Form Ir - Income Tax Return - City Of Springdale - 2004
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1
22004
FORM IR
FILING REQUIRED EVEN IF NO TAX DUE
DUE ON OR BEFORE
INCOME TAX RETURN
IF TAXPAYER AND SPOUSE ARE FULLY RETIRED
APRIL 15, 2005
WITHOUT TAXABLE INCOME, MARK THIS BOX,
City of Springdale
SIGN, DATE & RETURN THIS FORM.
FILE WITH
DID YOU HAVE W-2 INCOME?
YES
NO
SPRINGDALE TAX COMMISSION
DID YOU OWN RENTAL PROPERTY?
YES
NO
11700 SPRINGFIELD PIKE
LATE FILING WILL RESULT IN PENALTY AND INTEREST CHARGES
DID YOU PARTICIPATE IN A BUSINESS,
SPRINGDALE, OH 45246
PARTNERSHIP OR S-CORPORATION?
YES
NO
PHONE (513) 346-5715
EXTENSIONS MUST BE REQUESTED IN WRITING BEFORE THE DUE DATE.
IF ALL ANSWERS ARE "NO", PLEASE MARK, SIGN,
FAX (513) 346-5756
DATE AND RETURN THIS FORM.
TAXPAYER:
CURRENT EMPLOYER:
IF YOU ARE A NEW RESIDENT, FILING FOR THE FIRST
CITY WHERE EMPLOYED:
TIME OR HAVE MOVED SINCE THE LAST FILING DATE,
ACCOUNT NO.
SPOUSE:
PLEASE FURNISH CURRENT ADDRESS, DATE OF
CURRENT EMPLOYER:
MOVE AND COMPLETE LINE 20C.
CITY WHERE EMPLOYED:
MOVE IN: ___________________________________
TAXPAYER NAME(S) AND ADDRESS (CORRECT IF NECESSARY)
SOCIAL SECURITY NO.(S)
MOVE OUT: _________________________________
OFFICE USE ONLY
LOCAL TELEPHONE NO.
H:
W:
2004 SPRINGDALE TAX RETURN
OFFICE USE ONLY
$__________________ $__________________
1. W-2 QUALIFYING WAGES USUALLY BOX 5
(ATTACH ALL W-2'S AND PAGE ONE OF APPLICABLE FEDERAL 1040)
2. OTHER INCOME OR DEDUCTIONS FROM LINE 21 PAGE 2
$__________________ $__________________
3. TAXABLE INCOME
$__________________ $__________________
(LINE 1 PLUS OR MINUS LINE 2)
4. SPRINGDALE TAX
A. INCOME EARNED JANUARY 1 THROUGH JUNE 30, 2004 TAXED AT 1%
$_________________
$__________________
B. INCOME EARNED AFTER JULY 1, 2004 TAXED AT 1.5%
$_________________
$__________________
C. TOTAL SPRINGDALE TAX DUE
$
$__________________
5. TAX PAYMENTS AND CREDITS:
A. ENTER TOTAL TAXES WITHHELD BY EMPLOYER(S) FOR THE CITY OF SPRINGDALE
$_________________
$__________________
B. ENTER 2004 TOTAL ESTIMATED TAXES PAID TO THE CITY OF SPRINGDALE
$_________________
$__________________
C. ENTER CREDIT FOR 2004 TAX PAID TO ANOTHER CITY FROM WORKSHEET PAGE 2
$_________________
$__________________
D. ENTER PRIOR YEAR TAX OVERPAYMENT AMOUNT
$_________________
$__________________
(
)
(
)
E. TOTAL TAX PAYMENTS AND CREDITS
$
$__________________
(ADD LINE 5A THROUGH 5D)
6. IF LINE 4C IS GREATER THAN LINE 5E ENTER THE DIFFERENCE ON THIS LINE
$
$__________________
2004 TAX DUE APRIL 15, 2005
7. IF LINE 5E IS GREATER THAN LINE 4C, YOU MUST MARK THIS BOX FOR A REFUND OR
$
$__________________
REFUND
CREDIT WILL BE APPLIED TOWARD 2005 ESTIMATED TAX
$
$__________________
2005 CREDIT
TAX PAID TO ANOTHER CITY SHALL NOT BE REFUNDED OR CREDITED BY THE CITY OF SPRINGDALE.
NOTICE: BY LAW ALL REFUNDS AND CREDITS IN EXCESS OF $10 ARE BEING REPORTED TO THE APPROPRIATE TAXING AUTHORITIES.
NOTICE: NO ADDITIONAL TAXES OR REFUNDS OF LESS THAN $3 SHALL BE COLLECTED OR REFUNDED.
DECLARATION OF 2005 ESTIMATED INCOME TAX
(THIS SECTION IS REQUIRED TO BE COMPLETED)
FAILURE TO PAY 70% OF YOUR 2005 ESTIMATED TAX BY JANUARY 31, 2006 WILL RESULT IN PENALTY AND INTEREST CHARGES.
8. ENTER TOTAL ESTIMATED 2005 INCOME SUBJECT TO TAX $__________________ MULTIPLY BY 1.5% = TOTAL 2005 ESTIMATED TAX
$_____________________ $_____________________
(
)
(
)
9. 2005 TAX PAID TO A CITY AND/OR WITHHELD BY EMPLOYER(S)
$__________________ $__________________
(NOT TO EXCEED 1.5% OF THE INCOME TAXED)
10.TOTAL 2005 ESTIMATED TAX DUE AND PAYABLE BY JANUARY 31, 2006
$__________________ $__________________
11.AMOUNT PAID WITH THIS DECLARATION
$
$
(NOT LESS THAN 1/4 OF LINE 10)
RETURN FILED _______ MONTHS LATE
INTEREST DUE $___________
PENALTY DUE $_____________
$
FOR
70% TAX PAID ________ MONTHS LATE
INTEREST DUE $___________
PENALTY DUE $_____________
$
OFFICE
USE
TOTAL PENALTY AND INTEREST DUE
$
ONLY
TOTAL TAX, PENALTY AND INTEREST DUE
$
I CERTIFY THAT I HAVE EXAMINED THIS RETURN (INCLUDING ACCOMPANYING SCHEDULES AND STATEMENTS) AND TO THE BEST OF MY KNOWLEDGE AND BELIEF IT IS TRUE, CORRECT AND COMPLETE. IF PREPARED BY A
PERSON OTHER THAN THE TAXPAYER, THE DECLARATION IS BASED ON ALL INFORMATION OF WHICH PREPARER HAS ANY KNOWLEDGE.
TO PAY BY CREDIT CARD:
Enter number and expiration date fully and accurately.
s
r
r
TM
No.
SIGNATURE OF TAXPAYER OR AGENT (REQUIRED)
DATE
No.
EXP.
/
AMOUNT
$
DATE:
AUTHORIZED:
SIGNATURE OF PERSON PREPARING IF OTHER THAN TAXPAYER
DATE
PHONE
( H )
( W )
NUMBER:
CARDHOLDER
SIGNATURE:
ADDRESS
TELEPHONE NO.
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