Declaration Form Of Estimated Tax And Quarterly Estimated Payments Page 2

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Robert C. Schirack, Treasurer
CITY OF CANTON, OHIO
CITY OF CANTON
QUARTERLY ESTIMATE PAYMENT COUPON
INCOME TAX DEPARTMENT
2005 2nd Quarter
P.O. BOX 9940
CANTON, OHIO 44711-9940
AMOUNT PAID
$
TO CHARGE YOUR PAYMENT, PLEASE COMPLETE.
Federal I.D. No.
Account Number
Due on or Before*
6-15-2005
q
q
®
$
(Amount Authorized)
Name & Address
CREDIT CARD EXPIRATION DATE
/
* OR THE FIFTEENTH DAY OF THE SIXTH MONTH OF THE FISCAL YEAR
CARDHOLDER
Robert C. Schirack, Treasurer
CITY OF CANTON, OHIO
CITY OF CANTON
QUARTERLY ESTIMATE PAYMENT COUPON
INCOME TAX DEPARTMENT
2005 3rd Quarter
P.O. BOX 9940
CANTON, OHIO 44711-9940
AMOUNT PAID
$
TO CHARGE YOUR PAYMENT, PLEASE COMPLETE.
Federal I.D. No.
Account Number
Due on or Before*
9-15-2005
q
q
®
$
(Amount Authorized)
Name & Address
CREDIT CARD EXPIRATION DATE
/
* OR THE FIFTEENTH DAY OF THE NINTH MONTH OF THE FISCAL YEAR
CARDHOLDER
Robert C. Schirack, Treasurer
CITY OF CANTON, OHIO
CITY OF CANTON
QUARTERLY ESTIMATE PAYMENT COUPON
INCOME TAX DEPARTMENT
2005 4th Quarter
P.O. BOX 9940
CANTON, OHIO 44711-9940
AMOUNT PAID
$
TO CHARGE YOUR PAYMENT, PLEASE COMPLETE.
Federal I.D. No.
Account Number
Due on or Before*
12-15-2005
q
q
®
$
(Amount Authorized)
Name & Address
CREDIT CARD EXPIRATION DATE
/
* OR THE FIFTEENTH DAY OF THE TWELFTH MONTH OF THE FISCAL YEAR
CARDHOLDER

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