Individual Declaration Of Estimated Tax Form - The City Of Dublin Income Tax Division

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INDIVIDUAL DECLARATION OF ESTIMATED TAX
For Tax Year ___________
Name: ________________________________________________ Social Security Number: ______ - _____ - ______
Street: __________________________________ City:____________________ State: ______ Zip: _____________
1. Total income subject to tax $__________ Multiply by tax rate of 2% (.02).................................1
$
2. Subtract any estimated income tax to be withheld or paid to other cities.................................. 2
$
3. Balance of city income tax declared. Subtract line 2 from line 1............................................... 3
$
4. Tax due before credits................................................................................................................4
$
5. Less credits................................................................................................................................ 5
$
6. Net estimated tax due. Subtract line 5 from line 4..................................................................... 6
$
7. Amount Paid (Not Less than 1/4 of Tax Due).............................................................................7
$
Signature: _________________________________________ Date: _______________
Make check payable to: City of Dublin and remit to City of Dublin, Income Tax Division, PO Box 800, Dublin, OH 43017-0900

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