Form Jedd1-Er - Employee Tax Return - 2012
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1File with Fairfield Income Tax
WEST CHESTER JEDD 1
FORM JEDD1-ER
701 Wessel Drive
Employee Tax Return 2012
Fairfield OH 45014-3611
Your social security number
(513) 867-5327
Fax (513) 867-5333
Calendar year taxpayers file on or before April 15
th
and fiscal year taxpayers file by the 15
day of the
th
Make checks payable to West Chester JEDD1
Forms available on Internet at
fourth month after the close of the period.
Provide Name and Address in space below
Daytime Telephone Number_________________________________
EMPLOYER NAME: _____________________________________________________ Employed From: ______/________/2012 to: ______/________/2012
INCOME
1.
Total W-2 wages. W-2’s MUST BE ATTACHED ………………………………….……….……………… 1
$ ____________________
2.
Deduct wages earned prior to working at JEDD 1 Location (See instructions)……………….. 2
$ ____________________
3.
Total Taxable Income …………………………………………………………………………………….. 3
$ ____________________
DOT
4.
Days out of Town West Chester JEDD 1 taxable percentage from line 15..(__________)……. 4
$ ____________________
TAX DUE
5.
West Chester JEDD 1 tax is 1.0% (0.010) of line 4…………………………………………………… 5
$ ____________________
WITHHELD
6.
West Chester JEDD 1 tax withheld: Credit will only be given with proper documentation.
6
$ ___________________
BALANCE
7.
Balance Due, if Line 5 is greater than Line 6, (subtract Line 6 from Line 5) ……………………. 7
$ ____________________
REFUND
8.
Overpayment, if Line 5 is less than Line 6. (Subtract Line 5 from Line 6) ....…………………….. 8
$ ___________________
No tax due or refund if less than $1.00
DOT – Days out of Town - FOR USE BY EMPLOYEES PERMENANTLY TRANSFERRED TO WEST CHESTER JEDD 1 ON OR AFTER 9/15/09
9. DATE STARTED WORKING IN WEST CHESTER JEDD 1: ___________ / _________/ 2012
10. Total number of days of the year from Line 9 to 12/31/10: [Example: 1/01/12 to 12/31/12 = 366] …………… 10
________________________
11. Number of Saturdays and Sundays [Example: 1/01/12 to 12/31/12 = 104]…………………………………………. 11
________________________
12. Total days worked in year (Line 10 minus Line 11) [Example: 366-104 = 262] …………………………………….. 12
________________________
13. Total days worked outside of West Chester JEDD 1 …………………………………………………………………… 13
________________________
Include an itinerary of when and where work was performed.
When applicable your city/village of residency will be notified of your refund as tax may be due to them.
14. Total Days worked in West Chester JEDD 1 (Line 12 minus Line 13)
14
________________________
Note: All holidays, vacation and sick leave MUST BE INCLUDED in this total.
15. West Chester JEDD 1 taxable Income Percentage: (Line 14 ___________ divided by Line 12 ____________) 15
_________________________
Required:
As the supervisor and/or payroll manager for the above, I verify that all the above information, as submitted by the employee, to
be accurate.
__________________________________________
_________________________
_________________________
______________
Supervisor/Payroll manager Signature
Name & Title
Telephone Number
Date
The undersigned declares that this return (and accompanying schedules) is true, correct and complete for the taxable
period stated and that the figures used herein are the same as used for Federal Income Tax purposes.
May we discuss the return with the tax practitioner below?
___________________________________________________________________________________________________
Signature of Taxpayer
Date
Please circle one:
Yes
No
For Tax Division Use Only
____________________________________________________________________________
Signature of Preparer, if other than taxpayer
Date
Name and Address of tax Practitioner
_____________________________________________________________________________
_____________________________________________________________________________
Telephone Number __________________________________________________________
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