Form Fb-Ez - Income Tax Return 2004 - City Of Fairborn

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2004
PRSRT STD
U.S. POSTAGE
INCOME TAX RETURN
PAID
CITY OF FAIRBORN
FAIRBORN, OH
44 WEST HEBBLE AVE.
Permit 140
FAIRBORN, OH 45324-4999
ADDRESS SERVICE REQUESTED
To:
A A A A A TTENTION
TTENTION
TTENTION
TTENTION
TTENTION
IMPORTANT: PLEASE TURN PAGE TO SEE LIST OF ALL CHANGES
ALL RESIDENTS OF THE CITY OF FAIRBORN MUST FILE A TAX RETURN
RETURNS ARE NOW DUE BY APRIL 15TH
IF YOU HAVE TAXABLE INCOME YOU MUST FILE THE ENCLOSED FORM (R-1040). HOWEVER, IF YOU HAVE
NO TAXABLE INCOME, COMPLETE FORM FB-EZ (BELOW) INCLUDING YOUR SOCIAL SECURITY NUMBER
AND RETURN ENTIRE PAGE BY APRIL 15TH, 2005, IN THE ENCLOSED ENVELOPE TO:
DIVISION OF TAXATION
44 W. HEBBLE AVENUE
FAIRBORN, OH 45324-4999
FOR QUESTIONS OR ASSISTANCE IN PREPARING YOUR RETURN, CALL (937) 754-3006 OR VISIT THE DIVI-
SION OF TAXATION AT THE GOVERNMENT CENTER, FAIRBORN, OH.
______ NO EMPLOYMENT
______ ACTIVE DUTY MILITARY
______ RETIRED (NO INCOME OTHER THAN RETIREMENT)
______ I LIVED AND WORKED OUTSIDE FAIRBORN CITY LIMITS ALL OF 2004
______ UNDER 18 YEARS OF AGE, FULLY WITHHELD (ATTACH W-2’S)
______ BUSINESS CEASED OPERATION EFFECTIVE ______________________(DATE)
______ RENTAL OR BUSINESS SOLD ____________ (DATE) TO ________________________________
______ ONLY INCOME FROM NON-TAXABLE SOURCE, LIST SOURCE ____________________________
______ MOVED FROM FAIRBORN PRIOR TO 1-1-04, LIST DATE OF MOVE _________________________
______ TAXPAYER DECEASED, LIST DATE OF DEATH _________________________________________
______ OTHER, PLEASE EXPLAIN __________________________________________________________
DO NOT WRITE IN THIS AREA
I CERTIFY ALL INFORMATION TO BE TRUE:
___________________________________ DATE _______________
SIGNATURE
SOCIAL SECURITY NUMBER _______________________________
__________________________________ DATE _______________
SPOUSE (IF JOINT RETURN)
SOCIAL SECURITY NUMBER _______________________________
FORM FB-EZ

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