Income Tax Return - 2004 - City Of Canton, Ohio
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1
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3File th is return with C AN TO N TAX DE P ARTM E N T on or before April 15, 2005 or with in
METHOD OF PAYMENT - IF PAYING BY CHECK OR MONEY ORDER
4 m onth s after close of a fiscal year or period. Requests for extensions m ust be subm itted
MAKE PAYABLE TO:
in writing and filed on or before April 15, 2005 or Fiscal Deadline.
PHONE: (330) 430-7900
“ Robert C . Sch irack ,
MAIL TO:
C anton C ity Treasurer”
RO B E RT C . SC H IRAC K
TRE ASU RE R
®
Amt
Check
City of Canton, Ohio Income Tax Return
C ITY O F C AN TO N
ACCT. #
IN C O M E TAX DE P ARTM E N T
P O B O X 9 9 51
EXP. DATE:
For C alendar Y ear ending Decem ber 3 1, 2004 , or
2004
C AN TO N , O H 4 4 7 11- 9 9 51
SIGNATURE
Indicate Filing Status:
Individual
Joint Return
Other
for the
months ending
Occupation or Principal Business Activity:
FOR USE OF ALL INDIVIDUAL TAXPAYERS SUBJECT TO
CANTON INCOME TAX
Are you or the business entity a resident
(
) Yes
(
) No
Moved INTO CANTON on
PREV. ADDRESS
Moved OUT OF CANTON on
PRESENT ADDRESS
MAKE NAME OR ADDRESS CORRECTION
BIRTH DATE
ACCT NO.
Your Social Security No.
SPOUSE SS#
PHONE
FIL IN G RE Q U IRE D E V E N IF N O TAX DU E O R N O IN C O M E E ARN E D
1. T O T AL W AG E S
AL L W - 2 ’s MU ST B E AT T ACH E D
TAX PAID
CANTON TAX
EMPLOYERS NAMES
CITY PAID
TOTAL W-2 WAGES
OTHER CITIES
WITHHELD
TOTAL
2 .
T otal adjustments from B ack of F orm (if applicable)
2 . $
3. Deduct $
3.
W ag es earned outside Canton by part year non- resident or prior to 18 th birthday
4. Deduct $
4.
Allowable E mployee B usiness E x pense
(attach F orm 2 10 6 , Detail L ine 4, & schedule A filed)
5 .
T ax able Income (Add L ines 1 and 2 subtract L ines 3 and 4)
5 . $
6 .
Canton City T ax (2 % of L ine 5 )
6 . $
7. Deduct $
7 .
Senior citiz en tax credit (see instruction sheet)
8 .
Canton city tax liability (L ine 6 less line 7 )
8 . $
9 .
CRE DIT S
9a $
(a) Canton income tax withheld by employer(s)
9b $
(b) Municipal tax paid to other cities
9c $
(c) P ayment of Declaration of E stimated T ax
9d $
(d) CRE DIT ADJ U ST ME N T
9e $
(e) T O T AL CRE DIT S (add a, b, c, less d)
10 . $
10 .
B AL AN CE DU E (If L ine 8 ex ceeds L ine 9 e enter difference here)
11. $
11. $
11.
O v erpayment claimed (If L ine 9 e ex ceeds L ine 8 )
12. $
12. $
12 .
Credit to 2 0 0 5 E stimate (If no estimate due use L ine 13)
13. $
13.
T O B E RE F U N DE D (If estimate due use L ine 12 )
14.
L ate filing fine - (returns filed after filing deadline), enter $ 25.00 fine
14. $
15 .
Interest P enalty 3% per month, effectiv e the six teenth of each month
15 . $
16 .
E stimate less than 7 5 % - F ine $2 5 .0 0
Interest P enalty 9 % per q uarter
16 . $
M U ST B E P AID IN FU L L W ITH TH IS RE TU RN
17 . $
17 .
T otal amount due -
NO TAXES OF LESS THAN $1.00 SHALL BE COLLECTED OR REFUNDED
M AN DATO RY DE C L ARATIO N O F E STIM ATE D TAX FO R 2005
Must be filed
1.
T otal income subject to Canton tax $
Canton tax @ 2 % .
1. $
if a local
2 .
L E SS T AX T O B E W IT H H E L D
2 . $
tax, of at
3.
B alance estimated Canton tax
3. $
least 12 % is
4.
L ess Credits: a.
O v erpayment on prev ious year’s return
4a. $
not withheld
b.
O ther (Specify)
4b. $
T otal Credits
$
by your
5 .
N et T ax due (line 3 less total of line 4)
5 . $
employer
6 .
Amount paid with this return (not less than 1/4 X line 3 minus line 4) Make remittance payable to: Robert C. Schirack, Canton City T reasurer
6 . $
7 .
B alance of T ax
$
I CE RT IF Y I H AV E E XAMIN E D T H IS RE T U RN (IN CL U DIN G ACCO MP AN Y IN G SCH E DU L E S AN D ST AT E ME N T S) AN D T O T H E B E ST O F MY
K N O W L E DG E , I B E L IE V E IT IS T RU E , CO RRE CT , AN D CO MP L E T E .
Sig nature of P erson P reparing , If O ther T han T ax payer
Date
Signature of Taxpayer or Agent Required
Date
Address or N ame and Address of F irm
Spouse
Date
THIS SPACE FOR TAX OFFICE USE ONLY
AUDITED BY
NEW ACCOUNT
SUSP
M/M
POSTED TO
BANKING DATE
REFUND CK. NO.
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