Form I-7 - 1999 Wage Income Only - City Of Cleveland Heights Income Tax Return
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1FORM I-7 1999 WAGE INCOME ONLY
CITY OF CLEVELAND HEIGHTS INCOME TAX RETURN
MUST BE FILED BY MARCH 15, 2000
MAIL TO P.O. BOX 18850, CLEVELAND, OH 44118-0850
(216) 291-3978
PLEASE PRINT OR TYPE. MAKE CORRECTIONS IF ANY INFORMATION IS INCORRECT.
SS #
SS #
COMPLETE THIS BOX IF YOU HAVE MOVED SINCE
JANUARY 1, 1999
DATE OF MOVE: ________/________/________
MO.
DAY
YR.
Present Address ___________________________
Apt. __________
City/State _________________________________
Zip
__________
Old Address _______________________________
Apt. __________
City/State _________________________________
Zip
__________
Work Phone (
)
Home Phone (
)
❑ Joint
❑ Separate
Last year my filing status was:
❑ Joint
❑ Separate
This year my filing status is:
COLUMN A
COLUMN B
COLUMN C
COLUMN D
COLUMN E
COLUMN F
Income from
2106 Expenses
Subtract
Municipal tax
City Withholding
Do Not
Resident City
each W-2
if any
B from A
withheld
was paid to
Use
TOTALS
❑ Credit 2000
❑ Refund
The information on this form will be used to determine your 2000 Estimated Taxes. If there is an overpayment of 1999 taxes, check one:
Check here if you have used the worksheet to calculate your estimated tax: ❑
1. If any of the information on the address is in error, please
COLUMN C – Subtract the amount entered in Column B from
make the corrections.
the amount entered in Column A and enter the difference in
If you have a blank form, print your name, address, social
Column C.
security number, and phone number in the spaces provided.
A post office box should not be used.
COLUMN D – Enter the actual amount of municipal tax withheld,
2. If you moved into or out of the City of Cleveland Heights,
as it is shown on your W-2 form. If no tax was withheld, enter
indicate the date of your move. When completing this form
zero. If you are making direct payments to the city you work in
use only income earned while living in Cleveland Heights.
enter the amount paid to that city in this column. Do not enter
3. If you or your spouse had a different filing status, for city
payments you made directly to Cleveland Heights. If your
purposes, last year, please check the box provided and also
employer withheld income tax for Cleveland Heights, in addition
indicate whether that status was joint or separate.
to the tax withheld for the city in which you worked, read Special
Note 2.
COLUMN A – From your W-2, enter that portion of your income
that was earned while living in Cleveland Heights. Use one line
COLUMN E – Enter the name of each municipality to which
for each separate income. A W-2 form or copy of a 1099 must be
withholding in Column D was paid.
attached for each income. Legible photo copies are acceptable.
COLUMN F – Enter the name of the municipality in which you
COLUMN B – If you completed Form 2106 when filing your
lived when the wages on each line were earned.
Federal Tax Return, read Special Note 1. Otherwise enter zero
in this column. A copy of your Form 2106 must be attached.
ANY TAX AMOUNT THAT IS UNPAID BY APRIL 17, 2000 IS SUBJECT TO CHARGES OF PENALTY AND INTEREST
❑
I authorize the Income Tax Division to discuss my account with the preparer named below. Check here
The undersigned declares that this return is true and complete for the 1999 tax year.
X
Your Signature
Date
Preparer’s Signature (if not taxpayer)
Date
X
Spouse’s Signature (if filing joint return)
Date
Address and Preparer’s phone number
99
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