Income Tax Return - City Of Massillon - 2004

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City of Massillon, Ohio Income Tax Return
METHOD OF PAYMENT - IF PAYING BY CHECK
Tax Office Use Only
OR MONEY ORDER MAKE PAYABLE TO:
One James Duncan Plaza SE * P.O. Box 910 * Massillon, Ohio 44648-0910
PROCESSED
(330) 830-1709 * Fax (330) 830-2687 *
“CITY OF MASSILLON”
For calendar year ending December 31, 2004
BY
2004
®
CASH
VISA
MC
Amt
Check
DUE DATE – APRIL 15, 2005
CHECK
M/O
FILING REQUIRED IF NO TAX DUE
ACCT. #
EXP. DATE:
$
SIGNATURE
TAXPAYER SOCIAL SECURITY NO.
SPOUSE’S SOCIAL SECURITY NO.
Indicate Filing Status:
Individual
Joint Return
Other
BIRTH DATE
Home Phone (
)
Work Phone (
)
Are you or the business entity a resident
(
) Yes
(
) No
Moved INTO MASSILLON on
PREV. ADDRESS
Moved OUT OF MASSILLON on
PRESENT ADDRESS
PRINT NAME and ADDRESS IF MISSING (Indicate Changes)
IF EXEMPT FROM FILING TAX RETURN ENTER CODE # (See reverse
side)) #
TAX PAID TO
MASSILLON TAX
TOTAL W-2 & 1099
EMPLOYER’S NAME
WHERE EMPLOYED
ALL
OTHER CITIES
PAID
WAGES
W-2 & 1099
COPIES
MUST
BE
ATTACHED
TOTAL
$
$
$
1.
WAGES AND SALARIES - Use highest dollar amounts on each W-2.
1. $
2. $
2.
Total adjustments from Back of Form (if applicable) - Losses cannot reduce W-2 earnings
3.
Wages earned outside Massillon by part year non-resident or prior to 18th birthday
3. Deduct $
4.
Allowable Employee Business Expense
(Attach forms)
4. Deduct $
5.
Taxable Income (Add Lines 1 and 2 subtract Lines 3 and 4)
5. $
6. $
6.
Massillon City Tax (1.8% of Line 5)
7.
CREDITS
(a) Massillon income tax withheld by employer(s)
7a $
(b) Municipal tax paid to other cities (Limit 1.8% of Gross Wages for each W-2)
7b $
(c) Payment of Declaration of Estimated Tax
7c $
(d) TOTAL CREDITS (add a, b, c)
7d $
8.
BALANCE DUE (If Line 6 exceeds Line 7d enter difference here)
8. $
9.
Overpayment claimed (If Line 7d exceeds Line 6)
9. $
10.
Credit to 2005 Estimate (If no estimate due use Line 11)
10. $
11.
TO BE REFUNDED (If estimate due use Line 10)
11. $
12.
Late filing fine - (returns filed after filing deadline), enter $25.00 fine
12. $
13. $
13.
INTEREST - 1% PER MONTH - EFFECTIVE THE FIRST DAY OF EACH MONTH
14.
PENALTY - 1% PER MONTH FOR 1st SIX MONTHS - 2% PER MONTH THEREAFTER
14. $
MUST BE PAID IN FULL WITH THIS RETURN
15. $
15.
Total amount due -
NO TAXES OF LESS THAN $5.00 SHALL BE COLLECTED OR REFUNDED
MANDATORY DECLARATION OF ESTIMATED TAX FOR 2005
(NO ESTIMATE DUE IF TAX DUE IS $100.00 OR LESS)
1. $
1.
Total income subject to Massillon tax $
Massillon tax @ 1.8%
Must be filed
2.
LESS TAX TO BE WITHHELD
2. $
if a local
3. $
tax is
3.
Balance estimated Massillon tax
not withheld
4.
Less Credits: a.
Overpayment on previous year’s return
4a. $
by your
$
b.
Other (Specify)
4b. $
Total Credits
employer
5. $
5.
Net Tax due (line 3 less total of line 4)
6.
Amount paid with this return (not less than 1/4 X line 3 minus line 4) Make remittance payable to: City of Massillon
6. $
7.
Balance of Tax
$
I CERTIFY I HAVE EXAMINED THIS RETURN (INCLUDING ACCOMPANYING SCHEDULES AND STATEMENTS) AND TO THE BEST OF MY
KNOWLEDGE, I BELIEVE IT IS TRUE, CORRECT, AND COMPLETE.
Signature of Person Preparing, If Other Than Taxpayer
Date
Signature of Taxpayer Required
Date
Address or Name and Address of Firm
Preparers Phone
Spouse’s Signature
Date
File this return with MASSILLON TAX DEPARTMENT on or before April 15, 2005 or within 4 months after close of a fiscal
year or period. Requests for extensions must be submitted in writing on or before the filing deadline.

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