Form Fr 1172 - Individual Income Tax Return

WEST UNION INCOME TAX RETURN - 2011

Page 2

22 Taxable Income Not Reported on a W-2 Form ...........................................

(Attach copy of Federal Tax Document)

23 Net Profit (Loss) from Business or Profession

(Attach copy of Federal Tax Schedule)

(Enter loss as negative number)

24 Net Profit (Loss) from Rental Property

(Attach copy of Federal Schedule E)

(Enter loss as negative number)

25 Businesses Loss Total from Previous Year(s)

(Maximum Carried Forward 3 Years)

(Enter loss as negative number)

26 Nontaxable Income (Identify Source)

(Enter non-taxable income as negative number)

27 Total (Add Lines 22 to 26)

Enter total on Line 2 of Page 1

Note: Losses for businesses and rental activities cannot be used to reduce taxable wages reported on W-2 forms.

INSTRUCTIONS

Taxable income is all wages, salaries and other compensation paid to an individual for work or services performed prior to deduction of any

kind (except Section 125 deductions), the net profits from any business or profession located inside the Village of West Union or conducting

business inside West Union and/or the net profits from the rental of real estate property.

ADDITIONAL INFORMATION AVAIALABLE AT:

Income

Line 1

Add Total Taxable Wages from all W-2 and 1099 forms and enter total on Line 1.

Use the larger amount from Box 18, Box 5, or Box 1

from each W-2 form whichever amount is larger. Note: Income received from Social Security, retirement, interest income, disability

or similar non-employment income is not subject to the West Union Income Tax.

INCLUDE ALL W-2 & 1099 FORMS WITH RETURN

Line 2

Enter the additional net taxable income from Line 27, Page 2.

Note: Losses from business and rental activities cannot be used to reduce

taxable wages, but can be carried forward up to three (3) years to offset future profits.

Line 3

Add amounts on Line 1 and Line 2 and enter on Line 3.

Tax and Credits

Line 4

Multiply amount on Line 3 times tax rate of 1% (.01) and enter amount on Line 4.

Line 5

Enter the amount of estimated tax paid directly to West Union during 2011 for your 2011 tax liability. Do not include any payments

made in 2011 that were for the balance due for 2010.

Line 6

Enter the amount of Tax withheld for the Village of West Union in 2010 by your employers. If the city indicated in Box 20 of a W-2

form indicates West Union, enter the total amount indicated in Box 19 from each appropriate W-2 form.

Line 7

Indicate any overpayment from your 2010 tax return that was credited to 2011.

Line 8

Enter the Maximum Credit allowed for local tax paid to another city or village in 2011. To calculate the credit, multiple the taxable

wages subject to another city/village from each W-2 form (Box 18) by 1% (.01) then enter the smaller amount from the actual

amount listed in Box 19 or the amount from the calculation.

EXCESS TAXES PAID TO ANOTHER CITY ARE NOT REFUNDABLE

Line 9

Add the amounts in Lines 5 through 8 and enter on Line 9.

Refund/Credit

Line 10 If the amount on Line 9 is larger than the amount on Line 4, subtract Line 4 from Line 9 and enter the difference on Line 10.

Line 11 Enter the amount from Line 10 (if any) that is to be credited towards your 2011 tax liability.

Line 12 Enter the amount from Line 10 (if any) that is to be refunded.

REFUNDS OF LESS THAN $5.00 WILL NOT BE ISSUED.

Tax Due

Line 13 If the amount on Line 4 is larger than the amount on Line 9, subtract Line 9 from Line 4 and enter the amount due on Line 13.

Line 14 Enter the amount of Penalties for Late File, Late Pay Late Estimate and Interest charges. Contact Income Tax Office for amounts.

Declaration of Estimate (If after subtracting Lines 5 and 7 from Line 4 the amount is less than $100, you can skip to Line 21.)

Line 15 Estimate the amount of total income expected in 2012. (Use amount indicated in Box 5 of 2011 W-2 forms.)

Line 16 Multiply amount indicated on Line 15 by tax rate of 1% (.01) and enter on Line 16.

Line 17 Enter estimated amount of taxes to be withheld for West Union or for another city or village up to 1% (.01) of wages per W-2 form.

Line 18 Enter the amount indicated on Line 11 that is to be applied to your 2012 tax liability.

Line 19 Subtract the amount from Line 17 and Line 18 from amount indicated on Line 16.

Line 20 Multiple the amount on Line 19 by 25% (.25).

Amount You Owe

Line 21

Add amounts on Line 13, Line 14 and Line 20 and enter on Line 21. Make check payable to: Village of West Union

FROM LINE 1, PAGE 1 BUT CAN BE CARRIED FORWARD UP TO THREE (3) YEARS TO OFFSET FUTURE PROFIT.

NOTE: UNLESS ACCOMPANIED WITH PAYMENT OF TAX DUE (LINE 21) THIS IS NOT A FINAL RETURN

TAX PAYMENT SCHEDULE

ON OR BEFORE

04/15/2012

07/31/201

10/31/2012

01/31/2013

04/15/2013

FILE 2010TAX RETURN

PAY 2ND QUARTER

PAY 3RD QUARTER

PAY 4TH QUARTER

FILE 2011 TAX RETURN

PAY TAX DUE

2012 ESTIMATED TAX

PAY TAX DUE

Form Fr 1172 - Individual Income Tax Return - 2011 Page 2

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