Form Income Tax Return - City Of Brook Park - 2002
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1
2DATE RECEIVED
2002
RETURNS OR EXTENSIONS
FOR OFFICE USE ONLY
CITY OF BROOK PARK
DUE APRIL 30, 2003
OR 120 DAYS FROM
INCOME TAX RETURN
END OF FISCAL YEAR
INFO LINE
6161 ENGLE RD. • BROOK PARK, OHIO 44142
RETURNS WITH SCHEDULES MUST BE TIMELY
216-433-4115
VOICE MAIL
FILED TO RETAIN LOSS/CARRY FORWARD
FOR THE CALENDAR YEAR OR FISCAL PERIOD
TO
216-433-1533
PRIVILEGES
FAX LINE
ACCOUNT NO:
216-433-0822
social security number
social security number
FID NUMBER
NO EARNED INCOME - INDIVIDUALS
EXTENSIONS
IF YOU'RE NOT REQUIRED TO FILE THIS FORM, PLEASE NOTE THE REASON
DUE 4/30/2003
AND FORWARD THE SIGNED RETURN TO THE DEPARTMENT OF TAXATION.
80% payment due January 31, 2003 to avoid Penalty and Interest.
Fiscal Accounts use 30 days after Year End for Tax Year 2002.
HUSBAND
WIFE
Are you fully retired
(
) Yes (
) No
(
) Yes (
) No
Work part time
(
) Yes (
) No
(
) Yes (
) No
PHONE:
DAYTIME
(
)
EVENING
(
)
You can pay estimated tax payments electronically
We now
If APPLICABLE, SUPPLY MOVE DATES OR TAX CALCULATED FOR 12 MONTHS.
via touch tone telephone. Call Tax Department for
M
ast t er
C
ard
®
accept
®
registration information.
Into Brook Park on:
Out of Brook Park on:
(
)
Check
Do You Rent
Own
this home
One
New Address:
SEE INSTRUCTIONS
BOX 1
EMPLOYER'S NAME (PRINT)
CITY EMPLOYED
TAX PAID TO
BROOK PARK
LARGEST FIGURE ON W-2
OTHER CITIES
TAX WITHHELD
1(a). TOTALS
2.
TOTAL ADJUSTMENTS FROM PAGE 2 (IF APPLICABLE) (ATTACH COPY OF ALL SCHEDULES) ................................................................... 2.
$
3.
3.
TAXABLE INCOME (ADD 1 (a) AND 2) ..................................................................................................................................................................
$
*
SEE
BACK
4(a). LOSS CARRY FORWARD PREVIOUS YEAR (IF APPLICABLE 5 YEAR LIMIT) ..................................... 4(a). DEDUCT $
(
) ...............................................................................................................................
4(b). TOTAL INCOME
LINE 3 MINUS 4(a)
4(b). $
(
) ................................................................................................................
5.
BROOK PARK CITY TAX
2% OF LINE 3 OR 4(b)
5.
$
6.
REFUNDS RECEIVED (INDIVIDUALS ONLY) IN 2002 FROM OTHER MUNICIPALITIES ................................................................................... 6.
$
7.
7.
TOTAL INCOME TAX DUE BEFORE CREDITS .....................................................................................................................................................
$
8.
CREDITS: NOTE-EXCLUDE INCOME TAX PAYMENTS MADE TO SCHOOLS
(a) BROOK PARK INCOME TAX WITHHELD BY EMPLOYER(S) .............................................................................. 8(a). $
(b) LOCAL TAX PAID TO OTHER CITIES (2% LIMIT PER W-2; IF NOT WITHHELD SEE NOTE) ............................ 8(b). $
(NOTE) EXCLUDING PAYMENTS TO "REDUCED TAX CREDIT CITIES", NON RESIDENTS EXCLUDE RESIDENCY TAX.
(c) PAYMENT ON DECLARATION OF ESTIMATED TAX ........................................................................................... 8(c). $
(d) AMOUNT OF PRIOR YEAR CREDIT ..................................................................................................................... 8(d). $
〈
〉
$
(e) TOTAL CREDITS (ADD, a, b, c, d) ......................................................................................................................... 8(e). $
PAYMENT TO CITY OF BROOK PARK MUST ACCOMPANY THIS RETURN
9.
