Individual Income Tax Return - City Of Sidney - 2015

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SIDNEY - 2015 INDIVIDUAL INCOME TAX RETURN
City of Sidney Revenue Collections
Due on or before
201 W. Poplar St., Sidney OH 45365
April 18, 2016
Phone (937) 498-8111 Fax (937) 498-8149
Last Name
First Name
Initial
Social Security Number
If married filing joint, enter Spouse’s Last Name,
Spouse’s Social Security Number
First Name
Initial
-
-
Present Address #
Street
Apt
Did you file a Sidney Tax Return for Tax Year
2014?  Yes  No – If no, refer to instructions
and indicate why you were not required to file:
City
State
Zip Code
 Single
 Resident
 Non-Resident
 Married filing joint return (even if only 1 had income)
 Partial Year Resident please indicate below:
FILING
 Married filing separate return. Enter spouse’s social
RESIDENCY
DATE MOVED IN: ____________________________
STATUS
STATUS
security number: _________-_______-___________
DATE MOVED OUT: _________________________
Spouse’s full name: _________________________________
Former Address: _____________________________
SALARIES, WAGES, TIPS & OTHER COMPENSATION. Enter information from W-2’s or 1099’s (not reported on Schedule C)
OTHER CITY TAX
SIDNEY TAX
WITHHELD (UP TO
QUALIFYING
EMPLOYER’S NAME
CITY WHERE EMPLOYED
WITHHELD
1.75%)
WAGES
1. TOTAL FROM W-2’s OR 1099’s. Attach all W-2’s or 1099’s.
A
B
1.
2. LESS EMPLOYEE BUSINESS EXPENSES FROM WORKSHEET A ON PAGE 2. (Attach required documentation)
2.
3. TOTAL TAXABLE WAGES (Line 1 minus line 2)
3.
4. TAXABLE INCOME OTHER THAN WAGES FROM WORKSHEET B, LINE 10, PAGE 2
(If loss, enter $0)
4.
5. TOTAL SIDNEY TAXABLE INCOME (Add lines 3 & 4)
5.
6. SIDNEY INCOME TAX AMOUNT (Multiply line 5 by 1.75%)
6.
7. A. SIDNEY INCOME TAX WITHHELD - total from Box A above.
7A.
B. INCOME TAX WITHHELD/PAID TO OTHER CITIES from Box B above (1.75% MAX)
7B.
C. ESTIMATED PAYMENTS
7C.
D. PRIOR YEAR OVERPAYMENTS
7D.
E. TOTAL TAX CREDITS (Add lines 7A through 7D)
7E.
8. TAX AMOUNT DUE, IF Line 6 is greater than line 7E, subtract Line 7E from Line 6 *
8.*
9. Late Filing
Late Pmt
Late Pmt
Underestimation
Penalty
$
Penalty
$
Interest
$
Penalty
$
9.
10. BALANCE DUE FOR 2015 (Add Lines 8 & 9) (Do not stop here. Complete lines 12-16 below.)
10.
11. OVERPAYMENT, IF Line 6 is less than Line 7E, subtract Line 6 from Line 7E *
11. *
REFUND amount *
$
CREDIT amount to 2016 *
$
* NOTICE: Taxes of less than $1 shall not be collected or refunded.
DECLARATION OF ESTIMATED TAX FOR YEAR 2016 –
See Line-by-Line Instructions
12. TOTAL INCOME SUBJECT TO TAX $ ________________, MULTIPLY BY 1.75% (new rate)
12.
13. LESS: ANTICIPATED CREDITS (withholding, taxes paid to other cities & overpayments applied)
13.
14. NET TAXES OWED (Quarterly statements will not be mailed.)
14.
ST
15. AMOUNT PAID WITH THIS DECLARATION for 1
Quarter Estimated Tax
15.
16. TOTAL AMOUNT PAYABLE TO CITY OF SIDNEY (Add lines 10 and 15) DUE BY APRIL 18, 2016
16.
I certify I have examined this return, including accompanying Federal 1040 page one, W-2’s, schedules and statements, and to the best of my knowledge and belief it is true, correct
and that the figures are the same as for Federal Income Tax Purposes. If an audit of Federal returns is made which affects tax liability shown on this return, an amended return will
NOTE: Your return is not complete unless you have included page 1 of your Federal form 1040 and other appropriate
be filed within three months.
schedules.
May we contact your preparer directly with
_______________________________ _____________
________________________________ _________________
Spouse’s Signature
Your Signature
Date
Date
questions regarding the preparation of this
 YES  NO
__________________________
return?
_________________________________ _________________
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