2012
Click on the fields below and type in
Resident Refund Tax Return
your information. Then print the form
and mail it to our office.
City of Cincinnati
TO EXPEDITE PROCESSING,
Customer Service: (513) 352-2546
PLEASE DO NOT STAPLE
THIS SPACE IS FOR OFFICIAL USE ONLY
Use this return if you lived in Cincinnati for the entire year and you are filing for a refund of taxes
withheld by your employer. Part-year or Nonresidents should use the Nonresident Refund Tax Return.
Mail Completed forms to: PO Box 637876, Cincinnati, OH 45263-7876
Account # _____________________
Social Security # _______________________
Daytime Phone # ___________________
Name
Email:
Address
City/State/Zip
IF YOUR ACCOUNT INFORMATION IS INCORRECT, PLEASE MAKE CORRECTIONS AND CHECK THIS BOX.
W-2 EARNINGS
(GROSS WAGES, TIPS, SALARIES, COMMISSIONS, ETC.) INCLUDE COPIES OF ALL W-2 FORMS
1.
$
*IF YOU HAVE ANY ADDITIONAL TAXABLE INCOME PLEASE USE OUR REGULAR INDIVIDUAL TAX RETURN*
LESS UNREIMBURSED EMPLOYEE BUSINESS EXPENSE
{INCLUDE COPY OF FEDERAL FORM 2106
$
2.
(EZ)}
$
3.
ADJUSTED EARNINGS
(LINE 1 MINUS LINE 2)
$
4.
CINCINNATI INCOME TAX 2.1% (.021) OF LINE 3
$
5.
TOTAL CINCINNATI TAX WITHHELD BY EMPLOYER(S)
$
6.
TOTAL INCOME TAXES PAID TO ANOTHER CITY OR COUNTY
$
7.
TOTAL TAX CREDIT
(ADD LINES 5 AND 6)
$
8.
ENTER AMOUNT TO BE REFUNDED
(Line 7 minus Line 4)
(LESS THAN $5.00 WILL NOT BE REFUNDED)
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 AND THE FIGURES USED HEREIN ARE THE SAME AS FOR FEDERAL INCOME
TAX PURPOSES.
May the City Tax Division
PAID PREPARER SIGNATURE
PTIN
SIGNATURE OF TAXPAYER
DATE
discuss this return with the
preparer shown to the left?
(
) YES
(
) NO
PREPARER’S FIRM OR EMPLOYER
SIGNATURE OF SPOUSE
DATE
ADDRESS OF FIRM OR EMPLOYER
W-11