Form I-7 - Cleveland Heights Individual Income Tax Return - 2004
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1FORM I-7 SHORT FORM
CLEVELAND HEIGHTS INDIVIDUAL INCOME TAX RETURN
TAX YEAR 2004
MAIL TO: PO BOX 641747 CINCINNATI OH 45264-1747
(216) 291-3978
MUST BE FILED BY MARCH 15, 2005
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SS#
SPOUSE’S SS#
THIS YEAR’S FILING STATUS:
JOINT
SEPARATE
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LAST YEAR’S FILING STATUS:
JOINT
SEPARATE
NAME(S)
RECENT MOVE DATE:
/
/
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ADDRESS
From Cleveland Heights
To Cleveland Heights
CITY STATE ZIP
Previous or New Address (circle one)
City, State, Zip
Home Phone (
)
Work Phone (
)
TABLE I: WAGE INCOME (Income from W-2 and 1099 Misc. Forms)
COLUMN A
COLUMN B
COLUMN C
COLUMN D
COLUMN E
COLUMN F
List Wages From
2106 Expenses (if any)
Subtract B from A
Municipal Tax
City Withholding
Do not
Resident City
Each Employer
(Attach copy Federal
(Income after
Withheld
Paid to
use
(Highest Amount on W-2)
2106 Form)
Expenses)
Total
Total
WHO MAY USE THE I-7 FORM:
•
The I-7 Short Form is only for people with wage income from Federal Form W-2 or 1099 Misc.
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If you have Federal Schedule C or Schedule E non-wage income, you must use Cleveland Heights I-8 Long Form.
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When using this form, the City will calculate your tax and send you a bill if you owe tax.
INSTRUCTIONS:
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You must attach a copy of all W-2 and 1099 Misc. forms and mail between January 1, 2005 and March 15, 2005.
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For each employer enter your wages and withholding (if any) in Table I above. If your employer withheld for more than one
city on the same income, only list that income once, but use two lines for the municipal tax withheld.
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This form is due no later than MARCH 15, 2005 so that we can mail you a bill.
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Tax payments not received by April 15, 2005 are subject to 20% penalty, plus interest charges.
AMENDED 2005 ESTIMATE
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You must attach copy of Form 2106 to receive deduction.
$
2005 ESTIMATED TAX
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Estimated tax for 2005 will be calculated based on this year’s income and tax liability.
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To amend your estimate for 2005, please utilize worksheet on back. Indicate amended estimate in the above box.
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IF THERE IS AN OVERPAYMENT OF TAX, PLEASE:
CREDIT TO ESTIMATED PAYMENTS FOR TAX YEAR 2005
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REFUND
Examples of Taxable Income
Examples of Non-Taxable Income
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Wage Income:
Interest, dividends
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All income listed on Federal Forms W-2 or 1099 Misc.
Pensions, Social Security
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Wages, salaries, bonuses, and other compensation
Welfare, state-paid unemployment benefits
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(Includes deferred compensation contributions, [e.g. 401(k)]
Workmen’s Compensation, proceeds from insurance
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Educational grants (except portion for tuition/fees/books)
Active Military pay (does not include civilian personnel)
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Non-wage income: (cannot use this form – use I-8 Long Form)
Alimony
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Net profit from business (Federal Schedule C)
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Income from rental property (Federal Schedule E)
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Lottery winnings equal to or greater than $100,000
Any tax amount that is unpaid after April 15th is subject to 20% penalty plus interest.
Under penalty of perjury, the undersigned declares this return and attached documents to be true and complete:
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If this return was prepared by a tax preparer, check here if we may NOT contact him/her directly with questions regarding the preparation of this return.
Taxpayer’s signature
Date
Preparer’s signature (if not taxpayer)
Date
04
Spouse’s signature
Date
Preparer’s address and phone number
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Parent category: Financial