Form Ir - South Lebanon Income Tax Return - 2011
ADVERTISEMENT
1
22011 SOUTH LEBANON INCOME TAX RETURN 2011
Form IR
Filed With
MAKE CHECK OR
SOUTH LEBANON TAX DEPT.
FIILING REQUIRED EVEN IF NO TAX IS DUE
MONEY ORDER PAYABLE TO:
99 N. HIGH ST.
ON OR BEFORE APRIL 17, 2012
SOUTH LEBANON TAX DEPT.
P.O. BOX 40
LATE FILING WILL RESULT IN PENALTY AND INTEREST CHARGES
P
SOUTH LEBANON, OH 45065
HONE: (513) 494-2296
OFFICE HOURS 8:00 A.M. to 4:30 P.M.
FAX: (513) 494-1656
TAXPAYER’S NAME AND ADDRESS (IF SS#, Name, Address is incorrect make corrections)
SSN TAXPAYER
SSN SPOUSE
PHONE NO. (
) ____________________
If moved since the previous return was filed give date:
Moved INTO South Lebanon: ______________________
Moved OUT of South Lebanon: _____________________
PART A.
I/WE ARE NOT REQUIRED TO COMPLETE PART B OF THIS RETURN
DUE TO THE FOLLOWING REASON (PLEASE CHECK) SIGNATURE(S) REQUIRED AT BOTTOM OF FORM.
SUPPORTING DOCUMENTATION MUST BE ATTACHED.
____ TOTAL/PERMANENT DISABILITY
____ MOVED OUT PRIOR TO 2011; LIST MOVE DATE: ________________
LIST NEW ADDRESS: ___________________________________________
____ RETIREMENT INCOME ONLY
____ DECEASED: DATE OF DEATH: _____________________________
____ FULL TIME STUDENT
____ ONLY INCOME IS FROM NON-TAXABLE SOURCE; LIST
SOURCE: _____________________________________________________
PART B.
FORMS RECEIVED WITHOUT COMPLETE DOCUMENTATION WILL BE RETURNED.
OFFICE USE ONLY
1. TOTAL QUALIFYING WAGES
(
T
Y
P
I
C
A
L
L
Y
B
O
X
5
O
N
W
-
2
)
(
ATTACH W-2’S AND PAGE 1 OF FEDERAL
1040)
) ….$_____________________
$ _ _ _ _ _ _ _ _ _ _
(
T
Y
P
I
C
A
L
L
Y
B
O
X
5
O
N
W
-
2
)
(
ATTACH W-2’S AND PAGE 1 OF FEDERAL 1040
2. OTHER TAXABLE INCOME OR DEDUCTIONS FROM SIDE 2 – SEE INSTRUCTIONS ……………………………… $ _____________________
$ _ _ _ _ _ _ _ _ _ _ __
3. TAXABLE INCOME: (LINE 1 PLUS OR MINUS LINE 2) ……………………………………………………………………. $ _____________________
$ _ _ _ _ _ _ _ _ _ _ __
4. SOUTH LEBANON TAX – 1% OF LINE 3 ………………………………………………………………………………….… $ _____________________
$ _ _ _ _ _ _ _ _ _ _ __
5. CREDITS:
A. TAX WITHHELD BY EMPLOYER FOR VILLAGE OF SOUTH LEBANON …. $ _____________________
$ _ _ _ _ _ _ _ _ _ _ __
B. 2011 ESTIMATED TAX PAID TO VILLAGE OF SOUTH LEBANON ………
$ _____________________
$ _ _ _ _ _ _ _ _ _ _ __
C. PRIOR YEAR TAX OVERPAYMENT…………………………………………
$ ______________________
$ _ _ _ _ _ _ _ _ __
D. 2011 TAX PAID TO ANOTHER MUNICIPALITY……………………..
$ ______________________
$ _ _ _ _ _ _ _ _ _ _
N
N
O
O
T
T
T
T
O
O
E
E
X
X
C
C
E
E
E
E
D
D
½
½
%
%
O
O
F
F
T
T
H
H
A
A
T
T
P
P
O
O
R
R
T
T
I
I
O
O
N
N
T
T
A
A
X
X
E
E
D
D
P
P
E
E
R
R
W
W
-
-
2
2
.
