMENTS AND CREDITS. ADD LINES 7 THROUGH 10 ................................................................................ 11 $
12. BALANCE DUE. If Line 6 is more than 11, enter balance due here (No tax due if less than $1.00) ................................. 12 $
13. Penalty, if applicable ....................................................................................................................................................... 13 $
BALANCE
14. Interest, if applicable ...................................................................................................................................................... 14 $
DUE,
15. Total due. Carry to Line 25 below (No tax due if less than $1.00) .................................................................................... 15 $
REFUND OR
16. OVERPAYMENT. If Line 6 is less than Line 11, enter overpayment here ................................... 16 $
CREDIT
17. AMOUNT FROM LINE 16 TO BE REFUNDED (No refund if less than $1.00) .......................... 17 $
18. AMOUNT FROM LINE 16 TO BE CREDITED TO NEXT YEAR .............................................. 18 $
** NOTE: IF ALL INCOME IS FULLY WITHHELD UPON, STOP HERE, SIGN & DATE RETURN, ATTACH W-2’S & MAIL TO THE CITY OF KETTERING **
st
DECLARATION OF ESTIMATED TAX — 1
Quarter Voucher
Complete the computation below if total tax liability is $100 or greater
19. Total income subject to tax $__________________ Multiply by tax rate of 1.75% (.0175) .............................................. 19 $
ESTIMATE
20. Subtract Kettering income tax to be withheld or credit for tax paid to other cities ............................................................. 20 $
FOR NEXT
21. Estimated balance due (subtract Line 20 from Line 19) .................................................................................................. 21 $
YEAR
22. Credit from Line 18 above .............................................................................................................................................. 22 $
23. Balance of Estimated Tax Due ........................................................................................................................................ 23 $
24. Amount due with this return (A minimum of 22.5% of Line 23)* ...................................................................................... 24 $
*First Quarter Estimate should be paid with this return. Use enclosed estimate forms to make 2nd, 3rd and 4th quarter payments.
TAX DUE
25. Enter balance due from Line 15 above (No tax due if less than $1.00) ............................................................................ 25 $
26. TOTAL TAX DUE. ADD LINES 24 & 25. PLEASE MAKE CHECKS PAYABLE TO CITY OF KETTERING .................... 26 $
The undersigned declares that this return (and accompanying schedules) is a true, correct and complete return for the taxable period stated.
If this return was prepared by a
tax practitioner, check here if we may contact him/her directly with questions regarding the preparation of this return:
Yes
No
_____________________________________________
___________________
_____________________________________________
___________________
Signature of Taxpayer
Date
Signature of Spouse
Date
_____________________________________________
___________________
_____________________________________________
___________________
Signature of Preparer (other than Taxpayer)
Date
Preparer Name/Phone Number
_____________________________________________________________________________________________________________________________________________
Address of Preparer
Revised 11/04
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