BALANCE DUE (LINE 7 LESS LINE 8e)
.................................. 9.
$
10.
OVERPAYMENT CLAIMED (IF LINE 8e EXCEEDS LINE 7), ENTER DIFFERENCE HERE
10. $
SEE BACK OF FORM FOR
}
OVERPAYMENT INSTRUCTIONS
11.
ENTER AMOUNT OF LINE 10 YOU WANT CREDITED TO YOUR 2003 ESTIMATED TAX
11. $
•
THREE YEAR LIMITATION
IF APPLYING FOR REFUND
ATTACH DRIVERS LICENSE
11(a).
TO BE REFUNDED
11(a). $
AND UNDER 18
AND/OR BIRTH CERTIFICATE
ON REFUND REQUEST
12.
LATE FILING PENALTY - RETURNS FILED AFTER APRIL 30th, ENTER $25.00 FINE.
12. $
..................
13.
ASSESSMENT 3% PER MONTH, EFFECTIVE THE FIRST OF EACH MONTH, ENTER TOTAL HERE
13. $
..................
(MUST BE PAID IN FULL FOR 2002 INCOME TAX)
14.
TOTAL AMOUNT DUE -
...........................14.
$
•
•
PAYMENT PLAN IF BALANCE DUE $100.00 OR MORE. INTEREST CHARGED MONTHLY. OTHER ASSESSMENTS
NO TAXES OR REFUNDS OF LESS THAN $5.00
REQUEST PAYMENT PLAN
MAY APPLY. PROMISSORY COGNOVIT NOTE AND DIRECT DEBIT AUTHORIZATION REQUIRED.
SHALL BE COLLECTED OR REFUNDED.
DECLARATION OF ESTIMATED TAX FOR YEAR 2003 - 90% MUST BE PAID BY JANUARY 31, 2004
E1.
ESTIMATED TAXABLE INCOME FOR YEAR .................................................................................................................................................. E1. $
E2.
ESTIMATED TAX DUE 2% (.02) of line E1 ....................................................................................................................................................... E2. $
〈
〉
E3.
LESS: BROOK PARK TAX TO BE WITHHELD $
AND/OR PAID TO THE CITY OF
$ ......................................................... E3. $
CITY
(NOTE) EXCLUDING PAYMENTS TO "REDUCED TAX CREDIT CITIES", NON RESIDENTS EXCLUDE RESIDENCY TAX.
E4.
TOTAL ESTIMATED BROOK PARK TAX DUE ................................................................................................................................................ E4. $
E5.
CREDITS: a. OVERPAYMENT CLAIMED ON PREVIOUS YEAR'S RETURN .......................................................... E5(a). $
b. 2003 DECLARATION PAYMENT PREVIOUSLY REMITTED ............................................................... E5(b). $
〈
〉
c. TOTAL CREDITS ........................................................................................................................................................................ E5. $
.........
E6.
NET TAX DUE (LINE E4 LESS LINE E5C)
(90% MUST BE PAID BY JAN. 31, 2004) ........................................................................ E6. $
(MUST BE PAID FOR 2003 DECLARATION)
E7.
AMOUNT PAID (NOT LESS THAN 22.5% OF LINE E6).
............... E7. $
............................
E8.
BALANCE OF ESTIMATED TAXES TO BE BILLED QUARTERLY
E8. $
I CERTIFY I HAVE EXAMINED THIS RETURN INCLUDING ACCOMPANYING SCHEDULES AND STATEMENTS AND TO THE BEST OF MY KNOWLEDGE BELIEVE IT IS TRUE,
ADD LINES 9 + 12 + 13 + E7
CORRECT AND THAT THE FIGURES USED HEREIN ARE THE SAME AS FOR FEDERAL INCOME TAX PURPOSES
AND PAY
Print Name of Person Preparing If Other Than Taxpayer
Date
Signature of Taxpayer or Agent
Date
Address or Name and Address of Firm or Employer
Phone Number
Title, If Signing For A Business or Signature of Spouse if Joint Return
Phone Number
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