.
A
A
T
T
T
T
A
A
C
C
H
H
A
A
P
P
P
P
R
R
O
O
P
P
R
R
I
I
A
A
T
T
E
E
D
D
O
O
C
C
U
U
M
M
E
E
N
N
T
T
A
A
T
T
I
I
O
O
N
N
.
.
L
L
I
I
M
M
I
I
T
T
E
E
D
D
T
T
O
O
½
½
O
O
F
F
T
T
H
H
E
E
T
T
A
A
X
X
O
O
N
N
L
L
I
I
N
N
E
E
4
4
.
.
E. TOTAL CREDITS (ADD 5A – 5D)……………………………………………………………………………………$(____________________)
$(_ _ _ _ _ _ _ _ _ _ _)
6. IF LINE 4 IS GREATER THAN LINE 5E PAYMENT OF BALANCE MUST ACCOMPANY THIS RETURN –TAX DUE : $ ____________________
$ _ _ _ _ _ _ _ _ _ _ _
A.
LATE FILING PENALTY $ 25.00, INTEREST $ ___________.....................................……..TOTAL $ ___________________
$
B.
TOTAL AMOUNT DUE FOR 2011………………………………………………………………. …………………………...……………
7. OVERPAYMENT TO BE REFUNDED $ _______________ OR CREDITED $ _______________ TO NEXT YEARS ESTIMATED
*NO TAXES DUE OR REFUNDS OF LESS THAN $1.00 SHALL BE COLLECTED OR REFUNDED*
2012 DECLARATION OF ESTIMATED TAX FOR YEAR 2012
8. TOTAL INCOME SUBJECT TO TAX $ ________________________ MULTIPLY BY TAX RATE 1% FOR GROSS TAX OF ………………$ _______________________
9. LESS EXPECTED TAX CREDITS:
A.
TAX WITHHELD BY EMPLOYER FOR VILLAGE OF SOUTH LEBANON …………………………… $ ____________________
PAYMENTS ON TAXABLE INCOME TO ANOTHER MUNICIPALITY (NOT TO EXCEED 1/2%)…. $____________________
B.
C.
OVERPAYMENT FROM PRIOR YEAR ………………………………………………………………….. $ ____________________
TOTAL CREDITS (ADD LINES A -C)…..………….……………………………………………………….. $ ____________________
D.
10. NET TAX DUE (LINE 8 MINUS LINE 9D) …………………………………………………………………………………………………………………… $ ___________________
ST
11. AMOUNT PAID WITH THIS DECLARATION (NOT LESS THAN ¼ OF LINE 10) …………………………………1
QTR. 2011 TAX DUE $ _______________________
$
12. 2011 TAX DUE (LINE 6B) $ ___________________, PLUS 2012 DECLARATION (LINE 11) $ _____________________ = TOTAL DUE
I CERTIFY THAT I HAVE EXAMINED THIS RETURN (INCLUDING ACCOMPANYING SCHEDULES AND STATEMENTS) AND TO THE BEST OF MY KNOWLEDGE
AND BELIEF IT IS TRUE, CORRECT AND COMPLETE. IF PREPARED BY A PERSON OTHER THAN TAXPAYER, THE DECLARATION IS BASED ON ALL
INFORMATION OF WHICH THE PREPARER HAS ANY KNOWLEDGE.
__________________________________________
____________________________________________
SIGNATURE OF PERSON PREPARING OTHER THAN TAXPAYER
DATE
SIGNATURE OF TAXPAYER OR AGENT (REQUIRED TO BE VALID)
DATE
__________________________________________
PREPARER’S ADDRESS
TELEPHONE NO.
__________________________________________
___________________________________________
PREPARER’S FID OR SSN
SIGNATURE OF SPOUSE
DATE
Check here if we may contact the above preparer with questions.
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