Form E-1r - Individual Earnings Tax Return - City Of St. Louis - 2010

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CITY OF ST. LOUIS
Form E-1R
CALENDAR
INDIVIDUAL EARNINGS TAX RETURN
YEAR
(11/10)
(REFUND REQUEST)
Telephone: (314) 622-3292
2010
PLEASE PRINT YOUR NAME AND
ADDRESS IN THE SPACE BELOW
Social Security No.
Telephone No.
Email Address:
• ALL W-2 FORMS MUST ACCOMPANY THIS RETURN.
• EMPLOYER MUST COMPLETE VERIFICATION SECTION ON REVERSE SIDE.
• IF YOU ARE REQUESTING A REFUND FROM TWO OR MORE EMPLOYERS, EACH EMPLOYER IS REQUIRED
TO COMPLETE A SEPARATE VERIFICATION FORM ON REVERSE SIDE.
1
Salaries, Wages, etc. from Box 1 on Form(s) W-2. See Instructions on Back. Use Form E-1 if you owe City Earnings Tax.
A
$
B
$
C
$
D
$
2
GROSS SALARIES, WAGES, etc. (Total of Lines A, B, C, D (attach Form(s) W-2).
$
3
Non-Residency Deduction (Complete formula on reverse side. Combine totals if more than one employer).
$
4
NET TAXABLE EARNINGS (Subtract line 3 from line 2).
$
5
EARNINGS TAX (1% of line 4).
$
6
EARNINGS TAX WITHHELD (from Box 19 on Form(s) W-2).
$
7
Refund Due (Subtract line 5 from line 6)). No refund issued under $1.00. Use Form E-1 if you owe City Earnings Tax.
$
Pursuant to the Revised Code of the City of St.Louis, §5.22.100, the Collector of Revenue or his duly authorized agent has the authority to audit facilities or tax
returns of an employer or taxpayer subject to this section of the Tax Code. I declare this return has been examined by me and is true, correct and complete to
the best of my knowledge and belief.
(DATE)
(SIGNATURE)
(TYPED OR PRINTED NAME)
PREPARER
PREPARER EIN
PREPARER TELEPHONE
MAIL TO: GREGORY F.X. DALY, COLLECTOR OF REVENUE, EARNINGS TAX DEPT., 410 CITY HALL
1200 MARKET ST., ST.LOUIS, MO 63103.
JOINT RETURNS ARE NOT ALLOWED
WEBSITE ADDRESS:

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