Form L-Es - Declaration Of Estimated Tax For Individuals - City Of Lakewood
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1
2City of Lakewood - Division of Municipal Income Tax
12805 Detroit Ave., Suite 1
Lakewood, OH 44107
Telephone: (216) 529-6620 Fax: (216) 529-6099
Website:
Email:
taxdept@lakewoodoh.net
Form L-ES – Declaration of Estimated Tax for Individuals
Tax Year: ___________
Per Lakewood Ordinance §128.1303 and 128.1304, taxpayers owing two hundred dollars ($200.00) or more of estimated
tax are required to file a declared estimate of income tax on or before the April filing deadline, or within four (4) months
of the date the taxpayer becomes subject to tax for the first time.
_________
_________
Primary Social Security Number
Spouse Social Security Number
_________________________________________
_____________________________________________
Primary Last Name
First Name
Initial
Spouse Last Name
First Name
Initial
__________________________________________
_________________
_ ____
______________
Present Address
Apt. #
City
State
Zip Code
ESTIMATED TAX CALCULATION
1. a. Total taxable income for current tax year
$____________
Prorated Income (use this calculation if lived in Lakewood part of the year)
b. Annual income Line 1a / 12 months = $______________
c. Monthly income Line 1b x _______ months in Lakewood = $____________
Enter the applicable amount on Line 1 from Line 1a or Line 1c
1. ___________________
(Line 1a or Line 1c)
2. Does your employer withhold income tax for the city you work in
2. ___________________
YES – enter 1% or .01 on Line 2
NO – enter 1.5% or .015 on Line 2
3. Multiply Line 1 by Line 2. Enter amount on Line 3. This is your estimated income
3. ___________________
tax for the entire year. If this amount is less than $200 – STOP, no estimate required.
4. Multiply Line 3 by 25% or 0.25.
4. ___________________
5. Estimated income tax payments are BILLED quarterly on the following dates:
5. ___________________
th
March 1st
May 15th
August 15th
November 15
th
th
th
th
Due April 15
Due June 15
Due September 15
Due December 15
Circle the dates that already passed as of the date you are completing this form and
enter the number of the dates circled above on Line 5.
6. Multiply Line 4 by Line 5. Enter the amount on Line 6. This is the amount due with
6. ____________________
this form.
I hereby declare the information supplied above to be true, correct and complete.
Primary Signature _________________________________________________
Date _________________________
Spouse Signature __________________________________________________
Date _________________________
Mail completed form to the above Lakewood address or fax to: (216) 529-6099
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