Form 2012-Decl - Declaration Of Estimated Tax - 2012
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12012
CITY OF GREENVILLE
DEPARTMENT OF TAXATION
MUNICIPAL BUILDING, 100 PUBLIC SQUARE, GREENVILLE OH 45331
PHONE 937-548-5747
FAX 937-548-3035
(Form 2012-DECL)
Check your status as a taxpayer: Employee
Proprietor
Partnership
Resident
Non-Resident
Corporation
NAME AND ADDRESS
OCCUPATION OR NATURE OF BUSINESS:
SOCIAL SECURITY NUMBER OR FEDERAL ID NUMBER:
SPOUSE’S SOCIAL SECURITY NUMBER:
DECLARATION OF ESTIMATED TAX FOR THE CALENDAR YEAR 2012
OR
FISCAL PERIOD
to
1. INCOME SUBJECT TO TAX $
TIMES TAX RATE OF 1.5% FOR GROSS TAX OF…….. $
2. GREENVILLE CITY TAX WITHHELD………………………………….......................... $____________
3. OTHER CITY TAX CREDIT (NOT TO EXCEED 1.5% OF THAT PORTION TAXED... $____________
4. NET TAX DUE (LINE 1 LESS LINE 2+3)................................................................................................................ $_____________
5. LINE 4 TIMES .25 ………………………………………………………………………………………................. $
6. LESS OVERPAYMENT CREDIT FROM 2011 RETURN....................................................................................... $
7. AMOUNT PAID WITH THIS DECLARATION (LINE 5 MINUS LINE 6)........................................................
$
8. BALANCE OF ESTIMATED TAX....................................................................................... $____________
THE UNDERSIGNED DECLARES THAT THIS DECLARATION IS A TRUE, CORRECT, AND COMPLETE DECLARATION FOR
THE TAXABLE PERIOD STATED.
SIGNATURE OF TAXPREPARER
DATE
YOUR SIGNATURE
DATE
ADDRESS OF PREPARER
DATE
SPOUSE’S SIGNATURE
DATE
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