Form Ir-25 - City Income Tax Return For Individuals - 2016

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2016
Staple W-2’s to the back of this page
IR-25
City of Columbus, Income Tax Division
City Income Tax Return For Individuals
Primary Social Security Number
Check the appropriate box if:
REFUND
(An amount must be placed in
First name and Middle Initial
Last Name
Line 6B for this return to be
Spouse's Social Security Number
considered a valid refund request)
AMENDED
tax year
If a joint return, spouse's first name and initial
Last Name
Did you change residence
YES
NO
Filing Status:
during 2016?
Single
Home Address (number and street)
If YES, enter date of move
NO
YES
0
Should your account be inactivated?
Married-Filing Jointly
If YES, explain
City
Zip Code
State
Married-Filing Separately
YES
NO
Did you file a City return in 2015?
Attach all forms and applicable Federal schedules and/or documentation to the back of this return.
Occupation or nature of business
TAXABLE WAGES
Employer(s) and address where work performed
Part A
(+)
Trade Name
City of Employment #1
(+)
ADJUSTMENTS
City of Employment #2
(-)
City of Employment #3
NET WAGES (enter in Column B below)
(=)
City of Residence
Part B
TAX CALCULATION
A Declaration of Estimated City Tax (form IR-21) is REQUIRED for all individuals whose tax is not fully withheld.
Column B
Column C
Column D
Column E
Column F
Column G
Column A
C
TAX
O
LESS TAX WITHHELD (W-2)
CITY
INCOME FROM NET
INCOME FROM WAGES,
TOTAL NET
TAX DUE
NET TAX DUE
RATE
PAID BY A PARTNERSHIP OR
D
PROFITS, RENTS AND
SALARIES, COMMISSIONS,
TAXABLE INCOME
PAID DIRECTLY TO CITY WHERE
E
OTHER TAXABLE INCOME
ETC. (SEE NET WAGES)
INCOME WAS EARNED
COLUMBUS
01
2.5%
2.0%
GROVEPORT
09
2.5%
OBETZ
10
CANAL WINCHESTER
11
2.0%
MARBLE CLIFF
(UFR)
13
2.0%
BRICE
2.0%
14
**
HARRISBURG
(UFR)
1.0%
16
*ALTERNATE CITY
* Alternate City Line (see Instructions)
** NOTE: residents of Harrisburg may only take credit for taxes paid or withheld to their resident city (Column F). UFR = Universal Filing Requirement - residents must file a return.
1
1. TOTAL NET TAX DUE (TOTAL OF COLUMN G)
..................................................................................................................................................
2
2. LESS CREDITS FOR ESTIMATED TAX PAYMENTS AND OVERPAYMENT FROM PRIOR YEAR RETURN ONLY .......
3. BALANCE DUE (LINE 1 LESS LINE 2).
........................................
3
If Line 2 is greater than Line 1, enter amount (in brackets) here and carry to Line 6.
4. PENALTY: 15% $_____________ + INTEREST $_____________ + LATE CHARGE $_____________ = .........................................................
4
(see instructions)
(see instructions)
(see instructions)
5. TOTAL AMOUNT DUE (ADD LINES 3 AND 4). NOTE: NO PAYMENT IS DUE IF AMOUNT IS $10.00 or less
..............................................
5
6
6. OVERPAYMENT CLAIMED (IF LINE 2 EXCEEDS LINE 1) .............................................................................................
A. Enter the amount from Line 6 you want
CREDITED to your next year tax estimate ....................
6A
REFUNDED (must be greater than $10.00)
6B
B. Enter the amount from Line 6 you want
INCOME FROM SOURCES OTHER THAN WAGES, SALARIES, COMMISSIONS, ETC.
(COMPLETE
Part C
REVERSE SIDE OF
FORM FIRST)
C
CITY
Column H
Column I
Column J
Column K
O
INSERT APPLICABLE
INCOME (OR LOSS) FROM
OTHER INCOME FROM
RENTAL INCOME (OR LOSS) FROM
TOTAL OTHER INCOME
D
PART E OR SCHEDULE Y
CITIES BELOW
PART F (SECTION 1)
PART F (SECTION 2)
E
(OR LOSS)
Third
YES
Do you want to allow another person to discuss this matter with the City of Columbus?
(see instructions)
NO
Complete the following
Party
Designee’s
Phone
Print Form
(
)
Designee
Name
No.
SSN
The undersigned declares that this return (and accompanying schedules) is a true, correct and complete return
SIGNATURE
MAILING INFORMATION
for the taxable period stated, and that the figures used are the same as used for federal income tax purposes
Reset Form
and understands that this information may be released to the tax administration of the city of residence and the
NO Payment Enclosed:
Sign
Your
I.R.S.
Mail to:
Columbus Income Tax Division
Date
Here
Signature
PO Box 182437
If a joint return,
Spouse’s
Columbus, Ohio 43218-2437
Date
both must sign.
Signature
Payment Enclosed:
Paid
PTIN
Make payable to: CITY TREASURER
Preparer’s
Date
Signature
Mail to:
Columbus Income Tax Division
(
)
Phone No.
Use Only
PO Box 182158
Rev. 3/3/17
Columbus, Ohio 43218-2158

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