Form Ir-22 - City Income Tax Return For Individuals

CITY INCOME TAX RETURN FOR

1999

IR-22

BEGINNING Jan. 1st or

ENDING Dec. 31st or

INDIVIDUALS

Your social security number

Filing Status - check only one

Name (Spouse’s Name) and Current Address

Single

Married-Filing Joint

Spouse’s social security number

Married-Filing Separate

•

Did you change residence during 1999?

YES

If YES, enter date of move

(see instructions)

•

Should your account be inactivated?

NO If YES, explain:

YES

Part A

Employer(s) and address where work performed

TAXABLE WAGES

•City of Residence

(see Page 2 for Adjustments to Taxable Wages)

(+)

•City(ies) of Employment/Income #1

•Occupation or nature of business:

City

Tax

(+)

City

Tax

City

Code

Rate

City

Code

Rate

Columbus

2.0%

Lithopolis (UFR)

1.0%

(+)

Brice

1.0%

Marble Cliff

1.0%

Canal Winchester

2.0%

Obetz

2.0%

(+)

Grove City

2.0%

Worthington

1.65%

Groveport

2.0%

NET WAGES (enter in Column B below)

(=)

UFR = Universal Filing Requirement of

Harrisburg (UFR)

1.0%

all residents of these municipalities.

Attach all forms W-2 and applicable Federal schedules and/or documentation - TO BACK

Part B

1999 Tax Calculation

If you file with more than two (2) cities, call 645-7370 and request form IR-25.

Attribute income to the city(ies) in which it was earned, services were performed or rental property was located. If income was earned outside of all cities on this form, attribute to your city of residence.

Credit for tax paid to other city(ies) (Column F) includes only municipal income tax paid to the city or cities where income was earned. Credit may not exceed tax due city of residence.

Column A

Column B

Column C

Column D

Column E

Column F

Column G

TAX

INCOME FROM WAGES,

INCOME FROM NET PROFITS,

LESS TAX WITHHELD (W-2) OR

NET TAX DUE

CITY

TOTAL NET TAXABLE

TAX DUE

RATE

SALARIES, COMMISSIONS ETC.

RENTS AND OTHER TAXABLE

PAID TO CITY WHERE INCOME

INCOME

(SEE NET WAGES)

INCOME (Pg. 2)

WAS EARNED

*ALTERNATE CITY

*Columbus, Canal Winchester, Grove City, Groveport, Obetz and Worthington residents use ALTERNATE CITY LINE for additional tax due to city of residence as a result of having paid a lesser tax to city

of employment (be sure to indicate city and tax rate).

1. TOTAL NET TAX DUE (TOTAL OF COLUMN G).........................................................................................................................................................................................

2. LESS CREDIT FOR DECLARATION PAYMENTS AND OVERPAYMENT FROM PRIOR YEAR RETURN ONLY (NOT W-2).................

3. BALANCE DUE (LINE 1 LESS LINE 2). If Line 2 is greater than Line 1, enter amount (in brackets) here and on Line 6. ...........................................................................

4. PENALTY: 10% $_____________ + INTEREST .667% PER MONTH $_____________ + LATE FEE $_____________ = ..................................................................

(see instructions)

5. TOTAL AMOUNT DUE (ADD LINES 3 AND 4)

6. OVERPAYMENT CLAIMED (IF LINE 2 IS GREATER THAN LINE 1).........................................................................................................

CARRY THIS AMOUNT TO LINE 8

6A $

A. ENTER THE AMOUNT FROM LINE 6 YOU WANT CREDITED TO YOUR NEXT YEAR TAX ESTIMATE......

B. ENTER THE AMOUNT FROM LINE 6 YOU WANT REFUNDED (MUST BE GREATER THAN $1.00)

Part C

2000 Declaration of Estimated Taxes

A declaration of estimated tax is required if all taxes are not fully withheld.

Column H

Column I

Column J

Column K

Column L

Column M

Column N

LESS TAX TO BE WITHHELD

TOTAL

TAX

ESTIMATED INCOME FROM

ESTIMATED

(W-2) OR PAID TO CITY WHERE

ESTIMATED TAX DUE

NET ESTIMATED

RATE

CITY

NET PROFITS, RENTS AND

WAGES, SALARIES,

NET TAX DUE

INCOME WILL BE EARNED

INCOME

OTHER TAXABLE INCOME

COMMISSIONS - ETC.

*ALTERNATE CITY

7. TOTAL NET ESTIMATED TAX DUE (TOTAL OF COLUMN N) ...................................................................................................................................................................

8. OVERPAYMENT CREDITS FROM PREVIOUS YEAR RETURN (FROM LINE 6A)....................................................................................

9. TOTAL CREDITS (AMOUNT FROM LINE 8)...............................................................................................................................................

10. UNPAID BALANCE DUE (SUBTRACT LINE 9 FROM LINE 7)....................................................................................................................

11. LESS AMOUNT PAID WITH THIS DECLARATION (A minimum 25% of Line 7 due now)............................................................................................................................

12. ESTIMATED TAX BALANCE PAYABLE IN EQUAL INSTALLMENTS EACH QUARTER (Line 10 less Line 11)[pay June, Sept. and Dec.]

13. TOTAL AMOUNT PAID (ADD LINE 5 [if positive] AND LINE 11)

The undersigned declares that this return (and accompanying schedules) is a true, correct and complete return for the taxable period stated, and that the figures used are the same as used for federal income

tax purposes and understands that this information may be released to the tax administration of the city of residence and the I.R.S.

Has your Federal tax liability for any prior year been changed in the year covered by this

Due on or before April 15th.

See instructions for penalty, interest and late filing fees.

return as a result of any examination by the Internal Revenue Service?

YES

DO NOT SEND CASH THROUGH U.S. MAIL.

If YES, has an amended City return been filed for such year or years?

YES

Make checks payable to: City Treasurer

Mail to:

Columbus Income Tax Division